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Early Ankle Sprain Treatment can help to speed recovery and minimize the symptoms. Here are a few simple treatment steps to follow for sprained ankle. For better understanding of Ankle Sprain Treatment, lets first understand-
An Ankle sprain is actually an injury to the ligaments of the ankle joint, which are elastic, band-like structures that hold the bones of the ankle joint together and prevent excess turning and twisting of the joint. In normal movement, the ligaments can stretch slightly and then retract back to their normal shape and size. A sprain results when the ligaments of the ankle have been stretched beyond their limits. In severe sprains, the ligaments may be partially or completely torn.
The ankle joint is fairly unstable and largely depends on the ligaments for its stability. The ankle sprain is of two types-
The most common type is the inversion ankle sprain (85%), in which the ankle rolls over on the outside. In the sprained ankle the most common damage is done to the talo-fibula ligament (if the ankle sprain is worse, the calcaneo-fibula ligament can also be damaged) - sometimes the tendons also get damaged.
The ligament is injured when the plantar flexed foot is suddenly forced into inversion, which may cause rupture, sprain of lateral ligament.
The injury is common in sports activity. It is quite common when a person slips off or walk on uneven surfaces. The foot is forced into inversion and plantar flexion which results in external rotation of tibia. The site of injury is generally the centre and distal attachments of anterior and middle band of the ligament.
When sudden inversion force occurs with the ankle in mid position of dorsi and plantar flexion, the injury involves the calcaneo-fibular ligament(CFL). Whereas when the excessive inversion-adduction movement is associated with forced plantar flexion, the injury commonly involves anterior talo-fibular ligament(ATFL). This can be identified by the site of pain and tenderness. Pain and tenderness over talus indicates injury to talo-fibular ligament while the same over calcaneus indicates the involvement of calcaneo-fibular ligament. This identification is necessary for prompt treatment.
First degree ankle sprain- Some stretching or mild tearing of the ligament.- Little or no functional loss - the joint can still function and bear some weight (...but hurts!!!).- Mild pain-Some swelling- Some joint stiffness- Return to activity/functional phase in 1-2 weeks with proper ankle sprain treatment.
Second degree ankle sprain:- Some more severe tearing of the ligaments-Moderate instability of the joint- Moderate to severe pain - weight-bearing is very painful- Swelling and stiffness- Return to activity/functional phase in 2-3 weeks with proper treatment.
Third degree ankle sprain:- Total rupture of a ligament - there is a loss of motion-Gross instability of the joint - joint function is lost-Severe pain initially followed by no pain- Severe swelling- Usually extensive bruising- Return to activity/functional phase in 3-6 weeks with proper ankle sprain treatment.
Physical examination reveals mild swelling in grade 1 sprains and moderate to severe swelling in a diffuse pattern in grade 2 and 3 sprains. Tenderness is usually elicited at the anterior edge of the fibula with ATFL injuries and at the tip of the fibula with CFL injuries. The region of the syndesmosis and the base of the fifth metatarsal should also be palpated to rule out injuries to these structures.Once proper physical examination and diagnosis is done Ankle sprain Treatment can be started.
The Anterior drawer test and the Talar tilt test are commonly used to identify signs of joint instability. The Anterior drawer test is performed by stabilizing the distal tibia anteriorly with one hand and pulling the slightly plantar flexed foot forward with the other hand from behind the heel. A positive finding of more than 5 mm of anterior translation indicates a tear of the ATFL. The Talar tilt test is performed by stabilizing the distal tibia with one hand and inverting the talus and calcaneus as a unit with the other hand. A positive finding of more than 5 mm with a soft endpoint indicates a combined injury to the ATFL and CFL. It is important to always compare the affected ankle with the contra lateral side because some patients are naturally very flexible (generalized ligament laxity), and this could result in false positive test.
Differentiating between a sprained ankle and an ankle fracture can be difficult, and sometimes an x-ray is needed.
A good thorough examination of ankle joint is necessary for Ankle Sprain Treatment, which include-
Goals-Acute Stage-Ankle Sprain Treatment
Decrease pain and swelling, protect from re injury and maintain appropriate weight bearing status.
Goals-Sub-Acute Stage-Ankle Sprain Treatment
Decrease pain and swelling, increase pain free range of motion, begin strengthening, begin non-weight bearing proprioceptive training and provide protective support as needed.
1) Modalities to decrease pain and swelling
2) Weight bearing
Progress weight bearing as symptoms permit. Partial weight bearing to full weight bearing if no signs of antalgic gait is present.
3) Physiotherapy exercises for ankle sprain
Goals- Rehabilitative Stage- Ankle Sprain Treatment
Increase pain-free ROM. Progress strengthening. Progress proprioceptive training. Increase pain-free activities of daily living. Pain-free full weight bearing and uncompensated gait.
1) Therapeutic exercises for ankle sprain
2) Continue modalities as needed, specifically after exercise to prevent re occurrence of pain and swelling.
3) Taping, Bracing and orthotics used as needed. To avoid re injury.
Goals- Return to Activity stage- Ankle Sprain Treatment
Regain full strength. Normal biomechanics. Return to participation. Protection and strengthening of any mild residual joint instability.
1) Therapeutic exercises
Continue progression of ROM and strengthening exercises. Sports specific strengthening and training.
2) Running progression
Return from Ankle Sprain Treatment to sports physical therapy
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