| Introduction Sprained ankles are one of the | | | | |
| leading causes of athletes to miss games | | | | Immediate care following ankle sprain - |
| during the season. Many times they are taped | | | | Following a turned ankle, it is difficult to |
| up & rushed back to the field without proper | | | | determine the severity based on a number of |
| rehabilitation. More often than not, the | | | | factors. Swelling may occur immediately |
| ankle gets re-injured or worse, they end up | | | | making the injury seem worse than it actually |
| with a knee, hip or low back injury. These | | | | is. If the ankle does not swell, this does |
| injuries can be prevented by providing the | | | | not necessarily minimize the possibility of |
| proper healing time and rehabilitation. The | | | | torn ligaments. Tenderness will usually be |
| same premise holds true for non-athletes. I | | | | present on the outside of the ankle with an |
| have worked with a number of patients that | | | | inversion sprain. It also may be difficult |
| have had multiple ankle sprains that were | | | | to stand on the injured foot. The safest |
| never given the opportunity to fully | | | | advice would be to keep the shoe/sneaker tied |
| rehabilitate. The most common complaint is | | | | tight to prevent the ankle from swelling. |
| that their ankle turns over at any time | | | | Keep the weight off the foot as much as |
| without warning. All it takes is a slight | | | | possible. When the shoe is taken off, the |
| bend in the pavement and the ankle turns. | | | | leg should be elevated above the heart and an |
| This type of injury is frustrating and can | | | | ice pack should be compressed against the |
| become debilitating. This article discusses | | | | ankle. This will help decrease both the pain |
| the different types of ankle sprains, what to | | | | and swelling. This technique is called |
| do following a sprain, and what does | | | | R.I.C.E standing for Rest, Ice, Compression, |
| rehabilitation of the ankle involve? Brief | | | | Elevation. R.I.C.E is a good pneumonic for |
| Anatomy The ankle is made up of three primary | | | | any injury to the extremities. Should I go to |
| bones. The tibia & fibula, which are the | | | | the hospital? If you are having difficulty |
| longs bones of the lower leg and the talus | | | | putting weight on the foot, if the swelling |
| which is a major bone of the foot. Together | | | | is severe, and the pain has not reduced after |
| they make up the talocrural joint. The | | | | a few hours of using the R.I.C.E technique, a |
| mobility of these bones allows the foot to | | | | visit to the hospital is recommended. |
| flex and extend which is required for | | | | Prepare to wait in the emergency room for a |
| propulsion during walking. The other major | | | | while. Ankle sprains are not usually treated |
| joint of the ankle is formed by the lower | | | | as a priority. The doctor will examine the |
| portion of the talus and the upper portion of | | | | ankle looking for joint and ligament |
| the calcaneus (heel bone). These two bones | | | | instabilities. He/She may also order an |
| form what is called the subtalar joint, which | | | | X-ray to check for fractures. On occasion, |
| allows for movement in and out (inversion | | | | an MRI will be ordered to assess ligament |
| eversion). This inversion motion is the most | | | | damage.Physical Therapy/Rehabilitation It is |
| common mechanism of injury. The ligaments | | | | common following an ankle sprain to be placed |
| are tissues that connect bone to bone. Their | | | | on crutches. More severe sprains are placed |
| function is to provide stability to the | | | | in a boot or air cast to help with ankle |
| joint. There are three main ligaments on the | | | | stability. There are four major categories |
| outside of the ankle called the lateral | | | | of impairments that occur following an ankle |
| collateral ligaments. Their function is to | | | | sprain. These include 1. Ankle joint |
| prevent the ankle from inverting too far. | | | | instability due to weakened ligamentous |
| The inside of the ankle is protected by the | | | | structures 2. Muscle weakness 3. Poor |
| deltoid ligament, which functions to prevent | | | | balance (proprioception) 4. Pain and |
| excessive eversion or turning out.Mechanism | | | | swelling. Each of these impairments must be |
| of injury - The most typical ankle sprain is | | | | addressed for a successful rehabilitation. |
| an inversion sprain. This occurs when the | | | | Physical therapists will utilize various |
