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A B M P m e m b e r s ea r n F R E E C E h o u r s by rea d i n g t h i s i s s u e ! 29 A B M P m e m b e r s ea r n F R E E C E h o u r s by rea d i n g t h i s i s s u e ! 29 Visual examination can reveal signs of swelling, bruising, and skin color changes, while palpation aids in identifying areas of tenderness and evaluating ligament integrity. The subsequent physical examination, including range of motion and resistance testing, should help narrow down the affected ligaments and their contribution to the pain. For example, during both active and passive movements, any motion that further stretches the ligament is likely painful. This assessment will also help you differentiate ankle sprains from other soft-tissue injuries. In addition to these techniques, special orthopedic tests can provide further insights. Tests such as the anterior drawer test, targeting the ATFL, and the talar tilt test, focusing on the CFL, can be instrumental in confirming the presence and gauging the severity of ligament injuries. TREATMENT STRATEGIES Crafting an effective treatment plan for an ankle sprain should evolve directly from the information gathered during the assessment process. A multifaceted approach is most effective in treating ankle sprains and combines immediate care strategies, manual therapy, rehabilitative exercises, and advanced treatment options when necessary. Massage therapy is a core component for treating sprains. It can be used with other treatments used by other providers, such as laser therapy, ultrasound, microcurrent, and electrical stimulation. RICE Protocol The rest, ice, compression, and elevation (RICE) protocol is the widely accepted initial protocol for the acute phase of ankle sprains. The acute injury stage covers the first 48–72 hours after injury. In the early stages, immediately after the injury, ice has analgesic effects and reduces initial swelling. However, research indicates that prolonged use of ice can interfere with, and slow, healing. Rest, compression, and elevation are necessary to start the healing process. Nonsteroidal anti-inf lammatory drugs (NSAIDs) are often used at this stage. Practitioners should avoid treating the region if it is still in an acute inf lammatory phase. Manual and Massage Therapy Massage or soft-tissue treatments are core, indispensable components of any ankle sprain treatment regimen, offering a range of benefits. These begin after the acute phase. Post-strain discomfort is often a result of excess f luid in the area that presses on nerve endings and fills the interstitial spaces. Light massage will reduce this swelling. Gentle stroking in a proximal direction aids lymphatic drainage in the area, which reduces excess tissue f luid and decreases pain. Swelling can persist for several weeks post-injury. Do not wait until the visible swelling is gone or you will miss the ideal window of opportunity for injury rehabilitation. Massage techniques can be delivered in moderation, even if chronic swelling persists. Just use caution and work within your client's tolerance. As the swelling begins to subside, deep transverse friction at the injury site will aid in repairing ligament tissue damage, in part by stimulating fibroblast activity. In addition, deep transverse friction plays a role in mobilizing the ligament and preventing it from adhering to adjacent tissues. This friction is typically performed in a direction that is perpendicular to the direction of the ligament's fibers (Image 4). In addition to the foot, the lower leg muscles are treated, especially if they are in a protective spasm following the injury. For example, after an inversion sprain, there is usually tightness in the peroneal muscles— the muscles are likely to become hypertonic. Not everyone experiences the same rate of injury healing. Someone with scar tissue from an older injury could take longer to regain proper functional movement than someone with a recent sprain. It is essential to achieve early mobilization in the area for the most beneficial healing. But because passive movement runs the risk of overstretching the damaged tissue, active movement is preferable, especially in the early stages. The client is unlikely to perform movements that hurt too much, so active movement is self-limiting and not likely to cause further damage. It is helpful to stretch muscles that might also be in protective spasm. Leave stretching for the later recovery stage to develop healthy and functional movement. Finally, rehabilitative exercise is a cornerstone of ligament sprain recovery. A pivotal aspect of preventing further sprains and ensuring safe ligament healing involves enhancing proprioceptive awareness and strengthening the surrounding muscles. This is typically conducted in physical therapy sessions, using tools like a wobble board. CONCLUSION Ankle sprains are among the more frequently seen injuries in the massage clinic. Massage has a core role in their treatment. We can significantly contribute to our client's recovery by making our care as informed and efficient as possible. Not only will the client return to function quicker, but they will also endure less pain. Whitney Lowe is the developer and instructor of one of the profession's most popular orthopedic massage training programs. His text and programs have been used by professionals and schools for almost 30 years. Learn more at academyofclinicalmassage.com. CLINICAL EXPLOR ATIONS