~ 223 ~ International Journal of Physical Education, Sports and Health 2022; 9(3): 223-226 P-ISSN: 2394-1685 E-ISSN: 2394-1693 Impact Factor (RJIF): 5.38 IJPESH 2022; 9(3): 223-226 © 2022 IJPESH www.kheljournal.com Received: 07-03-2022 Accepted: 10-04-2022 Dr. Deepali Shinde MPT Student, Musculoskeletal Physiotherapy, MGM Institute of Physiotherapy, Aurangabad, Maharashtra, India Surendra Wani Professor and Head of Musculoskeletal Department, MGM Institute of Physiotherapy, Aurangabad, Maharashtra, India Sanket Mungikar Associate Professor, MGM Institute of Physiotherapy, Aurangabad, Maharashtra, India Corresponding Author: Dr. Deepali Shinde MPT Student, Musculoskeletal Physiotherapy, MGM Institute of Physiotherapy, Aurangabad, Maharashtra, India Integrated manual therapy program along with exercise training for the rehabilitation of lateral ankle sprain: A case report Dr. Deepali Shinde, Surendra Wani and Sanket Mungikar DOI: https://doi.org/10.22271/kheljournal.2022.v9.i3d.2540 Abstract Lateral ankle sprain is most common injury occurred during sports after forceful inversion. A comprehensive rehabilitation protocol is needed for faster recovery and avoiding recurrence. A case of 23-year-old male, amateur football player, had an injury to his left ankle. He developed sudden onset of pain, swelling and was not able to bear weight on his left ankle. Orthopaedic doctor suggested him 6 weeks of immobilization in plaster cast after confirmation of anterior talo-fibular ligament grade III and Posterior talo-fibular ligament and Deltoid ligament grade I sprain on MRI. After cast removal, he was referred to physiotherapy. The patient presented with pain, swelling, decrease muscle strength, kinesiophobia and incomplete ROM of the left ankle joint. A customized physiotherapy protocol was followed for 12 weeks after immobilization period. Phase wise integrated manual therapy program along with exercise training showed significant improvement in ankle joint function after lateral ankle sprain. Keywords: Exercise, lateral ankle sprain, manual therapy, PNE, proprioception 1. Introduction Ankle sprain is the most common injury occurred during sports participation. Lateral ankle sprain constitutes more than three-quarters of all acute ankle sprains. Approximately 73% of these are injuries to the anterior talofibular ligament [1, 2] . Sprains of the lateral ligaments of the ankle are the most common traumatic injury sustained during sports participation due to forceful inversion of plantarflexed foot [3] . Acute overstretching or tearing of the ligaments and fibrous capsule of the ankle joint causes functional limitations in ambulation, joint mobility, proprioception, balance etc. Supervised rehabilitation is warranted for complete and speedy recovery following lateral ankle sprain [4] . Therefore, this study intended to design a rehab protocol including integrated manual therapy and the proprioceptive exercises along with other traditional exercises following lateral ankle sprain. 2. Case presentation A 23-year-old male amateur football player. While playing football his left ankle of grounded foot twisted inwardly and lost his whole balance. He heard a pop sound at the inverted foot. He developed sudden onset of pain, swelling and was not able to bear weight on the left ankle joint. He consulted Orthopaedic, that suggested him for 6 weeks of immobilization in plaster cast after confirmation of Anterior talo-fibular ligament (ATFL) grade III and Posterior talo- fibular ligament (PTFL) and Deltoid ligament grade I sprain on MRI. During immobilization, he was advised for partial-weight bearing walking with the help of elbow crutch. After removal of the cast (6 weeks of period) he was referred to the outpatient physical therapy department having complaints of pain, swelling, incomplete ROM and difficulty in walking with full weight bearing on left ankle joint. The patient was assessed accordingly. Customized physiotherapy protocol including the integrated manual therapy program along with the exercise training was designed to achieve the goals. On first visit, pain neuroscience education was given. The physiology of pain and the biopsychosocial model of pain was explained. Pain physiology education with movement approaches helps to increase physical capacity, reduce pain and improve quality of life. It helped the patient perception and to cope with the fear of weight bearing on the left ankle joint. As he was amateur football player and educated about the condition, helped for the good prognosis.