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rehab

Ankle Sprain 2: Standing on your own two feet

A few posts back, I said I would outline some important points you want to be thinking about if you have an acute ankle sprain, as well as what you can do if you already ARE someone with a "bad ankle". 

Even if this isn't your first rodeo when it comes to ankle sprain, I would encourage you to read this post as every time you injure your ankle will little different from the last!

The first place to start when it comes to ankle injury is just how serious is it? 

So what can go wrong?

We all know its sore, and we have all seen a puffed up and inflamed ankle, but what exactly is going on when you injure it? 

By far, the most likely mechanism of injury in an ankle is rolling outwards or "over the top" of your ankle. This direction of movement accounts for the Anterior Talofibular Ligament (literally meaning, the ligament at the front that connects your ankle bone of your foot, or Talus, to the bone that runs on the outside of your lower leg making that bump on the outside of your ankle, your fibula) being the most commonly injured tissue in an ankle sprain injury.

In my opinion, it is this injury to ligaments that causes ongoing issues in regard to ankle sprain, as ankles can take 12- 24 MONTHS to heal completely (depending on the severity of injury) and most people don't continue their specific rehab for long after the ankle is no longer in pain, which is usually much faster than this. This lack of correct rehab leads to other issues longer term. 

What else can be injured?

Beyond the Anterior talofibular ligament, other sites on injury can include the ankle cartilage or even in more extreme cases, fracture of the fibular or the foot itself!

When do you need to X-ray?

There are various factors to take into consideration when determining if you need an X-Ray of your injury.

Some are best assessed by a health care professional such as exactly where it is sore, what type of pain do you have, as well as the exact mechanism of the injury. 

As a general rule though, if you have injured your ankle and you are trying to decide if you should go to the emergency department, the best thing to ask yourself, according to the Ottawa rules for determining need for X-ray is this:

- Could I weight bear immediately after the injury occurred?

and 

Can I walk at least 4 steps now?

If either of these are a yes, it is likely a radiograph will be warranted and I would recommend either contacting your health practitioner and letting them know, or visiting the emergency room immediately.

But if there is no fracture, what else can go wrong?

As discussed above and in a previous post, a major issue can be the damage to relevant ligaments, but there is yet another structure that can be affected by intense or repeated ankle sprain, and thats cartilage. 

The cartilage in your ankle is special in that it possesses healing and regenerative properties that are better than many other areas of your body, to account for extra stress in such a mobile weight bearing joint. Yet, even this area can be permanently damaged. 

Due to the healing, the ankle is an unlikely region to suffer from arthritis as a primary issue, but is one of the MOST likely joints in the body to develop arthritis in response to an injury as secondary symptom. Another reason that ongoing and thorough management and rehab is paramount to insult to the ankle!

When can I be back on it and how much can I do?

This is the most important question in getting you  (for want of a better term), back on your feet. The main area of focus is OPTIMAL LOADING. Not too much too soon injuring you further, and not too little so as to hamper your recovery. 

This is best assessed in person with your health care practitioner. 

If you have any concerns about your ankle, or you re not sure who you SHOULD be seeing about your injury, please do not hesitate to contact us at Align, we would love to help you be back up and running as soon as possible.

 

Image of ankles doing what they are MEANT to do, take you confidently wherever you would like to go.

Image of ankles doing what they are MEANT to do, take you confidently wherever you would like to go.

Ankle Sprains...are you doing it wrong?

I don't know if its the time of year or if I have just been noticing it more, but it feels like there has been a lot of ankle injury limping into the practice in the last few weeks.  

Ankle sprains and strains are common, they are not just for sports people and most importantly, are usually really poorly managed when they happen. 

Sure, getting people out of pain doesn't usually take too long but there is a lot more to it than that. 

As a lot of you already know, at Align a big part of our practice is looking after families. There are a few things you notice when you have families with school aged kids coming in and one of the more common injuries we will see is ankle sprain or strain.

So what do I mean by poorly managed? The problem is, getting on top of these very common injuries is at the same time, very important but very BORING to deal with. 

If you are lucky enough to have avoided issues with your ankles, I am willing to bet we all know SOMEONE we went to school with who rolled their ankle early on in high school, and by year 12, nearly overtime they took to the field, court or even walked next to you down the street, they would put their foot down at one point and over they would go!

In practice, we often here this described as their "bad ankle".

Structurally there is usually nothing "bad" about their ankle, so why do they have such a problem? 

A "Bad Ankle"

A "Bad Ankle"

In my experience, up until recently, treatment for most ankle injury would consist of people would ice on their ankle till the swelling went down and they could walk on it without pain, then they would hope for the best until inevitably, the next episode of the "bad ankle" would happen, increasing in frequency, leaving them with no confidence in their own body and an inability to enjoy playing sports or exercise how they should be able to. Sound familiar?

The reality is, when you really sprain your ankle, what you are actually doing is causing damage of specific ligaments around your foot and ankle. The pain from these injuries is just one part of the issue. The other, equally important part is the movement issues that a sprain will introduce into our ankle's support systems. 

I touched on these movement issues in my last blog about posture but in a nutshell, when we injure tissues it can cause movement control issues in the affected joint, making it harder for our nervous system to be certain of how to position and manage that joint in the future. 

This is why it's so important that any management of these injuries includes longer term rehab thinking, as well as care for the immediate area and work on the connected support structures. 

In my next blog, I plan to outline some important points you want to be thinking about if you have an acute ankle sprain, as well as what you can do if you already ARE someone with a "bad ankle"