This week I am going to focus on the ankle and foot joint again. If you have been struggling with pain for some time now keep an open mind and do not think you are somebody who cannot be fixed. With the right guidance, treatment and persistence you can make long lasting improvements. Ankle sprains are generally acute (sudden) injuries, so depending on how bad you have sprained it, will depend on the level of pain and how much weight you can place on it. Unfortunately, this type of injury can lead to chronic (long term) instability if not rehabilitated correctly. An ankle sprain is a stretch or a tear of the ligaments (bands of tissue that hold bones together) supporting the ankle joint. Most ankle sprains result from the ankle turning inwards during an activity. This can be caused by a fall, a sudden twist, or landing on the side of the foot. The severity of the ankle sprain can vary and are graded accordingly.
Grade I • An over stretch of the ligament • Minimal swelling and bruising around the ankle • Pain with ankle movement • Able to put weight on the foot, but may limp • With appropriate exercises and treatment, it can take about 2 weeks before returning to activities Grade II • A partial tear of the ligament • Moderate swelling around the ankle. Some bruising may appear within a couple of days • Pain and difficulty moving the ankle • Difficult to put weight on the foot; may need crutches for a few days • With appropriate exercises and treatment, it can take 3–6 weeks before returning to activities Grade III • A complete tear of the ligament • Significant swelling and bruising around the ankle • Pain and unable to move the ankle • Difficult to put weight on the foot; will need crutches for a few weeks • With appropriate exercises and treatment, it can take 2–3 months before returning to activities
The very first thing that you need to do is follow the RICE principle, this stands for Rest, Ice, Compress, and Elevate. So rest up ASAP, get ice on it, after icing it get a compression bandage on it (most good pharmacies will have these), raise it up, keep the weight off it. There are a few intrinsic risk factors that increased chances of ankle sprains. Four risk factors are important: poor strength, poor proprioception, poor range of motion and poor balance. Proprioception is the medical term that describes the ability to sense the orientation of your body in your environment. The way that we can tell that an arm is raised above our head, even when our eyes are closed, is an example of proprioception. This is important when it comes to the stability of the ankle when performing in sports and even walking and running. All four factors above must be incorporated into rehabilitating the joint to return to sports or even just walking pain free. These exercises below are what you should start doing as soon as you are able. They should also be performed pain free so don’t rush into them. First and foremost, you need to get full range of motion back, especially dorsiflexion (the ability to flex/bend the foot/ankle). The exercise below is a great way to compare how much your range of motion improves over time so as you can see in the photo below, it is a good idea to measure it.
Dorsiflexion - Re-gain range of motion 1. Using a hard back book bend your toes up, keeping the rest of your foot and heel on the ground. 2. You should then try and get your knee to the wall, if this is too easy bring your foot further back, compare to other ankle, they should be the same over time. Repeat this 10 times and do 3 sets.
Dorsiflexion with Pronation
If you have gone over your ankle laterally you need to teach the foot how to pronate again (the opposite)
1. Place a wedge under your heel (lateral/ outer side).
2. Repeat the instructions as above for first exercise.
3. Do 3 sets of 10.
Balance/ Proprioception and Strength exercise
Please only perform this if pain free
1. Get a thick cushion or a cushion from a couch, try and stand on the cushion with affected leg only (you should not be able to feel you feet touch the floor underneath it).
2. Hold for as long as possible and repeat 3 times
3. As this gets easier, do this with eyes closed and also do it throwing a ball off the wall in front of you and catch it
If you know anyone struggling with an ankle sprain, feel free to forward them on this link or give us a call on 0896150347