| Additional patient education materials
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Orthopaedic Consultants of Cincinnati, Inc.
Suite 110
| 4701 Creek Road | Cincinnati,
Ohio 45242 | USA
Standardized by:
Denver
T. Stanfield, MD
ANKLE SPRAINS
Rapid Return to Activity
From the Weekend warrior" to the accomplished athlete, thousands of patients
sustain ankle injuries each year. Most are ankle sprains, where quick diagnosis and
treatment can significantly speed recovery and return to activity.
An ankle sprain is an injury to the supporting ligaments which stabilize the joint.
Most ankle sprains result from forced and excessive inversion, an inward rolling
of the ankle. These sprains usually occur when a basketball player lands on another
player's foot or when a runner steps in a rut or hole. It is generally felt that
the high incidence of current sprains is primarily due to the failure of the athlete
to participate in and successfully complete an adequate and appropriate treatment
program.
Immediate Treatment
If you have the agility and mobility to run with a normal gait, you can continue
to compete. If not, you should stop and begin treatment immediately. The early treatment
goals are minimizing soft tissue swelling and regaining range of motion.
To control swelling most effectively, a compression dressing should be applied to
the ankle. Elevate the ankle to a position higher than the heart. Apply ice externally
to the ankle to help control internal bleeding and fluid accumulation, and to alleviate
pain associated with the injury. Apply ice every two hours while awake for the next
48 hours.
Crutches are required unless you can walk on the injured ankle with a pain-free heel-to-toe-gait.
When using crutches, place as much weight on the injured ankle as pain allows and
walk with a heel-to-toe-gait; this contributes to the goal of regaining range of
motion.
Elevate your foot whenever possible. Perform active range-of-motion exercises by
keeping your heel still and tracing the alphabet in capital Meters with your big
toe (air alphabet).
After 48 hours
The goals are to eliminate all swelling and pain, regain full range of motion, and
to restrengthen the muscles that stabilize the ankle. After the initial 48 hours
of applying ice as described above, begin contrast baths three times daily. (Remove
the compressive dressing prior to the baths.) Use two containers large enough to
immerse your ankle comfortably. Fill one with hot (1040 F) water, the other with
crushed ice and cold water. Start in the hot water and perform the active range-of-motion
exercises ( the air alphabet). In the cold water, perform isometric eversion exercises:
while keeping the heel of the injured foot on the bottom of the container, lift and
rotate the foot up
and out until it makes contact with the side of the container. Hold it there for
eight seconds and then relax for two seconds. Repeat six times each time the foot
is in the cold water. Start the hot water exercises and perform them in descending
periods of 5,4,3,2, and 1 minute. Alternate each of them with one minute intervals
of cold bath exercises.
Continue to use the compression wrap or brace until the ankle has no swelling and
is pain free. Continue the air alphabet until the size of the lepers you can trace
are as large as those you can make with your non-injured foot.
The use of nonsteroidal medications such as Advil or Aleve, are recommended during
this period to help reduce the swelling, reduce the inflammation, decrease the discomfort
and thereby speed the overall recovery time.
Conditioning your ankle
In addition to properly identifying the injury and early treatment, an organized
and aggressive rehabilitation program is essential. I, along with most sports clinicians,
advocate functional management of ankle sprains as the most efficient way back to
full activity, rather than cast immobilization or surgery as was taught in the past.
The rehab program should overlap with the initial treatment. The entire program from
injury to complete recovery can be divided into three phases.
Phase 1 which begins in the initial 48 hours, is designed to control your pain
and inflammation, encourage early weight-bearing, and provide protected mobilization
of the ankle. Flexibility exercises should begin as soon as tolerated. Athletes should
perform active pain-free range of motion, stopping at the point of pain. Heel-cord
flexibility can be increased with gentle, passive dorsiflexion through towel stretches.
Improving flexibility allows a more normal gait during early rehab. Some form of
external splinting or bracing should be used during early weight bearing. Crutches
should be used initially until a normal gait pattern is possible.
Phase 2 is aimed at restrengthening appropriate muscles and reeducating the ankle's
proprioception mechanism. The use of ice and flexbility exercises should continue
during this period. The stabilizer muscles of the ankle are strengthened with bilateral
and unilateral calf raises and inversion / eversion exercises with flexible tubing
or bands. Proprioception retraining comes through multiple techniques, including
the use of a wobble board, or Biomechanical Ankle Platform System (BAPS) board. Dribbling
a basketball with weight supported on the injured leg is helpful as is merely standing
and balancing on the ball of the injured foot for 20 to 30 seconds. You may also
begin cycling, swimming and short jogs as the condition improves. By the end of this
phase, patients should have nearly full range of motion, minimal edema, and full
weight bearing without pain. The time range for this phase can be varied according
to the severity of injury, the athlete's goal and the time of presentation after
injury.
Phase 3 is designed to return athletes to their former activity level. They should
also continue strengthening, flexibility, and proprioceptive exercises at a lower
level throughout their active lives, to help prevent reinjury. A wide variety of
external support devices are available to help prevent reinjury.