Physiotherapy for Ligament Injuries in Edmonton

KEY TAKEAWAYS

• Ligaments are tough bands of connective tissue that stabilise joints. They can be stretched, partially torn, or fully ruptured, and the grade of the injury changes how long recovery takes and what the plan should look like.
• The old advice of strict rest, ice, anti-inflammatories, and prolonged immobilisation has been replaced by a more active approach. Current sports medicine guidance favours early, progressive loading over extended rest.
• Most grade 1 and grade 2 ligament injuries recover well with physiotherapy. Grade 3 full ruptures of certain ligaments (such as the ACL) may benefit from a surgical opinion, but many heal well with conservative care alone.
• Focused shockwave therapy is one of the tools we add at Unpain Clinic for ligament injuries that have plateaued or that involve significant scar tissue in the surrounding structures.
• At Unpain Clinic Edmonton, ligament injury care combines a thorough assessment, manual therapy, progressive loading, and the right add-on modalities for your specific injury. We tell you honestly if we are not the right fit.

You stepped off a curb the wrong way and felt that sickening pop in your ankle. Or you twisted your knee playing weekend hockey and now the joint feels loose, swollen, and sore. Or you took a fall on outstretched hands and the thumb or wrist has not been the same since. These are all variations of the same problem: a stretched, torn, or ruptured ligament.

Ligament injuries are among the most common reasons people end up in physiotherapy, and the way they are treated has changed substantially in the last decade. The classic advice (rest, ice, anti-inflammatories, keep the joint immobilised) is largely outdated. Modern recovery looks different, and the outcomes are better. Here is what is actually happening when you sprain a ligament, what modern physiotherapy looks like, and how we approach it at Unpain Clinic in Edmonton.

WHAT IS A LIGAMENT INJURY?

A ligament is a tough, slightly elastic band of connective tissue that connects two bones at a joint. Ligaments are different from tendons (which connect muscle to bone) and different from cartilage (which lines the joint surfaces). Their job is mechanical: they hold bones in alignment and limit the range of motion to what is safe for that particular joint.

When a joint moves beyond its safe range, the ligament gets stretched or torn. The most common ligament injuries in clinic include:

• Ankle ligaments, especially the anterior talofibular ligament on the outside of the ankle. These are the classic "rolled ankle" sprain.
• Knee ligaments, including the medial collateral (MCL), lateral collateral (LCL), anterior cruciate (ACL), and posterior cruciate (PCL).
• Wrist and thumb ligaments, including the ulnar collateral ligament of the thumb (sometimes called skier's thumb).
• Shoulder ligaments, including those that stabilise the AC joint at the top of the shoulder.
• Spinal ligaments, which are involved in many cases of acute neck and low back pain after a sudden movement.

The mechanism is almost always the same: a force pushed the joint past its normal range, and the ligament took the strain.

WHAT ARE THE GRADES OF LIGAMENT INJURY?

Ligament injuries are graded by how much of the ligament was damaged.

• Grade 1 (mild). The ligament is stretched or has microscopic tearing but is still mostly intact. The joint is stable. There is some swelling and pain but you can usually still bear weight and move the joint, even if it hurts. Most grade 1 sprains settle in one to three weeks with good early care.
• Grade 2 (moderate). A partial tear of the ligament. The joint feels less stable, the swelling is more pronounced, and bearing weight or loading the joint is uncomfortable. Most grade 2 sprains settle in four to eight weeks with a structured rehabilitation plan.
• Grade 3 (full rupture). The ligament is completely torn through. The joint is unstable on testing. Swelling is significant, and load tolerance is poor. The recovery timeline depends heavily on which ligament is involved and what you want to return to. Some grade 3 injuries (like an MCL of the knee or many ankle ligaments) heal well with conservative care alone. Others (like a full ACL rupture in an active person who wants to return to cutting and pivoting sports) often involve a surgical conversation.

What complicates the grading is that the surrounding tissues do not stand still while the ligament heals. The muscles around the joint will start compensating within days. The opposite limb, the joint above, and the joint below all subtly recalibrate. If the injury is not assessed and treated properly, those compensations become part of the problem long after the ligament itself has healed.

WHY EARLY TREATMENT MATTERS

The first one to two weeks after a ligament injury sets the trajectory for the next several months. Three things tend to go wrong when the early phase is handled badly.

