[Music]
hi folks I'm Bob Shrum physical
therapist rad hi NIC physical therapy
because we are the most famous physical
therapist on the Internet in our opinion
of course rad today we're gonna talk
about five things they don't tell you
about ankle sprains these are things
that are not real commonly known sure I
mean they're known by some therapists
but they're not as smart as we are so
say no more about alright so we're gonna
start off with the first one now most
ankle sprains happen on the what we say
the lateral the outside of the ankle you
turn your ankle this way yep and that
ligament is anterior talofibular legs
right so and that ligament is and I hope
Lonnie I hope you're not too far away on
this but it's right up in this region
here and the reason I want you to know
that is because the first thing that I
want you to try is what we call
cross-fiber friction massage now this
isn't something you can do the first you
know first day or two if it's also not
real painful it needs it needs of some
right right you always start off with
the the rice Ric II rest ice compression
and elevation we got a video on that
yeah so you're going to want to start
with that and you know let that calm
down for a couple days but what happens
is when you stretch the ligament there's
often quite often some tears that may
have occurred and when the tears occur
when they're start to heal they form
scar tissue and that scar tissue can
give you continued pain or it's just not
as strong as it should be so this is why
you're going to do cross fiber massage
and that you can see the orientation of
the ligament here hope it can you see
that Lonnie okay so what you're gonna do
is you're gonna go across this so you
see the look and it runs this way I'm
gonna exaggerate this a little bit but
it's not this long but that's the
direction of the fiber right so I'm
gonna go this way with my massage and
you're gonna use you know you can use
one finger over on top of the other or
you can use two fingers side-by-side and
you're gonna find you're gonna get right
to that spot and you're gonna rub across
it so I'm rubbing this direction and you
start off generally kind of a little bit
light but then if if you can tolerate it
okay you really want to
start hitting it pretty hard right so
actually you can see he's pushing into
the skin the whole the skin and beneath
this kid is actually moving those fibers
below the skin are actually getting
moved wrong they're starting to you're
trying to break up that that's scar
tissue that's laying on top of your
incorrectly yeah what happens when it
starts to heal and it starts to heal
like a web right it's disorganized it's
not as strong as it should be I actually
was just seeing some studies on this
Brad with the the strength of this
tendon after a damage is like 18 percent
or 10 percent of what a normal one is
sure so I mean it that's way a lot
weaker way what meat that means is you
can re hurt REE injury over also so
again you can do this cross fiber I'd
like to see you doing it you know what
what you want to see a good sign is that
if you do this is that after a while it
actually starts to level the pain levels
off or even gets less and that while is
I'd say about 30 seconds maybe 40
seconds after that a long time of doing
this it starts to feel better or if your
mama SH yep exactly and that's a good
sign that means that's what you should
be doing this is really good for someone
who's had an ankle sprain it just
doesn't seem to be getting better these
are a good thing to try you can do that
for like five minutes and you can do it
every day if you'd like that you know as
long as your skin's tolerating it but
again little secret that a lot of people
don't know about is doing the cross
fiber massage so ok next thing Brad Bob
there's one thing I want to talk about
is there are some new people out there
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below okay moving on bone shift all
right this is one that's really not
known by a lot of people Brad a lot of
times when you sprain your ankle now you
look here you got two bones in the lower
leg here tibia and fibula this fibula
this thinner bone sometimes it gets
shifted forward this way mm-hm and where
I really see that Brad is if you bring
your foot up like this right it doesn't
go up as high as the other one it's
limits your range of motion in dorsiflex
right so if you compare your two feet
and you bring them both up towards you
your toes towards you one of them go you
know if the injured one doesn't going
nearly as far as the other one here's a
good example
so the injured one only goes this far so
you can see how the non sock for it only
goes this far
that would be the injured one right that
would be a good example of how I look
yeah so in that case what we often will
do is we actually manually push that
bone back in place again and then we
tape it in place this is one that may be
hard to do at home yeah I don't think
you can do this at home this is more for
a therapist yeah so just real quickly
but I want you sit up on here okay and
put your foot up on yeah so what we do
is we actually take my thinner Eminence
they call it or the pad of my thumb yeah
and I actually pushed that bone back and
up a little bit and I'm pushing like
this and then after I push it I go ahead
and I put down some underlying tape
around here like this and then I take
another piece of tape and I put it on in
the bone like this so are you gonna get
a little little hair there okay Bob so I
