- Certainly, grade one ankle sprains
are probably the easiest to treat.
These are the ones that we see most commonly
with our weekend warriors, and also,
our athletes of any capacity.
Those are patients that we typically
will place in some sort of supportive brace,
whether it's an ankle stirrup brace, or an Aircast.
It's important that we follow the recipe of
rest, ice, elevation, and compression.
We also try to get these patients into physical therapy
as quick as possible.
We find that the faster we're able to get the swelling,
and the fluid, and the inflammation out of the joint,
the faster the patients are able
to return to athletic activity.
In patients with a grade one ankle sprain,
we'll often fit them with something called an Aircast.
This is basically a stirrup brace that fits on the inside
and outside of the ankle to basically, give it support.
In patients who are of a grade two,
a strong grade two or grade three ankle sprain,
we'll get patients fitted with something called
a Cam Walker boot, which is a very protective,
soft, spongy boot, that will act almost as a cast
for the patient, that they can bear a little weight in,
and often use some sort of assisted device,
such as a crutch or a walker,
to help them with mobility.
In patients who are active or in an athletic situation,
and even some patients who are recovering
from a prior ankle sprain,
we'll fit them in something like this,
which is called a Velocity brace.
This has a nice, rigid outer and inner structure,
but it also has laces for nice,
tight rigidity of the ankle, so that patients
in an athletic situation have the support that they need
without having to worry about their ankle
giving out or twisting.
Grade two and grade three ankle sprains are a little bit
more challenging to treat, in the respect that we follow
the same paradigm of treatment, however,
the time for those patients to heal is a lot longer.
Your typical grade one ankle sprain will heal
in about two to three weeks, whereas,
grade two and grade three can often lead to
four, six, to eight to twelve weeks,
in the most severe cases.
It's not uncommon for a grade three ankle sprain
to actually take longer to heal than an ankle fracture.
Because of that, it's imperative that those patients
are in physical therapy,
it's imperative that those patients are really doing
their strengthening and stretching exercises
to get the ankle back into the shape that they need
to do their activities.
In severe cases, we'll see a rare instance
where we'll have to go in arthroscopically,
clean out a joint, especially in a severe grade two
or a grade three ankle sprain, where there's so much
soft tissue damage to the inside of their joint,
that we have to go in arthroscopically and clean it out.
Typically, that's not done for about two to three months,
or even sometimes up to six months,
depending on how the quality of their
physical therapy regimen is following.
On a different note, high ankle sprains,
it's imperative to look at your x-rays
with good scrutiny.
It's also important to look at the MRI so that you can see.
If there's a ligament tear to the ligaments
that hold the tibia and the fibula together,
it's almost always a surgical situation
where you have to screw the bones back together,
so that the ligament can heal itself.
It's important to remember that the ligaments
in our ankle are there to create
a healthy and stable environment for the foot
to support us on.
If those ligaments are not functioning the right way,
what will happen is the ankle will continually start
to turn, and they'll get repetitive sprains.
The more repetitive a sprain,
the more problems the patient will have in the future.
That can lead to a ligament that does not heal,
that can lead to a situation where the patient will step
on something as small as a pebble on the road,
and their ankle will overturn.
That can become a situation which can, again,
lead to a surgical problem.
- The time spent in physical therapy
is dependent on the phases that you're in.
Acute phase usually takes about
four to seven days.
The middle phase, the recovery of range of motion phase,
could take from seven days to about
two to three weeks,
depending on what type of tear
or disruption they may have.
To recover to full activity could be anywhere
from seven days up to about four to six weeks.
Goals following an ankle sprain are, primarily,
rest, ice, compression, elevation.
Rest the injury, mobilize it so it has
a proper healing environment.
Ice helps decrease the inflammation.
Compression will help decrease the swelling.
Elevation also helps decrease the swelling,
decreases the amount of blood flow to that area.
