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