can think and then I push the bone back
and then I wrap it around like that
leave it on there but yeah what does n't
bother me I can take it off now I know
one thing when I do this and I think
you've mentioned this too is when you're
pushing you can have the patient do
range of motion with it and all of a
sudden nail could go 50 percent of the
range and with the pressure there's less
pain and they can go much further all
right yeah yeah it's I tell you this is
probably my number one go-to technique
when someone injures their you know
sprains are ankle it doesn't always work
but when it works as a therapist it's
really fun because the patient just
thinks oh my god cuz I walking out
feeling much better I had a patient that
came in a month later after sprained her
ankle ankle just was not getting better
and this is all we did and she you know
yeah if she danced out of there how many
visits it was only a couple of visits as
it doesn't take very long again this is
a very skilled thing this is not
something here but I I even showing some
of my assistants how to do this it takes
them a while to get it you need to know
the anatomy pretty
yep you do alright the third thing that
a lot of people don't know is that
they're wondering why they keep
spraining their ankle they think their
ankle is weak they always say that Brad
my ankles weak that's why I keep turning
it the fact is they've lost the
proprioception
proprioception proprioception is a the
ability to tell where your your your
foot is in space your your your joint is
it in space or so you know one one thing
we even do sometimes Brad is all I'll
put the foot at a certain degree using
my goniometer yep you want to grab that
goniometer and see so we'll measure it
let's put it on I'll put it like right
there okay and then uh then I'll have
them close their eyes and try to
recreate that and if they can't that's a
good sign that they don't have a good
sense of where their ankles right I mean
they may start you put the ankle down
there the closedrier is reposition it
and they might put it there and think
it's in the same right when it's 40
degrees different but I see the one you
can do at home that's really easy to do
Brad yeah is just a simple standing test
so on your good ankle you're gonna go
ahead and I got a shoe on this side but
on your good ankle you're gonna stand
with the foot up and maybe even your
eyes closed and see if you can stand
steady then you go on the other ankle
with the you know with the bad ankle and
and you might be all over the place
that's a sign your proprioception is
gone sir yep so am i clear on that Brad
I think they understand Bob alright
these all are smart all right let's go
on so you're gonna want to work on
proprioception and we're gonna do
another video on that Brad we're gonna
do a video on the rehab that what you
should do so number four a lot of people
don't know what the best brace is to
wear especially if you go back into
athletics I would say you're going to
want to use the ASO so this is an ASO
brace there is little stabilizing
orthoses these there are other braces
that are good I know this is one that I
recommend I personally have used this
many times I'm a runner run out in the
woods and I'll link up to this one yes
we sure ought to put this one on but
that's gonna show real quickly yeah it
does it takes a little bit of time but
you need to it's a double double brace
system I'm not going to
take the time to lace it all the way up
put you later sky races and here's the
here's the key part he's got these
straps that go on now this is the one
that really is does the work you come up
on this side and right where's that Bob
show more that ligament is I was right
in here right so this goes right over
the top of that I pull up and I get some
nice support and boy it feels good too
you know you getting good support on
there this is a little slap yeah I would
take more time to get it on morning
what's nice about this is I mean it fits
well in your shoe and I mean you
definitely can go right into athletics
with it's made sure running you could
play soccer with it all those things
yeah it's it's probably the best brace
you're gonna do after your for athletics
right sort of the athlete all right
number five people often don't know or
they're not told when can I go back to
sports mm-hmm you know so what what we
generally like to see Brad is one the
swelling is gone too there's no pain
when you jump on it right some impact
yeah three I'd like to see that the
range of motion is back you know so that
the range is going to equal you know the
motion is on that foot is going to equal
the one on the left the other foot sure
so and then that proprioception you
should be able to do two 30-second
balance tests on both legs equally sure
we do have a video on how to do the hop
the jump or the hop test do we yep
mm-hmm oh well we're gonna do another
video on that that was your update we're
gonna do a rehab video which is you know
we'll do in a week or two and then we're
going to show all the rehab that you can
do it we're gonna show the hop tests
because there's a whole bunch of way you
can do hop tests you can do it for speed
you can do it for time you can do it for
accuracy and all that so I hope that
helps you please subscribe like we said
already if you haven't and take care
yeah and remember what are we supposed
to remember about we're not pretty
we're pretty obvious no we're pretty
handy they're not listening
you