Article by Timothy Maiden
Senior Podiatrist at The Foot Practice (Singapore)
Untreated ankle sprains can lead to chronic problems such as pain, joint instability, and diminished range of motion. Yet many patients with acute ankle injuries never seek medical attention .
Not to scare you, but poor recovery from ankle injury and long-term ankle instability is associated with the development of painful degenerative joint disease. This risk can be reduced or eliminated with proper ankle care and rehabilitation. Ankle sprains are among the most common injuries to the musculoskeletal system, accounting for approximately 2 million injuries per year .
It’s no surprise that the most important risk factor for ankle sprains is a history of previous ankle sprains! Therefore, it’s absolutely imperative to follow an up-to-date rehabilitation program. An ounce of prevention is worth a pound of cure, and prevention of ankle sprains is especially crucial during the seven-week period after acute injury. In this guide, we’ll discuss ankle injury severity, the four-step rehabilitation process and the application of an orthosis (brace for an ankle injury).
Ankle Injury Severity
Depending on injury severity, ankle sprains are graded from I to III. It’s helpful to familiarize yourself with the grades, since injury severity informs treatment.
Grade I ankle sprains exhibit minimal loss of functional ability, pain or swelling, and an intact ankle ligament. A grade II ankle sprain entails a partial ligament tear and moderate pain, swelling, and loss of function. Finally, grade III is characterized by a complete ligament tear, with severe loss of function, pain, and swelling, as well as marked difficulty bearing weight.
The Perfect Ankle Sprain Rehabilitation Regimen
What’s the goal of ankle rehabilitation? Isn’t it enough to relax on the couch and let the healing process occur by itself? Rest and relaxation are certainly an important part of rehabilitation, but there are a number of other steps you can take to hasten recovery and prevent future injuries.
The goal of ankle sprain rehab is to I) decrease inflammation, II) regain your full range of motion, III) increase muscle strength, power, and endurance, and IV) improve proprioception. Proprioception is just a fancy word for how you perceive different parts of your body. Amputees, for example, would have disturbed proprioception as a consequence of their injury.
Start Rehabilitation Early!
Early rehabilitation hastens recovery after ankle sprains . Recent evidence suggests that early movement by range-of-motion exercises and isometric/isotonic strength exercises improves healing. Or in medical jargon: a study that found early mobilization leads to a beneficial orientation of collagen fibers compared to an immobilized ligament .
Remember grade III ankle sprains? This was the most severe kind of ankle injury. Well, for grade III ankle sprains, 7-14 days of immobilization (using a brase or orthosis) assisted by crutches may be needed if you’re in constant pain. Oral NSAIDS are useful for pain relief and reduce inflammation. Remember, decreasing inflammation was goal #1 of ankle sprain rehabilitation.
There are four phases of ankle rehabilitation:
- Manage pain and swelling
- Restore range of motion
- Begin muscle strengthening
- Regain full strength, functional rehabilitation, and return to normal activity
Ankle Bracing and Orthotic Therapy
Orthotics is a medical specialty that designs and applies orthoses – devices used to modify the structure or function of the musculoskeletal system. An example of an orthosis is an ankle brace. Ankle braces come in three flavors: I) lace-up, II) stirrup, or III) an elastic configuration.
What are ankle braces for? They provide mechanical stability to the injured area and facilitate the healing process. Orthosis has a number of advantages: cost-effectiveness, ease of use, and you can do it yourself at home (you don’t need assistance from a medical professional to apply it!)
Orthotic therapy has been shown to enhance joint position sense, provide added stabilization, support, and sensorimotor feedback during exercise, improve balance after injury, reduce postural sway, fatigue and pain perception and protect against future injuries without significantly affecting athletic performance.
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