Ankle Sprain | Physiotherapy Management and Prevention.

Have you ever lost balance and suffered a foot twist, while landing on your ankle? If yes, then this is condition of “ankle sprain”. If the ankle pain quickly disappears then you usually stop thinking about it but if the pain is severe, gives rise to swelling and starts hurting on bearing weight, then it requires necessary treatment. Several interventions have been recommended in the management of acute ankle sprains, among them, physiotherapy has been recommended with a higher level of evidence and should be incorporated in the rehabilitation process.  The physiotherapy program includes exercises ranging from simple range of motion, stretching, strengthening exercises to neuromuscular, proprioceptive, and sport-specific exercises. Through this blog, we will try to enhance your knowledge about ankle sprain and the various physiotherapy interventions which can be used as a treatment intervention for the same.

 

Ankle Sprain

Acute ankle injury is one of the most prevalent lower limb injuries occurring mostly in physically active individuals. An ankle sprain mostly occurs in females, children, and athletes taking part in indoor and outdoor sports. An ankle joint instability can occur due to the injury to the bone or muscular structures, ligaments like the lateral, medial and syndesmosis injury play a major role in ankle instability. An ankle sprain occurs when one or more ligaments of the ankle are stretched or torn. If a sprain is left untreated, it can lead to long-term ankle problems. During Injury the ankle is either rolled inward or outward. Inward twisting injury sprains are the most common type, cause pain along the outer side of the ankle. Depending on to what extent the ligaments are injured, the sprain can be classified as Grade I, II, or III.

 

Ankle Sprain Classification

• Grade 1- Mild.
• Grade 2-Medium.
• Grade 3- Severe.

 

Grade I ankle sprain

• Rest: Take rest
• Ice:  By applying ice the swelling comes down. Apply it for 10 to 20 minutes after every 1 to 2 hours during the day.
• Compression:  Compression helps to control swelling and immobilizes the part to enhance the process of healing.
• Elevation: Elevate the foot by placing it above the level of the heart.

 

Grade II ankle sprain

• Follow the R.I.C.E. program and immobilize it by using a bandage or splint.

 

Grade III ankle sprain

• There is a risk for permanent ankle instability. Rarely, surgery might be required to repair the damage or put a short leg cast for two to three weeks or a walking boot.

 

Ankle Sprain Healing Goals:

• To relieve pain.
• Regain strength.
• Regain range of motion.

Once the patient starts to stand on the ankle again, the physiotherapist gives exercises to strengthen muscles and ligaments and increase flexibility, balance, and coordination.

 

Physiotherapy Treatment:

Depending on the severity of the ankle sprain, the physiotherapist designs a treatment program to enhance the healing process and advices to return to activities and sports.

The physiotherapy interventions include the use of ice packs, heat packs, modalities like TENS, Ultrasound, Shockwave therapy, and exercises like:

 

Range-of-motion exercises:

To move the joint as far as it can be in every direction.

Ankle alphabet

• Sit in a chair, with leg extended trace the letters of the alphabet in the air with the big toe. Repeat this 2 or 3 times, moving the ankle in all directions.

Knee motion

• Sit in a chair, place the foot flat on the floor. Then slowly move the knee from side to side for 2 to 3 minutes.

 

Stretching exercises:

To keep the Achilles tendon flexible while the ankle heals.

Standing calf stretch

• Stand in front of a wall facing towards it, put the hands on the wall. Place the injured ankle one step back and the uninjured foot forward. Keep the back heel flat on the floor, slowly bend the knee of the uninjured leg until a stretch is felt in the calf of the injured side. Repeat 3 times, hold for 30 secs.

Heel raise

• Stand with the hands in front, resting against the wall, or chair back for support. Place the feet shoulder-width apart, slowly rise on the toes and come back down.  Repeat 10 times then progress to 20.

 

Strengthening exercises:

To strengthen the muscles and support the ankle.

Elastic band push

• Sit on the floor.  Extend the leg and slightly raise it to 20 degree to keep the heel off the floor. Place the elastic band around the ball of the foot and hold the two ends. Slowly push the ankle forward by pointing the toe. Then slowly bring it back. Repeat this 10 times.

Elastic band pull

• Sit on the floor, hook the upper foot and the toes into the band.  Slowly pull the foot back towards the body and return it to a vertical position. Repeat 10 times.

 

Balance and control exercises:

To help the foot and ankle respond to activities, which can help prevent reinjury. Balance and control exercises should be started when there is no pain on standing.

One leg raise

• Place hands on a wall, lift the uninjured leg behind so that the weight rests on the injured ankle. Try to hold this position for 20 to 30 secs.

Pillow balance

• Do basic balance exercises while standing on a pillow.  The foot will wobble around a lot and constantly need to be corrected to maintain balance.  Maintain this position for 30 50 secs.