The joint is immobilised for too long. Old advice often kept ligament injuries in a brace or boot for weeks. Modern evidence shows that prolonged immobilisation leads to muscle wasting, joint stiffness, and weaker scar tissue. The ligament needs controlled load to heal well, not zero load.

Anti-inflammatory medications are used as the default. Inflammation is part of how a ligament repairs itself. Routinely suppressing it with NSAIDs in the first few days may actually interfere with optimal healing, although there are situations where the medication is appropriate. This is something to discuss with your physician rather than self-prescribe.

The surrounding chain is ignored. By the time the ligament has structurally healed (usually six to twelve weeks), the muscles around the joint, the joint above, and the joint below have all changed how they work. Going back to your sport or your normal life without retraining those structures is one of the more common reasons people re-injure the same ligament within months.

A real plan addresses all three: appropriate early protection followed by progressive loading, sensible decisions about medications, and proper retraining of the whole chain.

WHAT DOES THE RESEARCH SAY IS THE BEST APPROACH TO LIGAMENT INJURY?

The modern framework most sports medicine clinicians use is summarised in a 2020 editorial in the British Journal of Sports Medicine that introduced the acronyms PEACE and LOVE for soft tissue injury management.

PEACE covers the first few days after the injury. Protection (avoid activities that aggravate the area). Elevation. Avoid anti-inflammatory medications routinely. Compression. Education (understand what is happening and what to expect). Notably, the authors question the routine use of ice, suggesting that while ice can reduce pain it may also delay healing in some situations.

LOVE covers the subacute and recovery phase. Load (early, progressive loading of the joint as soon as it is tolerated, not waiting until the pain is gone). Optimism (psychological factors strongly predict recovery). Vascularisation (cardiovascular activity to support healing). Exercise (specific, progressive rehabilitation rather than just rest).

The shift from RICE to PEACE and LOVE is not a marketing rebrand. It reflects two decades of research showing that early controlled loading produces stronger ligament healing, faster return to function, and lower re-injury rates than prolonged rest. It is also why competent physiotherapy in the first few weeks is one of the single most important variables in how well a ligament injury recovers.

HOW IS A LIGAMENT INJURY TREATED AT UNPAIN CLINIC EDMONTON?

A first visit is a 60-minute one-on-one assessment. We take a history of what happened, check the grade of the injury, look at the surrounding joints, and screen for any red flags that suggest the injury needs a medical or surgical opinion before we proceed. If imaging would change the plan, we tell you and recommend a conversation with your family doctor.

If you are a fit for our approach, the plan usually has four pieces.

Manual therapy and joint mobility work. Restoring normal movement of the joint above and below the injured ligament reduces the load that ends up at the healing tissue. This is more important than it sounds. An ankle sprain that does not regain full ankle dorsiflexion ends up loading the knee differently for months.

A progressive exercise program. Start with what the joint can tolerate without aggravating the swelling. Add range of motion. Add controlled isometric loading. Add eccentric and concentric strength work. Progress to balance, proprioception, and (for athletes) sport-specific drills. This is the part you own between visits, and it is the single biggest predictor of recovery.

Focused shockwave therapy when appropriate. Shockwave is not a first-line treatment for every fresh sprain. Where it earns its place is for ligament injuries that have plateaued, for chronic scar tissue around an old injury, and as an adjunct in the rehabilitation phase. A 2025 systematic review and meta-analysis in BMC Musculoskeletal Disorders looked at extracorporeal shockwave therapy combined with standard rehabilitation following ACL reconstruction across five trials and 242 participants. The evidence is still developing, but the picture is that adding shockwave to rehabilitation can support recovery, especially with focused shockwave, and the safety profile is consistently good.

EMTT for the broader region when appropriate. EMTT uses pulsed electromagnetic fields delivered through a loop applicator placed over the joint. You feel nothing during the session. It can be useful when the irritation extends beyond the focal ligament into the surrounding capsule, muscle, and soft tissue.

For patients whose ligament injury was part of a larger trauma or whose chronic pain has clearly sensitised the nervous system, we sometimes add NESA neuromodulation as an additional layer. It is not used on every ligament case.

DOES SHOCKWAVE THERAPY HELP WITH LIGAMENT INJURIES?

The evidence for shockwave in ligament injuries is most developed for post-surgical rehabilitation, particularly after ACL reconstruction. A 2025 systematic review in BMC Musculoskeletal Disorders found that adding shockwave therapy to standard post-operative rehabilitation produced improvements in some patient-reported outcomes, although the body of evidence is still developing and trial methodology varies. The strongest signal was with focused shockwave rather than radial shockwave.

