Ankle Sprain Physiotherapy Treatment
Sprained ankles are very common and repeated sprains can lead to a swollen, painful ankle, problems walking on rough ground and the risk of re-injury. The physiotherapist begins with asking: How did the injury occur? Was there a high level of force involved? What happened afterwards – could the patient walk or did they go to hospital? Was there an x-ray?
The amount of pain the patient suffered after the injury is extremely important and if the level of pain is very high or if it doesn’t settle, there might be a fracture. Pain should settle with time and if not the physio will refer the patient back to the orthopaedic doctor. The areas of pain should match the mechanism of injury, indicate which structures might be injured and should be tested by the physiotherapist later.
Special questions are asked about the past medical history and previous injuries, any drugs the patient is taking, their appetite level, whether they are losing weight, their sleep quality and pain in the morning, their bladder and bowel normality and any relevant family history. This is to clear the patient of any serious underlying condition so that treatment can be safely performed.
How Physiotherapists examine a sprained ankle
The physiotherapist will note any oedema, change of colour or abnormality of circulation. Ankle movements when not weight bearing are assessed by the physio, dorsiflexion is pulling the ankle upwards, plantarflexion involves pushing the foot down, eversion is turning the foot outwards and inversion turning the sole of the foot inwards. The physiotherapist assesses movement of the ankle as pain can limit movement and the readiness of the patient to engage in rehabilitation.
Depending on pain the physio may manually test the strength of the ankle muscles. This can occur on the plinth or up on their feet if the injury permits it. Once the active movements have been recorded, the physiotherapist performs passive movemenst of the joint, pushing carefully with their hands to explore stretch of the joint structures in each direction. The physio may manually palpate the area to test which structure is at fault, noting swelling or tenderness
Treatment protocols for Physiotherapy
Physiotherapy treatment starts with PRICE, which stands for protection, rest, ice, compression and elevation. Protection involves using a brace to prevent abnormal movement of the joint and further damage. Rest is important for damaged structures and allows the part to settle without stress. Cryotherapy or cold/ice treatment is useful to reduce pain and swelling.
A compression dressing such as a joint sleeve reduces or prevent swelling or effusion occurring as swelling can interfere with normal joint movement, and the joint is kept up to prevent swelling due to gravity. A walking aid such as a stick or elbow crutches may be useful if pain is severe and normal weight bearing gait is not possible. The physio’s hands can test for stiffness or pain in the ankle and allow improvement of the joint gliding movements to normalize joint mechanics. Reducing stiffness of the joint loosens it and eases pain which allows exercises to start in weight bearing. Less dynamic exercises are used initially, progressing to active exercises without support.
In proprioception or the sense of joint position the brain monitors the position of the ankle, quickly coordinating the muscle response to prevent risky positions. Rehab involves balance work by standing on one leg and progressing to working with balance on a wobble board. Balance and coordination are retrained until the joint can perform well on rough ground and in running and jumping. Good movements, little pain, good strength, normal balance and walking mean that the ankle has recovered.
About the Author
Jonathan Blood Smyth is a Superintendent Physiotherapist at an NHS Hospital in the South-West of the UK. With over 15 years experience of managing orthopaedic conditions and looking after joint replacements, he specializes in managing chronic pain. Visit his site if you are looking for Physiotherapists in London or throughout the UK.
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