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.
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Treatment for Achilles’ Tendon Injuries
The Achilles’ tendon is the largest tendon in the human body. It is made up of three different muscles and has a different type of sheath than the other tendons – a porous one, allowing blood to flow to the tendon itself. These particularities of the Achilles’ tendon explain in a great measure why its injury is considered one of the most serious ones both by doctors and physical therapists.
How do you know that you have hurt your Achilles’ tendon? In the lighter forms of the injuries, you feel constant pain in the heel and its back. This kind of pain usually signals an inflammation, either of the porous sheath or of the tendon itself. Left untreated properly (i.e. when you only apply topical treatment for pain relief), the inflammation may get worse over time and lead to rupture – the most serious form of Achilles’ tendon injury that leaves patients unable to walk properly, run or climb stairs.
Stage 1 – Diagnose
If you believe that you have suffered an Achilles’ tendon injury, it is very important to seek medical attention immediately and not attempt to put further stress on the injured leg. As explained above, even intermittent pain in the heel may signify an injury of the Achilles’ tendon, so do not self-treat the pain, ignoring its cause.
The most common test performed by doctors to determine a clear diagnosis is called the Thompson test: you will be asked to lie on your stomach, while the examining doctor will squeeze your calf. In healthy individuals, this action will result in a flexion of the foot. If your tendon is injured, your foot will not produce this response.
Stage 2 – Treatment
Depending on the severity of the case, the doctor may recommend either surgery or non-surgical treatment. The most common form of treatment is surgery, which is a routine procedure for medical professionals. It is the first choice for treatment in young, active athletes, and healthy individuals which do not suffer from conditions which pose a high risk in case of surgery.
Achilles’ tendon surgery can be either open or closed. Open surgery involves an incision allowing the surgeon to see the tendon clearly. Closed surgery is performed through several small incisions. However, in both situations a cast or postoperative boot is applied on the injured leg to allow complete healing without risk of renewing the injury.
Stage 3 – Recovery
Once your doctor confirms that your injury has healed and you may begin the recovery phase, you should contact a physical therapist, who will develop a specific routine to regain mobility in your ankle. The purpose of the recovery plan after Achilles’ tendon injury is to strengthen the tendon again, and to recover the mobility and stability in walking and running.
The most common types of physical therapy are:
Stretching – Stretching and flexibility routines are essential for a complete recovery. Your therapist will start with light routines, and progressively increase their complexity until you achieve complete mobility in your ankle.
Deep massage – Professional massage therapy is aimed at stimulating blood flow, helping your muscles and tendons recover, and preventing further injuries.
Throughout the treatment and recovery procedures, it is extremely important to follow your doctor’s and therapist’s recommendations and not attempt any kind of physical effort involving the injured leg. Achilles’ tendon injuries are some of the most serious types of running injuries and, if untreated properly, may leave you unable to run properly and unable to put your full body weight on your leg.
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.