Sports rehabilitation and ankle sprains are common to sports where there is severe turning in or out of the ankle causing ligaments to stretch beyond their normal length.
Ligaments surrounding the ankle hold the joint in place and provide stability. They function to protect the ankle joint from abnormal movements especially twisting, turning and rolling of the foot.
Ankle sprains are commonly seen in football, basketball, tennis, baseball and runners. This injury falls into 3 categories (1) Grade 1 where there is slight stretching and some tearing of the ligament fibers (2) Grade 2 where there is partial tearing of the ligament and there is laxity of the ankle joint and (3) Grade 3 where there is a complete tear of a ligament and gross instability of the ankle joint.
In this article I will discuss ankle sprain symptoms, diagnosis, sports rehabilitation and prevention.
With the onset of the injury the athlete experiences pain immediately at the site of the tear. The ankle starts to swell and bruise shortly thereafter and is extremely tender to the touch. Range of motion of the ankle becomes restricted in all planes. In grade 3 sprains the athlete may hear or feel something tear coinciding with a pop or snap. It is extremely difficult to bear weight on the ankle and there is a definite gait deviation or limp. When an athlete is in a sports rehabilitation program he receives an education on these symptoms.
An athlete should not delay on seeing an orthopedist or podiatrist after the suspected injury. The physical exam may be uncomfortable for the athlete because the physician needs to move the ankle through ranges of motion to see which ligament is damaged. The doctor may decide to perform an x-ray to rule out any fractures in the ankle or foot. If there is a suspected grade 3 sprain the doctor will usually order an MRI to determine the exact extent of tear and maybe pick up small bone chips.
From the physicians exam he will determine a course of sports rehabilitation. The doctor may say to the athlete (1) weight bear as tolerated without splinting or casting (2) immobilization with an air cast and physical therapy and (3) possible surgical repair of the ligament. If surgery is not performed then a longer immobilization period followed by sports rehabilitation.
Initially the athlete must apply the R.I.C.E. principles. That is (1) rest by limited and protected weight bearing (2) Ice to reduce acute swelling. Applications should be done about 4X/day for about 20 minutes (3) Compression with an ace bandage to support the weakened ankle joint and (4) elevate the leg above the heart for the first 48 hours so swelling does not collect in the ankle/foot.
Sports Rehabilitation should be started as soon as possible to decrease pain, swelling and prevent loss of ankle mobility. Physical therapists will implement the use of ultrasound to soothe the area and decrease inflammation; electrical stimulation to decrease swelling and reduce scar tissue and cold laser to quickly rid the area of bruising and hematoma. Many physical therapists will utilize sport massage to further reduce scarring. The sports rehabilitation specialist will gain mobility back with mild active and passive Range of Motion exercises.
Resistive strengthening to the ankle/foot is started with the reduction of acute pain and swelling. The therapist can utilize resistive bands and specific ankle strengthening devices. Lower extremity strengthening and endurance should be incorporated by using stationary bikes, velcro weights and hip/knee apparatus. Proprioception and balance training are extremely important in sports rehabilitation. Here the specialist will use BAPST boards and an assorted array of balancing techniques.
Once the athlete is pain free agility drills can be added to the program. For the athlete to be successful in rehab a home program of stretching and strengthening must be performed on a daily basis.
The best way to prevent ankle sprains is to maintain good strength, balance and flexibility. Some other important factors are (1) warm up properly before exercise or vigorous activity (2) pay attention to walking, running or work surfaces (3) wear good supportive shoes and sneakers and most important (4) pay attention to your body’s warning signs to slow the pace down when you feel pain or fatigue.