The intermediate phase, then, would be
to restore range of motion,
start proprioceptive basic strengthening exercises,
then, the last phase would be to
sport-specific or work-specific goals,
as far as, what to they need to do,
do the need to climb ladders?
Do they need to go back to running activities?
Or are they more sedentary?
Proprioception is the body's ability
to realize where it is in space,
and how to react to the forces,
uneven surfaces.
Your foot hits the ground, and it's an uneven surface.
So it has to know where it is,
then it has to fire the appropriate muscles
to respond to that uneven surface.
If we were in a general environment
where there's no clutter or uneven surfaces,
it probably wouldn't be important,
but it's not an ideal environment.
These people are working in steel rooms,
stepping over steel structures, stepping in ditches.
We really need to strengthen them and prepare them
to get back into their activity.
First thing we're gonna do is warm up your ankle.
Things stretch better when they're warmed up.
We're gonna do ankle pumps, up and down.
You're gonna do 30 to 50 reps at home.
You're gonna open your legs up a little bit,
then you're gonna go in and out.
We start with a warm-up, simply,
just ankle pumps in all different planes.
From there, I usually like to do a towel stretch,
where we pull the foot into a dorsiflex position,
or pull the foot up towards the shin.
From there, I like to get the patients on their feet.
We do that same stretch in a standing position.
We go into the strengthening phase,
I start with single-leg balance,
move to the opposite leg in different planes,
to throw themself off balance.
That gives them some proprioceptive response,
and it also gives them some strengthening
in a standing, more functional plane,
versus having them do something on a table.
From there, I will go into a lunge matrix,
where they're lunging at different angles,
and that will give them their deceleration
and explosion in a different direction.
Sports athletes and industrial athletes,
I treat, basically, the same.
The only difference is the sports athlete
has more of an explosion-type,
tied to fiber,
so we need to train them in that quick
explosion-type mechanism also.
We'll get their flexibility and everything back
to a certain point, then we have to take them
to that next level.
They need that quick reaction time.
Recurring ankle sprains are more common
when they do not follow-through with rehab.
It's when they have a plantar-flexed foot,
or they don't regain their full range of motion,
the ankle is what they call, in a loose-pack position.
So anytime they step on an uneven surface,
the ankle will roll to the weakest point,
and it will rollover to that sprain.
If they regain their full range of motion,
the ankle structure is able to lock up,
and it's more stable and you're less likely
to have a recurring ankle sprain.
I always tell my patients,
"It's not that I'm treating your ankle sprain,
"I'm trying to prevent a recurrence."
Ninety-five percent of how well the patient does
is what they do with their home exercise program.
I only see the patient two, three times a week,
for maybe, a half an hour to an hour session.
They're with themselves 24-7.
The immobilization phase, the resting position
for their foot is hanging down,
so the back structures of their leg get tight.
Just the resting phase of what we put them in,
creates a contracture of the ankle.
It's very important, since they're in that position
7/8 of their day, that they do their
home exercise program to counter the effects
of that immobilization.
Seeing me two, three times a week isn't gonna do it.
The exercise program started the first time
they come into the office,
and we assess the success of that home exercise program
each time they come in.
- After an ankle sprain,
physical therapy is very important.
You have to remember to be consistent
with that home exercise program.
It's the home exercise program that will help you return
faster to the activities you enjoy.
Those exercises focus on range of motion,
strength, and proprioception,
your body's ability to balance and stabilize.
Whether you have to get back to sports, or work,
or even just leisure activities,
it's important to continue working
on that ankle strength and stability.
Normal ankle function is essential
to any weight-bearing activity that you do.
At Coordinated Health, we work as a team
in your education and treatment,
but you're a key member of that team.
Maintaining a stable, pain-free ankle
means working hard to understand and apply
the physical therapy principles we teach you.
Stretching and strengthening your ankle consistently
allows better performance of all your
sports and daily activities without pain.
That's the art of medicine.