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