Chronic An­kle In­juries

The Star (St. Lucia) - - HEALTH -

Have you ever heard some­one com­plain­ing of an­kle pain and weak­ness years after they ex­pe­ri­enced an an­kle in­jury? It is al­most ex­pected that if you have sprained your an­kle, you will ex­pe­ri­ence weak­ness for­ever. Some­times as­so­ci­ated prob­lems may de­velop in the hip or knee or the other an­kle. Well, no need for worry; there are steps you can take to aid your re­cov­ery and build up your an­kle strength.

The an­kle joint sits be­tween the foot and lower leg (the tibia and fibula). It is a large com­plex joint made up of three bones: the tibia, fibula and the talus. It is ca­pa­ble of mov­ing the foot up and down, in and out. It acts, along with the foot, to pro­pel the body for­wards, back­wards and side­ways, adapt to un­even sur­faces, sup­port the body and main­tain sta­bil­ity. Be­cause of the need to adapt to move­ment on dif­fer­ent sur­faces, and also sup­port the body, it has a net­work of lig­a­ments run­ning in dif­fer­ent direc­tions that in­crease the an­kle’s sta­bil­ity. Lig­a­ments are thick, fi­brous, flex­i­ble bands of tis­sue that con­nect bones and limit ex­ces­sive move­ment. Lig­a­ments and the re­ac­tion times of our mus­cles to changes in the po­si­tion of our foot pro­tect us from in­jury. How­ever, there are times when this mech­a­nism fails; or is over­stretched, re­sult­ing in an an­kle sprain.

A sprain is a move­ment that takes the joint be­yond its nor­mal range and can be graded depend­ing upon the sever­ity of the in­jury. Re­gard­less of the sever­ity, an­kle sprains are of­ten ac­com­pa­nied by pain, swelling and de­creased func­tion.

Grade I – Mild sprain with no tears to the lig­a­ment. Re­sponds to rest, ice and a pe­riod of ex­er­cise to pro­mote quicker re­turn to ac­tiv­ity.

Grade II – Mod­er­ate sprain where some of the fi­bres are torn but the lig­a­ment re­mains in­tact; you may no­tice light bruis­ing. May re­quire a brace or splint to al­low bet­ter heal­ing of the lig­a­ments fol­lowed by re­ha­bil­i­ta­tion and ex­er­cise be­fore full func­tion is re­stored.

Grade III – Se­vere sprain where the fi­bres are com­pletely rup­tured. This is usu­ally ac­com­pa­nied by bruis­ing as the torn fi­bres cause bleed­ing be­neath the skin. These do not al­ways re­spond to con­ser­va­tive man­age­ment and may re­quire sur­gi­cal in­ter­ven­tion Heal­ing and re­turn to func­tion de­pend on the grade of the sprain and al­though pain and swelling may re­solve in a few weeks, it can take sev­eral months (some­times up to a year) for full lig­a­ment heal­ing to oc­cur. Not all an­kle sprains heal as ex­pected and if symp­toms are still present after six months, the con­di­tion is then clas­si­fied as chronic.

Most sprains oc­cur when the an­kle twists in an out­ward mo­tion, stretch­ing all the struc­tures on the out­side as­pect of the an­kle. In se­vere cases it may cause a com­plete rup­ture of the lig­a­ment or even a frac­ture which would re­quire im­mo­bil­i­sa­tion.

Why are some peo­ple more pre­dis­posed to in­jury than oth­ers? Age, poor balance, weak­ness and pre­vi­ous in­juries are all fac­tors that in­crease the risk of in­jury. A pre­vi­ous in­jury that is left to heal with­out re­ha­bil­i­ta­tion can de­velop lax­ity in the lat­eral sup­port­ing lig­a­ments, with tight­ness and weak­ness of ten­dons and mus­cles which can af­fect pos­tural con­trol, static and dynamic balance, pro­pri­o­cep­tion (re­ac­tion time), biome­chan­ics and gait.

As with any in­jury, pre­ven­tion is al­ways bet­ter than cure. But we do not al­ways know we have a prob­lem un­til after the in­jury oc­curs. Work­ing on an­kle and balance ex­er­cises can re­duce the risk of in­jury but if you have al­ready had an an­kle in­jury, or an in­jury that keeps re­cur­ring, a phys­io­ther­a­pist can help iden­tify any weak­nesses and al­tered biome­chan­ics and de­sign a unique ex­er­cise pro­gramme based on your in­di­vid­ual needs. A re­cent study con­cluded that lower limb and balance ex­er­cises pre­scribed and su­per­vised by a phys­io­ther­a­pist have a greater suc­cess rate on re­cov­ery and pre­vent­ing re­cur­ring prob­lems than in­jec­tions or ex­er­cises that just fo­cus on an­kle strength.

If you sprain your an­kle, the first step is to re­mem­ber the Pro­tect Op­ti­mum Load­ing Ice Com­pres­sion El­e­va­tion pro­to­col, then speak to a phys­io­ther­a­pist about de­vel­op­ing an ex­er­cise pro­gramme that grad­u­ally in­creases in in­ten­sity as your pain and swelling re­duce. The most im­por­tant take-home mes­sage is: don’t ac­cept the un­ac­cept­able; a weak, un­sta­ble an­kle can have neg­a­tive af­fect on the whole body and cre­ate more prob­lems in the fu­ture.

Kim Jack­son is a UK-trained phys­io­ther­a­pist with over 20 years’ ex­pe­ri­ence. She spe­cialises in mus­cu­loskele­tal pain and dys­func­tion in­clud­ing back pain and sci­at­ica, stroke and other neuro con­di­tions plus sports phys­io­ther­apy, hav­ing worked with lo­cal, re­gional and in­ter­na­tional ath­letes and teams treat­ing in­juries and analysing biome­chan­ics to im­prove func­tion and per­for­mance. She is reg­is­tered with the Al­lied Health Coun­cil and is a mem­ber of PASL. She cur­rently works at Bay­side Ther­apy Ser­vices in Rod­ney Bay, O: 458 4409 or C: 284 5443; www.bayside­ther­a­py­ser­

The pain from an an­kle in­jury can resur­face at any time, es­pe­cial­lly if you’re not care­ful.

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