| ankle turns inward and the bodies weight | | | | massage techniques and modalities to reduce |
| compresses the ankle brining the lateral | | | | inflammation. Manual therapy techniques will |
| malleolus close to the floor. This excessive | | | | be used to restore normal joint mechanics and |
| movement places the lateral ligaments on | | | | to retrain the proper muscle firing patterns |
| strain, stretches the tendons crossing the | | | | necessary for stability. An effort is |
| joint and can also lead to some of the tarsal | | | | required to normalize your walking (gait) as |
| bones compressing on one another. The | | | | quickly as possible to prevent compensations. |
| greater the inversion force results in a more | | | | Finally, a specific strengthening program |
| severe ankle sprain or fracture. For the | | | | that incorporates the entire lower extremity |
| purposes of this article, I will only be | | | | and core muscles is provided to improve |
| covering ankle sprains, not fractures. What | | | | overall strength, balance and coordination. |
| is the difference between a sprain and a | | | | Each ankle sprain is different from the next |
| strain? This is a common question. A sprain | | | | & everybody heals at a different rate. |
| results from a stress placed upon a ligament. | | | | Typically, rehabilitation following an ankle |
| Remember a ligament connects one bone to | | | | sprain can be as short as two weeks (4 |
| another bone. A sprain is a partial or full | | | | visits) up to eight weeks (20 visits). This |
| tear in the ligament or at the junction of | | | | does not take into account any other |
| where the ligament attaches to the bone. A | | | | co-morbidities.Conclusion Ankle sprains if |
| strain results from an excessive force or | | | | managed properly through physical therapy and |
| overload on a muscle leading to micro-tears | | | | a conscious effort to comply with a home |
| in the muscle belly or tendon. A tendon is | | | | exercise program are usually rehabilitated |
| a tissue similar in strength to a ligament | | | | very successfully with low chance of |
| that connects a muscle to the bone. Both | | | | re-injury. However, if an ankle sprain is |
| ligaments and tendons are non-contractile | | | | not fully rehabilitated, the chances of |
| tissue. Only muscle has the ability to | | | | re-injury with more severe damage increase |
| contract (shorten).Grading an ankle sprain | | | | greatly.Dr. Brad Gilden, DPT, MSPT, CSCS has |
| There are three different grades of an ankle | | | | been practicing orthopedic and sports |
| sprain based on the severity of the | | | | physical therapy over the past six years. He |
| injury.Grade I (1st degree)- This is the most | | | | recently completed his doctorate in |
| common type of sprain. The ligaments are | | | | orthopedics with an emphasis in upper quarter |
| overstretched but no visible tear has | | | | and hand therapy. Dr. Gilden is also |
| occurred. Microscopic tears have occurred | | | | recognized as a certified strength and |
| that will heal if treated properly. Minimal | | | | conditioning specialist. Dr. Gilden |
| swelling should occur and only minor ankle | | | | practices physical therapy in Westchester |
| instability will be present. | | | | County, NY and will be joining Elite Health |
| | | | Services, LLC a company that provides in-home |
| Grade II (2nd degree)- This is a more severe | | | | physical therapy and personal training. Dr. |
| injury and the ligament has sustained a | | | | Gilden works with patients of all ages and |
| partial tear. The ankle will typically be | | | | rehabilitation needs. He has advanced |
| more swollen and ecchymosis (bruising) will | | | | training in manual therapy and continues to |
| usually occur. The ankle will be more | | | | broaden his experience by taking continuing |
| unstable and painful compared to a grade I. | | | | education courses each year. Dr. Gilden |
| | | | lectures to personal trainers, patients and |
| Grade III (3rd degree)- This is the most | | | | other health professionals on various topics |
| severe injury as the ligament has been | | | | throughout the year. He is an active member |
| completely torn. This is the most painful | | | | of the American Physical Therapy Association |
| ankle sprain and will typically present as | | | | (APTA), and National Strength & Conditioning |
| very hot and swollen with a lot of ecchymosis | | | | Association. |
| sometimes tracking halfway up the lower leg. | | | | |