**3. Chronic ankle instability (CAI)**

Athletes with chronic ankle instability give a history of two or three severe ankle sprains with the main complaint being intermittent giving out of the ankle. The athlete often complains of difficulty and apprehension on uneven surfaces. Even mild exacerbations lead to short-term dysfunction. It is characterized by residual ankle instability as a result of either mechanical ankle stability or functional ankle instability or a combination of both [6].

## **4. Mechanical and functional instability**

Mechanical instability (MI) and functional instability (FI) are both due to recurrent lateral ankle sprains. Mechanical instability is defined as an increase in the accessory movements in the joint leading to hypermobility. Residual MI usually results from a tear or lengthening of one of the ligamentous structures supporting the joint and suggests a suboptimal healing process after injury. A lesser known phenomenon is hypomobility leading to ankle instability. Joint hypomobility can be intra-articular or extra-articular, giving rise to restricted range of motion at the ankle. Hypomobility occurs at the subtalar, talocrural joint, distal tibiofibular joint, and proximal tibiofibular joint [7, 8].

As the joint develops MI, proprioceptive changes occur, which result in alterations in defense mechanism to prevent injuries, thus leading to CAI. FI can result in balance deficits, joint position sense deficits, delayed peroneal muscle reaction time, altered common peroneal nerve function, strength deficits, a decreased range of motion (ROM), sinus tarsi syndrome, and anterolateral impingement syndrome.

### **5. Rehabilitation**

Early mobilization of ankle sprains as compared with cast immobilization has been shown to be more comfortable as it results in less pain and provides for an earlier return to work. Cast immobilization does not improve healing compared with an active mobilization rehabilitation program and may have negative implications in relation to muscle wasting and stiffness. Functional treatment is considered better in achieving more effective mobilization and an earlier return to daily activities. Lateral ankle sprains respond well to the conservative treatment which includes initially RICE—rest, ice, compression, and elevation—followed by early

**103**

**Table 1.**

*Rehabilitation of Lateral Ankle Sprains in Sports DOI: http://dx.doi.org/10.5772/intechopen.89505*

should begin immediately.

*5.1.1 Rest*

*5.1.2 Ice*

**5.1 Reduce pain and swelling**

*5.1.3 Compression and elevation*

*Cryotherapy generates four stages of sensation [9].*

mobilization. Rehabilitation focuses on restoring ROM, strength, balance, and normal gait patterns. Functional rehabilitation begins on the day of injury and continues until pain-free gait and activities are attained. Functional rehabilitation has four aspects: ROM, strengthening, proprioception, and activity-specific training. Ankle joint stability is a prerequisite to the institution of functional rehabilitation. Since Grade I and Grade II injuries are considered stable, functional rehabilitation

Rest is prescribed to avoid undue stress on the joint. It is required to reduce the metabolic demands on the injured tissue and thus avoid increased blood flow. It also helps in avoiding stress on the injured tissue that might disrupt the fragile fibrin bond, which is the first element of the repair process. Rest can be applied selectively

Cryotherapy involves a nice bath with a temperature of 4°–10°C for 12–20 min,

Ice application causes vasoconstriction which decreases blood flow and therefore swelling to the injured area. The lowering of tissue temperature decreases the metabolism and the chemical actions of cells and thus lowers the oxygen and nutrient needs in the affected area. Decreased blood flow limits edema; there is less histamine release and therefore less capillary breakdown than would normally be present after injury. There is better lymphatic drainage from the injured area

to allow some general activity, but athletes must avoid stressful activities.

one to three times per day, and applying an ice pack to the injured area for 15–20 min, one to three times per day. Ice therapy should be started immediately after the injury and ice application initiated within day 0 or day 1. Both have shown better results and return to full activity as compared to when the ice was applied after 48 h. Ice application should provide deep penetration to gain full benefits. Also the ice should not be held immobile in one area or frostbites may occur.

because of the lower pressure on the extravascular fluid (**Table 1**).

**Stage Duration (min) Sensation** Stage 1 1–3 A cold feeling is noted Stage 2 2–7 Burning or aching

Hence, the rationale of minimum 15 min of cryotherapy per treatment.

Compression and elevation work better in combination with cryotherapy. Compression with an adhesive bandage and a foot elevation of more than 45° is the standard prescribed treatment for lateral ankle sprains. Compression can also be

Stage 3 5–12 Local numbness and anesthesia (decreased conductivity of regional nerve

Stage 4 12–15 Reflex deep tissue vasodilation without an increase in metabolism

fibers)

mobilization. Rehabilitation focuses on restoring ROM, strength, balance, and normal gait patterns. Functional rehabilitation begins on the day of injury and continues until pain-free gait and activities are attained. Functional rehabilitation has four aspects: ROM, strengthening, proprioception, and activity-specific training. Ankle joint stability is a prerequisite to the institution of functional rehabilitation. Since Grade I and Grade II injuries are considered stable, functional rehabilitation should begin immediately.
