Tom, a 25 year old soccer player who rolled his ankle

Meet Tom: A Case Study of Grade 2 Lateral Ankle Sprain

Tom, a 25-year-old office worker and weekend soccer player, came to Blacktown Health with a painful and swollen right ankle. He had twisted his ankle during a soccer match two days ago and was struggling to walk normally. Let's follow Tom's journey from injury to recovery with our team of Physiotherapists, Chiropractors, and Exercise Physiologists.

Initial Assessment: Understanding Tom's Injury

When Tom arrived at our Blacktown clinic, our experienced Physiotherapist, Emma, began with a thorough assessment.

Questions We Asked

Emma started by asking Tom some important questions:

1. How did the injury happen?
2. Did you hear or feel a pop when you twisted your ankle?
3. Could you continue playing after the injury?
4. How much pain are you in on a scale of 0-10?
5. Have you had any previous ankle injuries?
6. What activities are difficult for you right now?
7. Have you tried any treatments at home?

Tom explained that he landed awkwardly after jumping for a header during his soccer game. He felt a sharp pain and couldn't continue playing. His pain was about 7/10, and he found it hard to put weight on his right foot.[Suggested Image: A diagram of an ankle, highlighting the lateral ligaments]

Physical Examination

Next, Emma performed a careful physical examination:

1. Observation: Tom's right ankle was visibly swollen and slightly bruised on the outer side.
2. Palpation: Emma gently felt around Tom's ankle. Tom reported tenderness over the anterior talofibular ligament (ATFL) and calcaneofibular ligament (CFL).
3. Range of Motion (ROM) Test: Using a goniometer, Emma measured Tom's ankle movement. His right ankle had reduced ROM compared to his left:
   • Dorsiflexion: Right 10°, Left 20°
   • Plantarflexion: Right 30°, Left 45°
   • Inversion: Right 20°, Left 35°
   • Eversion: Right 10°, Left 20°
4. Knee to Wall Test: This test measures ankle dorsiflexion. Tom could only move his right knee 5 cm from the wall, compared to 10 cm on his left side.
5. Dynamometry: Using a hand-held dynamometer, Emma tested Tom's ankle strength. His right ankle showed significant weakness compared to his left.
6. Special Tests: Emma performed the anterior drawer test and the talar tilt test, which both produced pain and showed increased laxity in Tom's right ankle.

[Suggested Video: Short clip demonstrating the knee to wall test and special tests for ankle sprains]

Diagnostic Imaging: Confirming the Diagnosis

Based on the initial assessment, Emma suspected a grade 2 lateral ankle sprain. To confirm this and rule out any fractures, she referred Tom for some imaging tests.

X-rays

Tom had X-rays taken of his right ankle. These showed:

• No fractures or bone chips
• Slight widening of the ankle joint space, indicating ligament damage

Ultrasound

An ultrasound scan revealed:

• Thickening and irregularity of the ATFL and CFL
• Small amount of fluid around the ligaments

MRI Scan

Although not always necessary for ankle sprains, an MRI was ordered to get a detailed look at Tom's soft tissues. The MRI showed:

• Partial tear of the ATFL
• Stretching of the CFL
• No complete ligament ruptures
• Mild bone bruising on the lateral talus

These imaging results confirmed Emma's initial diagnosis of a grade 2 lateral ankle sprain.[Suggested Image: Side-by-side comparison of normal ankle MRI and Tom's MRI]

Treatment Plan: Road to Recovery

With a clear diagnosis, Emma developed a comprehensive treatment plan for Tom, involving our Physiotherapy, Chiropractic, and Exercise Physiology teams.

Initial Treatment (Days 1-14)

1. PRICE Protocol:
   • Protection: Tom was fitted with a CAM (Controlled Ankle Movement) boot to protect his ankle and allow controlled movement.
   • Rest: Tom was advised to avoid high-impact activities for two weeks.
   • Ice: Apply ice packs for 15-20 minutes every 2-3 hours.
   • Compression: An elastic bandage was applied to reduce swelling.
   • Elevation: Tom was instructed to keep his foot elevated when resting.
2. Pain Management:
   • Our Chiropractor, Mark, used gentle manual therapy techniques to help reduce pain and improve joint mobility.
   • Tom was advised on appropriate over-the-counter pain medication.
3. Early Mobilisation Exercises:
   • Ankle alphabet: Drawing the alphabet with his toes.
   • Gentle ankle pumps: Moving his foot up and down.
   • Towel scrunches: Scrunching a towel with his toes.

[Suggested Video: Demonstration of early mobilisation exercises]

Follow-up Session (Day 7)

At the one-week mark, Tom returned for a follow-up session. His pain had reduced to 4/10, and swelling had decreased.

