Eccentric ankle evertor muscle strengthening is better than concentric strengthening after a lateral ankle sprain
May 29, 2010
How to prevent ankle sprains from happening … again
April 30, 2010
Have you ever wondered that maybe there is a way to change this?
Did you know that 85-90% of untreated ankle sprains will be recurrent, but with correct management after the first occurrence those number of cases can be brought down to only 35%?
What happens in an ankle sprain? Which structures are involved?
As a result of continued rolling, turning or instability of the ankle, the ability to make rapid adjustments in the position of the foot on uneven surfaces (proprioception) becomes limited. If this happens, the likelihood of a more severe ankle sprain occurring increases.
A sprain is actually a tear that occurs in the outer supportive ligaments of the ankle. As these ligaments are stretched, a critical point is reached beyond which ligaments do not return to their normal elastic function and a tear of the ligament occurs. Sprains can range from the relatively minor to completely torn ligaments where the ankle can be quite loose.
The common diagnosis for pain on the outer side of the ankle is an inversion sprain. This usually occurs when the foot lands in an awkward manner and rolls inwards, creating stress on the outside ligaments. When this stress is severe enough, an ankle sprain occurs.
There are three major ligaments attached to the outside of the ankle: the anterior and the posterior talofibular ligaments (ATFL and PTFL), and the calcaneofibular ligament (CFL). The ATFL is the most common ligament to sprain due to the mechanics and the limited support at the front of the ankle.
The other type of ankle sprain is an eversion sprain for pain on the inner side of the ankle. This happens when the foot is twisted outwards. The inner ligament, called the deltoid ligament, is over-stretched.
What can I do after spraining my ankle?
If you are unable to put weight or walk on it, you may have a small fracture. It is advisable for you to get it X-rayed. However, if you feel like you simply rolled over the ankle and putting weight on it hurts a little, apply RICE (Rest, Ice, Compression and Elevation) immediately. Head home and avoid walking on it as much as possible. Fill a wet thin towel with crushed ice or with a bag of frozen peas, and apply to the painful area for 10-15 minutes. Do not apply ice directly to your skin for more than five (5) minutes as it can cause cold-burns. Keep this up every 2-3 hours for the first 48 hours. This will help to minimize pain and control swelling in the area, limiting the extent of damage to the ankle.
For the ligaments to heal the ankle needs to be immobilized with either a cast or a boot. For minor sprains a brace can be applied to the ankle. Make sure it is tight enough to stop the swelling from going down into your ankle but not enough to make your toes turn blue. However, remember to take it off at night but put it back on even before you leave your bed. Keep your foot elevated at night by placing pillows underneath the affected foot to give you just enough elevation to sleep pain-free. Foot pumping exercises (continuously bending and pointing your foot out) are also especially useful when the foot is elevated to help push the fluid away from you and back to your heart. Strictly adhere to the RICE regiment for another 2-3 days or until the swelling is about 75% gone.
How do I prevent a recurrence?
If this is not the first time you have sprained the ankle, the bad news is that once a ligament has been overstretched and not taken care of, it loosens and will never go back to its original length. Not only do ligaments hold bones together, but they also part of your balance-control system by sending messages to your muscles (via the brain), telling them how to react to maintain your balance and prevent excessive movement
The basic philosophy of any rehabilitation programme is to retrained your ligaments to sense and send the required balance signals and strengthen the muscles. This restores and improves the balance around your ankle to help prevent recurring sprains and protect it from the stresses of everyday life.
A physiotherapy rehabilitation treatment programme may include:
1. Therapeutic ultrasound would be administered to promote healing and decrease in pain.
2. Soft tissue massage to aid lymphatic drainage and remove any residual swelling.
3. Individualised exercise programme which may include:
a. Calf stretch alphabet exercises – moving the ankle in multiple directions by drawing alphabets in lowercase and uppercase motions.
b. Isometric strengthening exercises, such as pushing against an immovable object (e.g. wall or floor) or with the unaffected foot, can begin.
c. Balancing exercises such as standing on your affected leg and try to hold your balance. You will probably notice at first that your injured foot is much more wobbly, which will get better with practice.
Finally, your physiotherapist would also work closely with you to plan a proper activity based training programme to get you back to sport or normal daily activities. You can follow this whole recipe for old recurrent sprains.
