The most common type of ankle injury is a sprain. A sprain is stretching and tearing of ligaments (fibrous bands connecting adjacent bones in a joint.) There are many ligaments around the ankle and these can become damaged when the ankle is forced into a postion not normally encountered.
The most frequently seen sprain occurs when weight is applied to a foot which is on an uneven surface, and the foot “rolls in” (inversion). Because the sole of the foot is pointing inward as force is applied, the ligaments stabilizing the lateral – or outside – part of the ankle are stressed. Many patients report hearing a “snap” or “pop” at the time of the injury. This is usually followed by pain and swelling on the lateral aspect of the ankle.
THE MOST IMPORTANT INITIAL MANAGEMENT OF A SPRAIN IS:
- R – rest
- I – ice
- C – compression
- E – elevation
Many of the problems resulting from sprains are due to blood and edema in and around the ankle. Minimizing swelling helps the ankle heal faster. The RICE regimen facilitates this.
- Rest – no weight bearing for the first 24 hours after the injury (Possibly longer, depending upon severity)
- Ice – apply ice packs using a towel over a plastic bag to the area that is painful. Be careful to avoid frostbite. Ice should be intermittantly applied for the first 24 hours.
- Compression – an ACE bandage or other soft elastic material should be applied to the ankle to help prevent the accumulaton of edema.
- Elevation – elevating the ankle helps in removing edema. By having the foot higher than the hip (or heart), gravity is used to pull edema out of the ankle.
In the initial 24 hours, it is very important to minimize swelling.WHEN TO SEEK MEDICAL ATTENTION
If the ankle is obviously fractured or dislocated, then medical attention should be sought immediately. Besides the initial RICE regimen proper diagnosis and treatment is very important. Athletes are encouraged to make an appointment with their physicians to assess the severity of the injury. Doctors will determine if X-rays are necessary, to be able to give instructions on proper rehabilitation of the injury.
DEGREE OF SEVERITY OF ANKLE SPAINS
Grades of Ankle Injury Severity When you experience an ankle sprain, it is the amount of force placed on your foot that will determine the grade of the sprain.
Grade 1 sprain: A mild sprain is a known as Grade 1. This occurs when there is slight stretching and some damage to the fibers (fibrils) of the ligament. Usually, you can place pressure on your foot and walk afterward.
• Some stretching or perhaps minor tearing of the lateral ankle ligaments.
• Little or no joint instability.
• Mild pain.
• There may be mild swelling around the bone on the outside of the ankle.
• Some joint stiffness or difficulty walking or running.
Grade 2 sprain: A moderate sprain is known as Grade 2. Here a partial tearing of the ligament occurs. If the ankle joint is examined and moved in certain ways, abnormal looseness (laxity) of the ankle joint occurs.
• Moderate tearing of the ligament fibers.
• Some instability of the joint.
• Moderate to severe pain and difficulty walking.
• Swelling and stiffness in the ankle joint.
• Minor bruising may be evident.
Grade 3 sprain: Finally, a severe sprain is known as Grade 3. In this kind of injury, a complete tear of the ligament occurs. If the examiner pulls or pushes on the ankle joint in certain movements, gross instability occurs.
• Total rupture of a ligament.
• Gross instability of the joint.
• Severe pain initially followed later by no pain.
• Severe swelling.
• Usually extensive bruising.
Depending on how severe the sprain is, you may to rely on crutches for a while to assist with walking. By using crutches, you will be able to decrease the amount of weight you place on your sprained ankle. This will rest the ligaments of the ankle and allow them to heal. It will also relieve the pain experienced with walking on the affected leg.
When permitted by your physician, you should start a gentle exercise program to improve the strength and motion of your ankle. Initial exercises should be performed without placing any weight on the ankle. With time, the exercises can be advanced to become more challenging. A standard exercise program after ankle sprain involves the following exercises:
• Range of Motion Exercises: These gentle exercises will help loosen your ankle. Often after an ankle sprain, the joint becomes stiff from lack of motion. It is important to regain the motion that may have been lost during the healing process in order to prevent future injury.
• Isometric Exercises: Isometric exercises allow you to build strength around your ankle joint without moving your joint against resistance. This is done early in the rehabilitation process when you want to become stronger, but still suffer from discomfort with movement of the ankle joint
• Resistance Exercises: Resistance exercises are performed by moving the joint against a force in the opposite direction that you are moving. These exercises work to strengthen the muscles around your ankle to provide additional support to the joint.With time, your ankle will fully recover and you will be able to perform the same activities that you enjoyed.
BALANCE AND PROPRIOCEPTION
Pain caused by sprained ankles, and a variety of other injuries common to highly trained athletes, often have nothing to do with strength. They often have little to do with flexibility. And rarely do they have anything to do with endurance. More often than not, sprains and strains have to do with balance. Proprioception, to be exact
The term proprioception refers to a sense of joint position. Proprioception training is highly common in rehabilitation of injured athletes, but it can just as easily be used to prevent injury. Even a strong ankle can sprain when running on uneven ground if the runner hasn’t trained the neuromuscular system to react appropriately. Slight deviations in terrain require slight adjustments of balance to avoid injury.
Balance and proprioception training is an important part of the injury recovery process and must be given the attention it deserves.
This information is courtesy of HECTORPTSPORTS www.hectorpt.com (518)577-5214 Colonie NY and Clifton Park NY.
Hector Physical Therapy Albany NY 12205- HectorPT Physical Therapy, 1 Wall Street 12065
HectorPT Sports Therapy Albany NY 12205.
Visit our Medical Library for information on ankle sprains http://www.eorthopod.com/eorthopodV2/index.php? ID=c088f90d6f348c958e5eb9f3a5c5a117&disp_type=topic_detail&area=19&topic_ id=47b4aef472e1d9fb476775b4b40ac065
"I always wanted to find a niche."
At the Beltrone Living Center in Colonie, an independent living facility operated by Colonie Senior Services , a new model for physical therapy has been in business for about 4 months . Physical therapist Hector Jasen operates Hector PT, a fu ll-service physical therapy office that offers Betrone residents, and the public , a fully equipped physical therapy facility that features traditional PT services, and a balance system that no one else in the Capital District has to offer.