Here is our latest podcast on the lessons learned from Dr. Eamonn Delahunt’s seminar on lateral ankle sprains and chronic ankle instability.
Ankle Sprain Injury
At Sports Physio Ireland we see a lot of people with ankle injuries. The most common clients with these injuries are just after a classic ankle sprain injury. They go over on the outside of their ankle, hear a ‘pop’ and feel pain when they try to walk. The ankle then becomes swollen over the next few hours, limiting the range of motion in the joint.
Your ankle joint has 3 ligaments that help stabilise the joint and protect you from ‘going over on it.’ An awkward fall or forced inversion injury can rupture these ligaments. Often causing bruising to the surrounding bone surface. Swelling occurs as the body realises it is injured and begins the healing process. This is why your joint swells, it is promoting blood flow to the area to initiate healing. People are often obsessed with getting rid of ankle swelling or stopping it all together, but it is necessary for the first 36 hours.
Swelling increases the temperature and pressure in the joint resulting in quite a sensitive, hot, red coloured joint. The best course of management for an ankle sprain is take the weight off it, use crutches or a physio boot. Swelling can be controlled in the first 36 hours by keeping the foot elevated as often as possible, submerging it in a bucket of ice for one minute at least 10 times throughout day one & two after the injury has occurred. A stretchy bandage also helps in this 36 hour window to keep the swelling under control.
At this point you must try regain full joint movement, through balance and strengthening exercises after the initial 36 hours. Once you have sufficient ankle balance and strength you can progress to hopping, straight line running, followed by cutting and change of direction drills, before you return to training.
Head Physiotherapist and Dublin Senior Hurler
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5 Steps to Recovery from Severe Ankle Sprain
It happens in a moment: you are running, then you side step and you fall to the ground with a cry and a poignant pain in your ankle. As you try to stand up, the pain shooting up through your leg from the ankle is unbearable and you notice the first signs of swelling. Within half an hour, your ankle is fully swollen, purplish in colour.
The diagnose? You suffered an ankle sprain, possibly a severe one. From the first moment when you are aware of the injury, it is important to take the right steps in order to encourage a fast recovery, and get back on the running track as soon as possible.
Today we will present you the first five steps you must take to recover from the sprain, protect your ankle, and make sure that when you start your first rehab exercises, it is safe to do so and there is no risk of a fresh injury. These 5 steps are known as the PRICE routine and they should become a second nature to you in case of any type of leg injury during running.
Step 1: Protect
Immediately after the injury, the tissue of your ankle is painful and tender. The tendons are overtaxed and are unable to support your joint in its normal position. Under no circumstances should you put your foot down and exert any kind of pressure or effort upon in.
During the first moments after the injury it is second nature to try to downplay its gravity and take a few steps to get your ankle back in shape. Resist this impulse, continue to sit down, and call an ambulance or a friend to take you to hospital. During the first days after the ankle sprain, you will be recommended to wear a removable plastic cast, or a plaster cast (which you will be wearing all the time until the doctor removes it).
Remember, protection is the key to correct alignment of your ankle joint and complete recovery.
Step 2: Rest
During the entire recovery procedure you must allow your ankle to heal. Absolutely no physical efforts are allowed, not even walking. You must use crutches, even if you have a solid plaster cast on your leg. No pressure should be put on the recovering tissues. You will also experience continuous pain, in most cases at tolerable levels. If you feel that the pain threshold exceeds your limits, you should consult with your doctor about prescribing painkillers.
Step 3: Ice
Ice packs should be applied for 20 minutes, with a break of 1-2 hours between applications. The ice pack should never be applied directly onto the skin. Wear thick socks and, preferably, also wrap the ice pack in a towel. The ice pack applications help a lot with pain relief for severe ankle sprains and also reduce the swelling and bleeding.
Step 4: Compression
Compression is very important to realign the twisted tendons and reset your injured ankle in the normal position. A plastic removable cast is very helpful in the early stages after the injury (up to
3 days). After this moment, according to your doctor’s recommendations, you can replace the plastic cast with an elastic ankle brace.
Step 5: Elevation
Throughout the initial healing period of your ankle sprain (up to 5 days) you should keep your ankle elevated compared to the rest of your body. This facilitates the blood flow, prevents the formation of blood clots, and also prevents the accumulation of liquid in the injured tissues. By elevating your injured foot on a pillow, you help reduce the swelling and the pain and speed up your recovery.
In the end, remember that whenever you feel that something is not right in the healing process of your sprained ankle, you should immediately contact your doctor.
Physiotherapy for Ankle Injuries
Ankle injuries are one of the leading causes of absence from sport. Many top GAA, soccer and even pro golfer Rory McIlroy have suffered from ankle injuires througout careers. The ATFL ligament, on the outside of your ankle is one of a number of main stabilisers for the joint. Ankle injuries can be divided into three types depending on severity: grade one, two or three.
The ankle plays a crucial part in generating power during jumping, running, cutting and even a golf swing. In the case of a grade three tear, surgery may be considered. However a strong physiotherapy rehab programme has been shown to have equally good, if not better outcomes for grade three ankle injuries.
Initially, I would help the player to reduce pain around the ankle joint, swelling and restore movement. The PRICE principal can be helpful here: Protect, Rest, Ice, Compress and Elevate.
The key to returning to play and preventing further ankle injuries is a dynamic and progressive rehab programme. This mainly involves strengthening the ankle, balance training and sports specific exercise.
The key aspects of my rehab programme are regaining full range of motion, improvement of balance and agility. This depends on the players sport of choice. Basic ways to achieve these are lunges, single leg work and plyometrics.
Ankle movement can be restored with mobilisations and by reducing swelling in the first week post injury. Balance reeducation can be initiated with jumping and landing exercises aswell as basic hopping. Agility is the final stage of physiotherapy. Here the physiotherapist must try replicate and train all movements the athlete is expected to perform when competing in their individual sport so return to top level performance is as easy as possible.
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Chronic Ankle Instability
Chronic ankle instability is an encompassing term used to classify an individual who presents with both mechanical and functional instability of the ankle joint following an initial lateral ankle sprain injury.
Mechanical Instability refers to measurable laxity of the ligaments, i.e. ligaments that are less stiff following injury, with some joint restrictions and synovial changes. Functional Instability is the lingering feeling of giving way or unsteady feeling which is generally attributed to neuromuscular and proprioceptive deficits.
Research has identified a number of potential reasons for long term issues with ankle instability after a sprain. One theory is that the ankle proprioception, where the joint is in space, is impaired creating an impaired reflex arc of the muscles that help stabilise the ankle joint. Swelling of the joint can cause the feedback system of the ankle joint to also alter and cause long term neuromuscular deficits.
So clinically, what can we do to help and reduce this occurring?
- Reduce pain and swelling of the joint
- Loading in functional tasks as soon as possible e.g. walking, running, cutting
- Establish baseline strength and power
- Improve proprioception of the ankle joint
- Practice tasks that are important to your need
- Landing/jumping mechanics