Treatment of post-traumatic ankle ligament adhesions – case report

Miłosz Parchimowicz, Adam Michoński, Oktawia Parchimowicz, Anna Lubkowska


Ankle sprains are the most common sports injuries, but they also happen to people that do not do any sports at all. Most of them are inversion-type traumas which could harm soft tissues like lateral collateral ligaments, capsule and peroneal tendons. The vast majority of these injuries are grade ͕ sprains where there is no clinical instability. Very often treatment is based on conservative protocols, i.e. RICE (rest, ice, compression, elevation), immobilization and avoiding weight bearing. Besides the above procedures, in the following period of time some modalities are planned, and there is not enough attention paid to regaining function after the acute stage. Such a conservative approach over a longer period of time should be reserved for fractures and grade ͗ sprains because immobilization leads to loss of proprioception and the formation of inelastic scar tissue caused by ligamentous adhesions. It takes about ͚ weeks to form adhesions, and clinically those patients complain about pain, sometimes also with swelling, after some exertion. One treatment option is deep friction and manipulation of adherent lateral ligaments to break the adhesions. The aim of this paper is to show an alternative treatment option which is safer than manipulation. The authors propose the use of a shockwave therapy in combination with a home exercise stretching programme in positions reproducing the trauma mechanism to remodel the scar tissue. Additionally, there should be proprioception exercises for prophylaxis and regaining normal function


ankle sprain; anterior talofibular ligament; calcaneofibular ligament; shockwave therapy

Full Text:

PDF (Język Polski)


Hubbard TJ, Hertel J. Anterior positional fault of the fibula after sub-acute lateral ankle sprains. Man Ther 2008;13:63-7.

Cleland JA, Mintken P, McDevitt A, Bieniek ML, Carpenter KJ, Kulp K, et al. Manual physical therapy and exercise versus supervised home exercise in the management of patients with inversion ankle sprain: a multicenter randomized clinical trial. J Orthop Sports Phys Ther 2013;43(7):443-55. doi: 10.2519/jospt.2013.4792.

Martin RL, Davenport TE, Paulseth S, Wukich DK, Godges JJ. Ankle stability and movement coordination impairments: ankle ligament sprains. J Orthop Sports Phys Ther 2013;43(9):A1-A40. doi: 10.2519/jospt.2013.0305.

Van der Ent FWC. Lateral ankle ligament injury, an experimental a clinical study. Rotterdam: Erasmus University Rotterdam; 1984. p. 18-20.

Ombergt L, Bisschop P, ter Veer HJ. A system of orthopeadic medicine. London: Churchill Livingstone; 1995. p. 1169-260.

Fallat L, Grimm DJ, Saracco JA. Sprained ankle syndrome: prevalence and analysis of 639 acute injuries. J Foot Ankle Surg 1998;37(4):280-5.

Cook C. Orthopedic manual therapy: an evidence based approach. USA: Pearson Prentice Hall; 2007. p. 544-87.

De Coninck S, Zupanic J, Leone M, Ridulfo G. Clinical reasoning in modern orthopeadic medicine. Belgium: OMConsult – ETGOM; 2012. p. 91-104.

Atkins E, Kerr J, Jane E. A practical to orthopaedic medicine assessment, diagnosis, treatment. London: Churchill Livingstone Elsevier; 2007. p. 329-69.

Notarnicola A, Morett B. The biological effects of extracorporeal shock wave therapy (eswt) on tendon tissue. Muscles Ligaments Tendons J 2012;2(1):33-7.

Caminoto EH, Alves AL, Amorim RL, Thomassian A, Hussni CA, Nicoletti JL. Ultrastructural and immunocytochemical evaluation of the effects of extracorporeal shock wave treatment in the hind limbs of horses with experimentally induced suspensory ligament desmitis. Am J Vet Res 2005;66(5):892-6.

McKenzie R, May S. The human extremities, mechanical diagnosis and therapy. A different approach of assessment of muscolosceletal problems. Minneapolis: Orthopedic Physical Therapy Products; 2000.

Gaida JE, Cook J. Treatment options for patellar tendinopathy: critical review. Curr Sports Med Rep 2011;10(5):255-70.

Mohammadi F. Comparison of 3 preventive methods to reduce the recurrence of ankle inversion sprains in male soccer players. Am J Sports Med 2007;35:922-6.

Mattacola CG, Dwyer MK. Rehabilitation of the ankle after acute sprain or chronic instability. J Athl Train 2002;37(4):413-29.


Copyright (c) 2016 Miłosz Parchimowicz, Adam Michoński, Oktawia Parchimowicz, Anna Lubkowska

License URL: