Sunday, August 28, 2011

Wobbly Ankles?

Tips to Avoid Developing Chronic Ankle Sprains

Did you know that if you sprain your ankle and it doesn’t heal properly that you have almost a 90% chance of spraining it again?

The truth hurts…. literally!  If you’ve ever experienced an ankle sprain then you know what I’m talking about.  In this article I’d like to outline a little bit about ankle sprains and how to treat them properly to avoid the dreaded recurrent sprain or ‘wobbly ankle syndrome’.

The most common ankle sprain is a lateral ankle sprain.  Usually the toes are slightly down and the sole of the foot turns inwards as the ankle rolls over stretching or tearing the ligaments on the outside of the ankle.  (See the picture to the right)  There are three main ligaments that support our lateral ankle and the one that is most commonly damaged is the anterior talofibular ligament (ATFL). 

Another important note is that there are degrees of ankle sprains.  A minor sprain is a grade 1 injury where there is some overstretching of the muscles and ligaments.  In a grade 2 sprain some of the fibers are torn and there is bruising and a lot of swelling.  The most severe ankle sprain is a grade 3, which is a complete rupture of one of the supporting ligaments which can leave the ankle unstable. 

So what should you do when you sprain an ankle?  First thing is to get it assessed to see how severe it is.  If it was a traumatic sprain then it is always safe to start with an X-ray to rule out a potential fracture.  If you simply rolled it, stay off of it for the first 24 hours and apply this basic at home first aid. 

1-    Ice the ankle – Apply an ice pack or bag of frozen veggies to the ankle for 10 minutes at a time.  Take it off for 10 minutes then apply the ice again.  Stick to this 10 on -10 off icing protocol for as long as you can stand it in the first 24 hours.  It will help control the pain and limit the amount of swelling in the ankle. 
2-    Elevate the ankle – Blood and fluid tends to pool when we are standing so stay off that ankle completely at the beginning and try to elevate it above the heart
3-    Compression – If you have a tensor bandage at home wrap the ankle, it will also help modulate the swelling in the area
4-    Medication - If the ice isn’t enough to take care of the pain then I would recommend a pain medication with some anti-inflammatory properties like Ibuprofen (Advil).  It reduces pain and helps control the inflammation in the area.  

**My recommendation is to go one step further.  If you really want this ankle to heal quickly get some Acupuncture pronto! Acupuncture helps reduce pain, modulate swelling and restore muscle coordination after an injury.  It has also been proven to speed up the repair of tissue.  

Okay the first 24 hrs are over and you may be feeling better, but this is where the real work begins.  It’s time to get your motion back and start rehabbing this ankle. 

There are 4 main parts to ankle recovery and you need all of them to successfully restore your ankle to its pre-injury state:  

  1. Regaining full, pain-free Range of Motion
  2. Strength training
    1. Isometric
    2. Dynamic
  3. Proprioception training
  4. Activity specific training

1.   Range of Motion Exercises
Don’t start walking on that ankle unless there is no pain and 80% of your ankle’s normal motion is restored.  The best way to start getting your range of motion back is to do the ‘Alphabet Exercise’:

In between your icing session start using your foot to trace out each letter of the alphabet in the air.  This will get your ankle moving in all the necessary directions.  Continue with the basic first aid and the alphabet exercise until the pain is gone and the ankle motion is restored.  It could take a while so be patient!  To speed up this phase of healing visit your practitioner and get some muscle therapy and acupuncture to reset the length of the muscles that were strained when the ankle rolled over.

Now the next part is so incredibly crucial.  We need to retrain this ankle so that you don’t roll it again.  Remember if you stop at this point your chances of rolling your ankle again are pretty high. 

Your practitioner should supervise you through this portion of the rehab which will involve strength and proprioception training. 

  1. Strengthening Exercises
Ligaments hold our bones together but the body relies on muscles to provide support for its joints.  Strength training starts with a) Isometric contractions - which means firing the muscles but without moving the actual joint.  The next step is to add some motion – b) Dynamic exercises.   My favourite dynamic exercise incorporates rubber tubing or a theraband.  Using light resistance you strengthen the different supporting muscles in the ankle in every direction.

3.   Proprioception Training

Here is the key – Once you damage the ligaments in your ankle that joint no longer has the ability to tell where it is in space and control its motions – this is called Propreioception and is so important to focus on in the recovery period.   Ligaments not only hold bones together but they also contain little nerve fibers that send signals to your brain to tell you where your ankle is in space.  Without these signals the brain can’t tell when the ankle is being overstretched and about to roll over again.  So that is why it is so common to re-injure your ankle if you don’t retrain and heal the proprioceptors. 

The first exercise I like to give is just standing on one foot.  At first the ankle will feel wobbly but you want to work up to being able to stand on one foot for 2 minutes without any pain or swaying of the ankle.  Next try closing the eyes and try to maintain that same stability.  Proprioception exercises can also be made more challenging by standing on a softer surface like a pillow or grass and can even be done on a wobble board which tilts from side to side.  (See photo to the right)

  1.  Activity Specific Training
This section may be different depending on what type of activity you are involved in but always progresses the same way.  After you have established your pain-free full range of motion in your ankle joint and completed your strength and proprioception training you are ready to return to activity.  First begin with in line motions like walking and jogging.  Next progress to forward and backward activities before adding cutting and figure-8 motions which put more force on the lateral side of the ankle.  If you are returning to competitive sport spend adequate time practicing drills in a non-competitive environment before returning to actual competition. 

Braces can also be prescribed and worn throughout the healing process to provide support and stability.

Remember ankle sprains are very common but there is no need for them to keep happening over and over again if they are cared for properly the first time. 

Dr. Lara Lever

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