Stretches For New Runners
March 20, 2010
It is important to include some stretching exercises before your running routine. If done correctly, stretches can help to improve your flexibility and joint range of motion, and can decrease your risk of injury to joints, muscles, and tendons while running. In this article, we will show you top 5 stretches to do before a run.
Disclaimer: Note that stretching is not warming-up. It is a common misconception that warming-up equates to stretching. ‘Warming-up’ literally means raising your core body temperature. It is advised that before you begin on your stretches and run, a general warm-up such as brisk walking between five to ten minutes be performed to prevent injury to your ‘cold’ muscles. (see To stretch or not to stretch before an event?
Top 5 stretches:
Hamstrings Stretch
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Calf Stretch
Quadriceps Stretch
Iliotibial Band (ITB) Stretch
Glueteus (Buttock) Stretch
When is Achilles Tendonitis not Achilles Tendonitis? When it is Retrocalcaneal Bursitis
February 13, 2010
Do you experience pain at the back of your heel? Is the back of your heel red and swollen? And you were told that it might Achilles Tendonitis? But so far treatment for Achilles Tendonitis does not seem to be working? You might be suffering instead from Retrocalcaneal Bursitis.
Background
www.merck.com
This condition is often mistaken for Achilles tendinitis but it can also occur in conjunction with Achilles tendinitis.
Signs and Symptoms
In retrocalcaneal bursitis, pain at the back of the heel is the main complaint from patients. Pain may worsen when tip-toeing, running uphill, jumping or hopping. Often, those who are accustomed to wearing high-heeled shoes on a long-term basis may also complain of pain at the back of the heel when switching to flat shoes. This is because when in high-heeled shoes, the calf muscle and the Achilles tendon are in a shortened position. Switching to flat shoes would cause an increased stretch to the calf muscle and Achilles tendon, irritating the Achilles tendon and the retrocalcaneal bursa. Other symptoms may include redness and swelling at the back of the heel.
What leads to Retrocalcaneal bursitis?
There are several factors which can lead to a person developing retrocalcaneal bursitis. In athletes, especially runners, overtraining, sudden excessive increase in running mileage may lead to retrocalcaneal bursitis. Tight or ill-fitting shoes can be another causative factor as they can produce excessive pressure at the back of the heel due to restrictive heel counter. A person with an excessively prominent posterosuperior aspect of the heel bone (Haglund deformity) may also have a higher predisposition to retrocalcaneal bursitis. In such individuals, pain would be reproduced when the ankle goes into dorsiflexion.
How do we tell that it is not Achilles Tendonitis?
Careful examination by your physician or physiotherapist can determine if the inflammation is from the Achilles tendon or from the retrocalcaneal bursa. Tenderness due to insertional Achilles tendinitis is normally located slightly more distal where the tendon inserts into the back of the heel, whereas tenderness caused by the retrocalcaneal bursa is normally palpable at the sides of the distal Achilles tendon.
Diagnosis can be confirmed with an ultrasound investigation, MRI or CT scan.
Management
- During the initial acute phase of the condition, patients should apply ice to the back of the heel for 15 to 20 minutes and follow the R.I.C.E.R regime. Avoid activities that cause pain.
- Gradual progressive stretching of the calf muscle and Achilles tendon is also advocated.
- Changing the footwear. Wearing an open-backed shoe may help relieve pressure on the affected region. For those whose symptoms were caused by a sudden change from wearing high-heeled shoes to flat shoes, the temporary use of footwear with a heel height in between may be helpful.
- Inserting a heel cup in the shoe may help to raise the inflamed region slightly above the shoe’s restricting heel counter and relieve the pain. It is advisable to also insert the heel cup into the other shoe to avoid any leg-leg discrepancies that can lead to other problems.
- Training frequency and intensity should be gradually progressed with adequate rest between trainings.
Train Proprioception to Prevent Sprains
December 17, 2009
Hi, I hear from my personal trainer that i need to train my proprioception because of my ankle sprains. What is proprioception and how is it relevant to my ankle problem? – John Koh
What is Proprioception? Read more
Exercises for Ankle Sprain
September 22, 2009
Following our article on the most common ankle sprain, this article focuses on the rehabilitation exercise that will help with an ankle sprain.
