Sprain Grades
1st Degree: A stretching of the ligament, no tear.
2nd Degree: A Partial tear of the ligament.
3rd Degree: A complete tear of the ligament.

Ankle Sprains
Mechanisms: Inversion, eversion, rotation on a planted foot, plantar flexion, & dorsiflexion.
1st Degree:
Sx: Mild Effussion, Limited AROM, Decreased Strength, and no laxity
Tx: R.I.C.E. & crutches
Rehabilitation: AROM, Isometric, Resistive Band Exercises, Balance Exercises, Ankle Weight Exercises, & various modalities. Progression will vary with the the severity of the injury.

2nd Degree:
Sx: Moderate Effussion, Ecchymosis, Limited AROM, Significant Decrease in Strength, and/or laxity.
Tx: RICE, crutches, immobilization, horseshoe, x-ray may be needed.
Rehab: AROM, Isometric, Resistive Band Exercises, Balance Exercises, Ankle Weight Exercises, & various modalities at a slower progression.

3r Degree:
Sx: Significant Effussion, Ecchymosis, Limited AROM, Significant Decrease in Strength, and/or laxity.
Tx: RICE, crutches, immobilization, horseshoe, x-ray may be needed.
Rehab: AROM, Isometric, Resistive Band Exercises, Balance Exercises, Ankle Weight Exercises, & various modalities at a slower progression.

Fractures:
Mechanism: Direct Blow, Inversion, Eversion, Rotation on a Planted Foot, Compression, Plantar Flexion, & Dorsiflexion
Sx: Point Tenderness, Immediate Swelling, Pain may be extreme, and/or Obvious Deformity
Tx: Immobilization, X-Ray, Dr. Referral

Strain Grades:
1st Degree: A stretching of the muscle, no tear
2nd Degree: A partial tear of the muscle
3rd Degree: A complete tear of the muscle

Achilles Tendon Strain
Mech: Usually cuased by extreme dorsiflexion, sometimes associated with an ankle sprain.
Sx: Tenderness along the Achilles tendon, pain & weakness with plantar flexion, edema, ecchymosis, and/or obvious deformity depending on severity.
Tx: RICE, crutches may be needed
Rehabilitation: AROM, Isometric, Resistive Band Exercises, Balance Exercises, Ankle Weight Exercises, & various modalities. Progression will vary with the the severity of the injury.

Achilles Tendonitis: Chronic Inflammation of the Achilles Tendon
Sx: Generalized pain and stiffness with running and jumping; Poor Flexability; Crepitus, & Pain near the insertion point.
Tx: Increase Flexability, Resistive Band Exercises, Limit Activity, & Modalities

Achilles Tendon Rupture
Sx: Usually associated with a chronic history of Achilles Tendonitis that results in microtear; significant pain, obvious deformity, inability to plantarflex.
Tx: Immobilization, Dr. Referral, Surgical Repair, cast
Rehab: AROM, Isometric, Resistive Band Exercises, Balance Exercises, Ankle Weight Exercises, & various modalities.















Peroneal Tendon Subluxation/Dislocation
Mech: 2nd or 3rd Degree Akle Sprain, Forced DF, or Direct Blow
Sx: Complains of a popping or clicking sensation; pain on the Peroneal Tendons near the malleolus, Effussion, Limited AROM, Decreased Strength, &/or Ecchymosis
Tx: RICE, Immobilization, Crutches
Rehabilitation: AROM, Isometric, Resistive Band Exercises, Balance Exercises, Ankle Weight Exercises, & various modalities.

Tendonitis: Anterior Tibialis Tendonitis, Posterior Tibialis Tendonitis, & Peroneal Tendonitis
Mech: Overuse for all three, Ant. Tib: Excessive Downhill Running; Post. Tib: Pes Planus/Excessive Pronation/Limb Length Differnce; Peroneal:Pes Cavus/Excessive Supination/Limb Length Differnce.
Sx: Tenderness over the affected tendons; Mild Edema may be associated.
Tx: Limit activity; orthotics can be used to correct mechanical problems; increase flexibility

Contusion
Mech: Direct Blow
Sx: Severe pain, limited AROM and localized swelling over the injured area.
Tx: RICE, limit activity, protective padding may be required.
Rehab: AROM, Isometric, Resistive Band Exercises, Balance Exercises, Ankle Weight Exercises, & various modalities.

Compartment Syndrome
Mech: Directs blow or overuse
Sx: Usually bilateral Sharp pain; Decreased cirulation; Muscle may feel like it is in constant cramp due to increased pressure of the muscle compartment; Raidating Pain; Knumbness; and Muscle weakness.
Tx: RICE for acute cases, surgery may be required to releave the pressure.
Rehab: AROM, Isometric, Resistive Band Exercises, Balance Exercises, Ankle Weight Exercises, & various modalities.

Stress Fx
Mech: Overuse, Pes Planus, Pes Cavus, & Limb Length Differnce
Sx: Gradual onset, Pin Point Tenderness, Constant pain even when non-weight bearing(NWB), & a bump may be detected on the injured area.
Tx: RICE, orthotics may be needed, crutches may be needed, X-ray, &/or bone scan.
Rehab: Rest and maintain cardiovascular fitness through NWB activities, i.e. swimming, biking, etc..

Reffernece: Arnheim's Princilpes of Athletic Training, 11th Edition, William Prentice