For non-surgical ligament rehabilitation, the case for shockwave is more individualised. The mechanisms are the same ones that make it useful for tendon problems: improved local blood flow, restart of a stalled healing response, and influence on disordered tissue and abnormal nerve ingrowth that can develop around a slow-to-heal area. A broader 2024 systematic review and meta-analysis in BMC Sports Science, Medicine and Rehabilitation supports the use of shockwave across multiple tendinopathies and adjacent soft tissue injuries, with a consistently good safety profile.

A systematic review of shockwave across orthopedic conditions in the British Medical Bulletin reached the same conclusion on safety, noting that adverse events are uncommon and mild when shockwave is applied by trained clinicians.

The honest summary on shockwave for ligament injuries: it is not the first thing we reach for in a fresh sprain, and it is not magic. It is one tool in a layered plan, and it has the most value when the assessment shows that the ligament has plateaued, scar tissue is contributing, or post-surgical recovery has stalled. The article on how focused shockwave therapy works goes through the technology in more depth.

WHAT CAN I DO AT HOME IN THE FIRST FEW DAYS?

The first few days set the trajectory. The right things to do are simpler than people think.

1. Protect the joint without locking it down. Use a brace or tensor if the injury is significant, but do not stay in it longer than necessary. Light, controlled movement starts as soon as the joint will tolerate it without aggravating the swelling.
2. Elevate the limb when you are resting. Above heart level helps. Two to three hours a day in the first 48 hours is reasonable.
3. Compress the area with an elastic bandage. Snug enough to give support; not so tight that the tissue below the bandage gets cool or numb.
4. Be cautious about routine anti-inflammatory medications. Talk to your physician about whether they make sense for your specific situation rather than reaching for them automatically. Some inflammation is part of how a ligament repairs itself.
5. Move what you can, without aggravating the injury. Walking on a sprained ankle within the limits of comfort is usually better than complete bed rest. Gentle range of motion of the knee within a pain-free range is usually better than total immobilisation. The principle is "as much movement as the injury will tolerate without flaring," not "as little as possible."
6. Get assessed within the first one to two weeks. Even if the injury seems mild. The trajectory of recovery is set in the first month, and the assessment is what lets you start the right plan rather than guessing.

“Dr. Lacina Barsalou at Unpain Clinic (Summerside) is absolutely amazing! I’ve been seeing her since December 2022, and she has been a game-changer in my recovery from a concussion, post-concussion whiplash, and migraines. Her care, expertise, and kindness are unmatched! She is incredibly gentle, thoughtful, and truly listens to your concerns. Every visit leaves me feeling better, both physically and mentally. She genuinely cares about her patients and always puts their well-being first. If you’re looking for an exceptional chiropractor, look no further—Lacina is the best! Highly recommend!” Morgan Morey

WHAT WE DO NOT OFFER

• We do not perform or order imaging. X-rays and MRIs are ordered by physicians. If your situation needs imaging, we will tell you and recommend a conversation with your family doctor.
• We do not perform injections of any kind, including cortisone or platelet-rich plasma.
• We do not prescribe oral or topical pain medications. We are physiotherapists and registered massage therapists, not physicians.
• We do not perform surgery. If your ligament injury is a grade 3 rupture and a surgical opinion is appropriate for your situation, we will tell you and refer you to an orthopedic surgeon. For many grade 3 injuries, conservative care is still a reasonable first option.
• We do not promise cures. Most ligament injuries recover well with the right plan, but not every case returns to 100 percent of the prior level. What we offer is an honest assessment, a clear plan, and a team that will tell you if we are not the right fit.

FREQUENTLY ASKED QUESTIONS

How long does a ligament injury take to heal?

It depends on the grade and the ligament. Grade 1 (mild) injuries usually settle in one to three weeks with good early care. Grade 2 (partial tear) injuries usually take four to eight weeks. Grade 3 (full rupture) timelines vary widely depending on which ligament is involved, whether surgery is indicated, and what you want to return to. A 60-minute assessment is the best way to get a realistic timeline for your specific injury.

Do I need an X-ray or MRI for a ligament injury?

Not always. X-rays show bone, not ligaments, so they are useful mainly for ruling out a fracture. MRI can show ligaments but is usually reserved for situations where the assessment suggests a significant tear, where the joint is not responding to conservative care, or where a surgical decision is being considered. Most grade 1 and grade 2 sprains do not require imaging.