Rehabilitation
Proper rehabilitative exercise is crucial in ensuring that new tissues are laid down and aligned properly during the healing phase. Rehabilitation exercise should comprise of four components: (i) range of motion exercises, (ii) progressive muscle-strengthening exercises, (iii) proprioceptive/ balance training, and (iv) activity-specific training.
Below are some recommended exercises that you can do at home. It is necessary to progressively increase the intensity of these exercises. Discuss with your sports physiotherapist so that they can progress you safely. Read more
Inversion Ankle Sprain
August 23, 2009
The ankle is one of the most common sites for acute musculoskeletal injuries accounting for 75 percent of ankle injuries. Among athletes, ankle sprains are the most common injury yet they are so often mistreated or not treated at all. A consequence of this neglect is a lasting weakness, an unstable joint and repeated sprains. This article will look at the most common ankle injury and its acute management.
Inversion Sprain
Inversion ankle sprains occur when the foot turns in or out to an abnormal degree relative to the ankle. The most common mechanism of an ankle sprain is a combination of plantarflexion and inversion where the foot is pointing downward and inward. The following video is an example of that.
Lateral Ligaments
The lateral ligaments are involved in an inversion ankle sprain and hence most commonly damaged. These ligaments are on the outside of the ankle, which includes the anterior talofibular (ATFL), calcaneofibular (CFL) and posterior talofibular ligaments (PTFL). Injury to the ATFL is the most common. When both the ATFL and CFL are injured together, ankle instability will be more noticeable. The PTFL is the strongest of the three ligaments and is rarely injured in an inversion sprain.
source: Flickr – Northcoast Footcare and Core Concepts
Sprain = Overstretched ligaments
Ligaments are like tough rubber bands that help to provide stability to the any joint by limiting movement. When one or more ligaments is stretched beyond the normal range, a sprain results.
Ankle sprains range in severity from Grade I to Grade III and is useful for more than classifying the severity of the injury; it also directs treatment and prognosis.
| Grade | Signs & Symptoms |
| Grade 1 | Ankle sprains are painful, but they have no increased laxity when compared with the uninjured side. This correlates with mild stretching of the ATFL. |
| Grade II | Ankle sprains are painful and have an increased laxity on testing. This correlates with a complete tear of the ATFL and a partial tear of the CFL. |
| Grade III | Ankle sprains are usually painful and have an unstable ankle joint on examination. This correlates with complete ruptures of both the ATFL and CFL. |
Causes
Common causes of ankle sprains include stepping up or down on an uneven surface, particularly when wearing high heels; stepping wrong off a curb or into a hole. In athletics, common causes include landing wrongly after a jump shot and having to make quick directional changes as in tennis, soccer, and netball.
In essence, when the ligaments and muscles are not able to support the joint at a certain position, the ankle gives way. This is why training the muscles is very important when ligaments are “loose” or overstretched.
Management
Treatment and rehabilitation starts the moment you have sprained your ankle. It is recommended that you start the R.I.C.E.R regime as soon as possible after the injury. An anti-inflammatory drug may be recommended and crutches provided for a few days if the ankle is too painful to bear weight.
Immobilisation using a brace or a cast can provide the injured ligaments with the rest they need to heal and reduces the risk of aggravating the injury. However, immobilisation should not be prolonged and must be followed within a week by exercises that prevent joint stiffness and muscle wasting.
Orthotics for Achy Feet
August 16, 2009
"Dear Sir, I am a lecturer and an avid, regular sports player. My feet aches every week and I go for regular foot massages. I did an analysis on my feet during one of the orthotic analysis booths at some shopping centre which reported I have high arch and pronation. I wonder what can be done to correct that and reduce my achiness? " - Mr Ho
How to tell the difference between an ankle sprain and a fracture
July 27, 2009
This is a brief video on how to tell the difference between an ankle sprain and an ankle fracture. If you are thinking of taking an X-ray to confirm if it is a fracture, the Ottawa Ankle Rules has a guideline to check if you need an x-ray.
Simple Exercises For Plantar Fasciitis Sufferers
June 26, 2009
In an earlier post, we discussed on what plantar fasciitis is about, including the causes, symptoms and treatment options available. If you think you might be sufferring from plantar fasciitis, read on and find out more about the exercises that you can do to help ease the pain in your foot!
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Lenia Teo, B.HSc(physio)
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