 

• To protect the ankle, bracing can be done and aids like crutches can also be recommended to avoid limping. With more severe ankle injuries a boot is recommended to allow proper healing.
• Ankle sprains almost take up to 4 months to heal completely, depending on the severity.  While playing sports ankle support like an ankle brace, air stirrup, or hiking boots may be recommended to be worn during the healing time to protect the ligaments. After the ankle is healed, taping can be done or an ankle brace to support the ankle.  To prevent reinjury continue stretching exercises especially before and after physical activities to prevent reinjury.  Muscle-strengthening exercises and balance exercises should be continued to maintain ankle strength. Long-term joint pain and weakness can be seen in people with severe or repeated ankle sprain therefore all the recommended exercises should be continued even after the pain the ankle mobility and strength are retained.
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  This Blog was first posted at CB Physiotherapy

 

Top Active Range of Motion Exercises for Upper and Lower Body

Have you heard of someone complaining of tired legs, aching ankles or stiffness, while getting out of bed? These are all common symptoms of past injuries or aging. Decreased movement at a joint can cause many problems, ranging from functional disability to psychological fears. Active ranges of motion (AROM) exercises are done by the individual, by using their own muscle strength and power, without external help. These exercises are prescribed by a trained physiotherapist who helps to increase joint flexibility, and overall functionality. In this blog, we have mentioned the benefits of doing active range of motion exercises, and a few easy-to-do range of motion exercises are given below.

 

Benefits

There are many benefits of doing AROM exercises if the movement is decreased at a joint. Some of them are:

• Increases joint range of motion
• Increases the functionality
• Improves and maintains joint integrity
• Improves movement efficiency
• Increases  independence

 

Upper Body Exercises:

Starting position:

• Sit or stand in a comfortable position.
• Face forward. 
• Shoulders should be straight and relaxed.

 

Head forward and backward movement:

·    Gently bend the head and try to touch the chin to the chest.  Raise the chin back to the starting position. Tilt the head backward and look up towards the ceiling and return to the starting position.

 

Head side to side movement:

·    Tilt the head to the side, by bringing the ear towards the shoulder. Do not raise the shoulder towards the ear, return to the starting position.

 

Head turns:

·    Turn the head to look over at the shoulder. Tilt the chin down and try to touch the shoulder without raising the shoulder to the chin, return to the starting position.

 

Shoulder and elbow exercises:

Starting position:

• Stand or sit on a chair without the arms.
• Hold the arms straight down by the side
• Palms facing towards the body.

 

Shoulder up and down movement:

·    Raise the arm forward and then up over the head, such that the inner arm touches the ear. Bring the arm down to the side. Bring it back as far as possible behind the body, return to the starting position.

 

Shoulder side to side movement:

·    Raise the arm by the side and then up over the head as far as possible. Return the arm to the side. Bring the arm across the front of the body and reach for the opposite shoulder, return to the starting position.

 

Shoulder rotation:

·    Raise both shoulders up toward the ears. Bring them back to the starting position, and relax the shoulders. Pull the shoulders back. And relax them again. Roll the shoulders in a smooth circular motion and then repeat the same in the opposite direction.

 

Elbow bends:

·    With the palm facing forward, bend the elbow. Try to touch the shoulder with the fingertips and return to the starting position.

 

Arm and wrist exercises:

Starting position:

• Sit down.
• Bend the elbow and rest the forearm on a flat surface, such as a table. Make sure the wrist hangs loosely over the side.

 

Wrist bends:

·    Bend the hand back towards the wrist, so that the fingers point toward the ceiling. Then bend the hand down with fingers pointing towards the floor.

 

Wrist rotation:

·    Move the hand from side to side. Then roll the hand in a circular motion in one direction and repeat the same in the other direction.

 

Palm up and down movement:

·    Stay in the same position, but tuck the bent elbow against the side. Face your palm down. Turn the palm so that it faces up towards the ceiling. Then turn the palm so that it faces down.

 

Hand and finger exercises:

Starting position:

• Sit or stand.
• Place the hand out in front.

 

Finger bends:

·    Make a tight fist, open and relax the hand.

 

Finger spreads:

·    Open the hand and stretch the fingers as far apart as possible, bringing them together again.

 

Finger-to-thumb movement:

·    Touch each fingertip to the pad of the thumb, one at a time.

 

Thumb-to-palm movement:

·    Move the thumb and rest it across the palm. Move it out and repeat again.

 

Lower Body Exercises

Hip and knee exercises:

Starting position

·    Lie on the bed with legs extended.

 

Hip and knee bends:

·    Slowly bend the knee up as close to the chest as possible. Straighten the leg and return  to the starting position

 

 Leg lifts:

·     Raise the leg to 300. And hold it in the same position for a few seconds and then return to the bed.

 

Leg side to side movement:

·    Flex the foot with toes pointing up towards the ceiling. Move the leg out to the side as far as possible and return to the starting position.

 

Leg in and out movement:

·    Put the leg extended on the bed. Bring the leg towards the middle, so that the big toe touches the bed. Then roll the leg out and try to make the smallest toe touch the bed.

 

Knee in and out movement:

·    Lie on the back of the bed. Bend the knee so that the bottom of the foot is flat on the bed. Slide the heel towards the buttocks and then return to the starting position.

 

Ankle and foot exercises:

Starting position:

·    Sit in a chair, place your feet on the floor.

 

Ankle bends:

·    Keep the toes on the floor and raise the heel as high as you can. Lower the heel and keep it on the floor and raise the toes as high as you can.

 

Ankle rotation:

·    Raise the foot slightly off the floor. Move the ankle in a circular motion then repeat the same in the other direction.

 

Toe bends:

·    Curl the toes down toward the bottom of the foot. Straighten them. Curl them up toward the ceiling. Then straighten them again.

 

Toe spreads:

·    Spread the toes apart. Bring them together again.

 

Avoid fast or jerky movements, the movements should be smooth and gentle. In case of pain or discomfort while doing the exercises, consult your physiotherapist.