Crisis Plan Series
Ankle sprain
A non-complicated ankle sprain could be a relatively easy injury to treat if the patient is seen early. On the other hand, it may lead to chronic (long-standing) stiffness, pain and recurrent sprain if full rehabilitation is not provided. Our role is to ensure the ankle recovers as fully as possible.
Advice on the R.I.C.E. technique should be given immediately after an ankle sprain. The ankle should be Rest from any painful activities but very gentle mobility exercises such as dorsiflexion (upward movement of the toes and ankle) could be performed within the limit of pain to maintain the range required for walking. Ice could be applied frequently, 5 to 10 minutes even hourly. Compression by a firm bandage or turbigrip helps to support the ankle and reduce swelling. Elevation of the ankle above the heart is often ignored, causing persistent ankle swelling and chronic adhesions. The patient should continue to RICE until full recovery.
Although the anterior talofibular ligament (at the outside and towards the front of the ankle) is the most commonly affected ligament in an ankle sprain, examinations must be detail enough to locate all injured structures. Intra-articular (within the joint) ankle joint damage is not uncommon but is often left untreated, causing residual stiffness and pain. Local deep friction massage is effective in removing superficial scarring but specific localized joint mobilizations such as joint gliding in all necessary directions are required for deep adhesions (scarring). Frequent home stretches and mobility exercises are important to prevent muscle tightness and to maximize movements. Self-mobilization techniques to end of range with over-pressure are not difficult to learn and should be taught to patients to optimize the rate of recovery. Strengthening exercises, especially eversion (outward and upward movement of the ankle), are important to restore strength and stability. Proprioceptive (sense of balance) exercises such as balancing on one leg, walking on heels or toes, wobble (balance) board or other specific training techniques are so often ignored but are so important in restoring joint proprioception (sense of balance) to prevent recurrent sprain. This is particularly important in less common cases when the ligaments are over-stretched causing joint instability. As indicated above, the frequently used electrotherapy may help but is certainly not enough to rehabilitate an ankle sprain fully.
Advice on the R.I.C.E. technique should be given immediately after an ankle sprain. The ankle should be Rest from any painful activities but very gentle mobility exercises such as dorsiflexion (upward movement of the toes and ankle) could be performed within the limit of pain to maintain the range required for walking. Ice could be applied frequently, 5 to 10 minutes even hourly. Compression by a firm bandage or turbigrip helps to support the ankle and reduce swelling. Elevation of the ankle above the heart is often ignored, causing persistent ankle swelling and chronic adhesions. The patient should continue to RICE until full recovery.
Although the anterior talofibular ligament (at the outside and towards the front of the ankle) is the most commonly affected ligament in an ankle sprain, examinations must be detail enough to locate all injured structures. Intra-articular (within the joint) ankle joint damage is not uncommon but is often left untreated, causing residual stiffness and pain. Local deep friction massage is effective in removing superficial scarring but specific localized joint mobilizations such as joint gliding in all necessary directions are required for deep adhesions (scarring). Frequent home stretches and mobility exercises are important to prevent muscle tightness and to maximize movements. Self-mobilization techniques to end of range with over-pressure are not difficult to learn and should be taught to patients to optimize the rate of recovery. Strengthening exercises, especially eversion (outward and upward movement of the ankle), are important to restore strength and stability. Proprioceptive (sense of balance) exercises such as balancing on one leg, walking on heels or toes, wobble (balance) board or other specific training techniques are so often ignored but are so important in restoring joint proprioception (sense of balance) to prevent recurrent sprain. This is particularly important in less common cases when the ligaments are over-stretched causing joint instability. As indicated above, the frequently used electrotherapy may help but is certainly not enough to rehabilitate an ankle sprain fully.
Luck LI
Musculoskeletal Physiotherapist
Musculoskeletal Physiotherapist