1. Progress Assessment:
   • ROM was re-measured, showing slight improvements.
   • The knee to wall test showed a 1 cm improvement.
2. Manual Therapy:
   • Our Physiotherapist performed gentle joint mobilisations and soft tissue massage to improve flexibility and reduce pain.
3. Exercise Progression:
   • Theraband exercises: Resisted ankle movements in all directions.
   • Single-leg balance: Standing on the injured foot for 30 seconds.
   • Calf raises: 3 sets of 10 repetitions.

[Suggested Image: Tom performing theraband exercises]

Intermediate Phase (Weeks 3-6)

As Tom's ankle improved, we progressed his treatment:

1. CAM Boot Removal:
   • At the start of week 3, Tom transitioned out of the CAM boot.
   • He was fitted with an ankle brace for additional support during daily activities.
2. Exercise Physiology Sessions:
   • Our Exercise Physiologist, Lisa, designed a progressive strengthening program.
   • Exercises included:
     • Single-leg squats
     • Step-ups
     • Calf raises on a step
     • Proprioception exercises on a wobble board
3. Gait Re-education:
   • Tom worked with our Physiotherapist to improve his walking pattern and gradually increase his walking distance.
4. Hydrotherapy:
   • Twice-weekly pool sessions were introduced to allow low-impact exercise and improve cardiovascular fitness.

[Suggested Video: Tom performing exercises in the hydrotherapy pool]

Advanced Rehabilitation (Weeks 7-12)

As Tom's strength and stability improved, we focused on preparing him for a return to soccer:

1. Sport-Specific Exercises:
   • Agility drills: Ladder drills, cone weaves, and shuttle runs.
   • Jumping and landing practice: Focus on proper technique and ankle stability.
   • Soccer-specific movements: Quick direction changes, jumping for headers, kicking drills.
2. Plyometric Training:
   • Box jumps
   • Hop sequences
   • Depth jumps
3. Strength and Conditioning:
   • Our Exercise Physiologist designed a gym program to improve Tom's overall lower body strength and endurance.
4. Balance and Proprioception:
   • Advanced exercises on unstable surfaces like BOSU balls and balance boards.

[Suggested Image: Tom performing agility drills with cones]

Monitoring Progress

Throughout Tom's treatment, we regularly assessed his progress:

1. ROM and Strength:
   • By week 12, Tom's ankle ROM had returned to normal, and his strength was 95% compared to his uninjured side.
2. Functional Tests:
   • Single-leg hop test: Tom achieved 90% distance compared to his uninjured leg.
   • Figure-8 hop test: Tom completed the course with good speed and stability.
3. Pain and Swelling:
   • Tom reported no pain during daily activities and only mild discomfort after intense exercise.
   • Swelling had completely resolved.
4. Patient-Reported Outcome Measures:
   • We used the Foot and Ankle Ability Measure (FAAM) to track Tom's perceived function. His scores improved from 40% at initial assessment to 95% by week 12.

Return to Sport

After 12 weeks of dedicated rehabilitation, Tom was ready to return to soccer:

1. Graduated Return:
   • Tom started with non-contact training sessions, gradually increasing intensity and duration.
   • He wore an ankle brace for additional support during training and matches.
2. Final Assessment:
   • Our team performed a comprehensive assessment, including strength testing, agility drills, and sport-specific movements.
   • Tom demonstrated excellent ankle stability and confidence in all tasks.
3. Ongoing Management:
   • We provided Tom with a maintenance exercise program to continue at home.
   • Regular check-ups were scheduled to monitor his progress and address any concerns.

[Suggested Video: Tom successfully completing a soccer training session]

Conclusion: A Successful Recovery

Tom's case demonstrates the effectiveness of a comprehensive, multidisciplinary approach to treating a grade 2 lateral ankle sprain. Through the combined efforts of our Physiotherapy, Chiropractic, and Exercise Physiology teams at Blacktown Health, Tom progressed from a painful, swollen ankle to a full return to his beloved sport of soccer.Key factors in Tom's successful recovery included:

• Accurate initial assessment and diagnosis
• Appropriate use of diagnostic imaging
• A tailored, progressive rehabilitation program
• Regular monitoring and adjustment of the treatment plan
• Patient education and home exercise program

Tom's dedication to his rehabilitation, combined with the expertise of our Blacktown Health team, resulted in a full recovery and a reduced risk of future ankle injuries. If you're dealing with a sports injury or any musculoskeletal problem, don't hesitate to reach out to our team at Blacktown Health. We're here to help you get back to doing what you love!