Is it better to rest or move a ligament injury?

The current evidence favours protected, progressive movement over prolonged rest. A 2020 editorial in the British Journal of Sports Medicine on soft tissue injury management replaced the old RICE acronym with PEACE and LOVE, which emphasises early loading rather than extended rest. The principle is "as much movement as the injury will tolerate without flaring," not total immobilisation.

Should I take anti-inflammatory medications for a ligament injury?

Talk to your physician before taking them routinely. Inflammation is part of how a ligament repairs itself, and there is evidence that routinely suppressing the early inflammatory response with NSAIDs may interfere with optimal healing. There are situations where the medication is appropriate, but it should be a deliberate decision rather than an automatic response.

Will shockwave therapy help my ligament injury?

It depends on the situation. Shockwave is not the first tool we reach for in a fresh sprain. Where it earns its place is in ligament injuries that have plateaued, in chronic scar tissue around old injuries, and as an adjunct to rehabilitation after a surgical reconstruction. A 2025 systematic review in BMC Musculoskeletal Disorders found promising results when shockwave was added to standard post-operative rehabilitation after ACL reconstruction.

Do I need a doctor's referral to come to Unpain Clinic?

No referral is needed. Physiotherapists and registered massage therapists in Alberta are primary contact providers, so you can book directly. Some extended health plans require a doctor's referral for reimbursement, so it is worth checking your benefits.

What if my ligament injury needs surgery?

For grade 3 ruptures of certain ligaments, especially the ACL in active patients who want to return to cutting and pivoting sports, a surgical opinion is appropriate. We will tell you if your assessment points that way and refer you to an orthopedic surgeon. Even when surgery is on the table, a conservative trial often comes first for many injuries, and post-surgical rehabilitation is itself a major part of recovery. We can be involved in either pathway.

ABOUT THE AUTHOR

Written by Uran Berisha, PT, RMT, Founder of Unpain Clinic and Medical Shockwave Institute. Uran is a physiotherapist based in Edmonton, Alberta, and an International Educator in Shockwave Therapy. Medically reviewed by Uran Berisha, PT, RMT.

READY TO GET YOUR LIGAMENT INJURY ASSESSED PROPERLY?

If you have sprained a ligament and the recovery is not going the way you hoped, or you want to get on the right track from the start, the next step is a 60-minute one-on-one assessment in Edmonton where we grade the injury, look at the chain around it, and build you a clear, written plan. No referral needed. No pressure. We will tell you honestly whether our approach is the right call, and we will refer you for a surgical or medical opinion if that is what your situation calls for. You can book a one-on-one assessment when you are ready.

REFERENCES

The following sources are linked inline in the body above. The full citations are listed here for completeness.

1. Dubois B, Esculier JF. Soft-tissue injuries simply need PEACE and LOVE. British Journal of Sports Medicine. 2020;54(2):72-73. doi:10.1136/bjsports-2019-101253. PMID: 31377722. https://pubmed.ncbi.nlm.nih.gov/31377722/
2. Shin J, Rhim HC, Kim J, Guo R, Elshafey R, Jang KM. Use of extracorporeal shockwave therapy combined with standard rehabilitation following anterior cruciate ligament reconstruction: a systematic review with meta-analysis. BMC Musculoskeletal Disorders. 2025;26:79. doi:10.1186/s12891-025-08277-9. https://pmc.ncbi.nlm.nih.gov/articles/PMC11756125/
3. Majidi L, Khateri S, Nikbakht N, Moradi Y, Nikoo MR. The effect of extracorporeal shock-wave therapy on pain in patients with various tendinopathies: a systematic review and meta-analysis of randomized controlled trials. BMC Sports Science, Medicine and Rehabilitation. 2024;16(1):93. doi:10.1186/s13102-024-00884-8. PMID: 38659004. https://pubmed.ncbi.nlm.nih.gov/38659004/
4. Schmitz C, Császár NB, Milz S, Schieker M, Maffulli N, Rompe JD, Furia JP. Efficacy and safety of extracorporeal shock wave therapy for orthopedic conditions: a systematic review on studies listed in the PEDro database. British Medical Bulletin. 2015;116(1):115-138. doi:10.1093/bmb/ldv047. PMID: 26585999. https://pubmed.ncbi.nlm.nih.gov/26585999/