Ankle sprain or twisted ankle

A sprained ankle or twisted ankle is a common cause of ankle pain.  

More common is an inversion sprain (or lateral collateral ligament sprain) where the ankle turns over so the sole of the foot faces inwards, damaging the ligaments on the outside of the ankle.

A medial ligament sprain is rare but can occur particularly with a fracture. This happens when the ankle rolls the other way, so the sole of the foot faces outwards, damaging the ligaments on the inside of the ankle. 

The lateral collateral ligament comprises of 3 bands connecting the fibula anteriorly and posteriorly with the talus and with a 3rd band on the sides with the calcaneum. Severe the injury more the no. of bands injured.

In addition to the ligament damage there may also be damage to tendons, bone and other joint tissues, that is why it is important to get a professional to diagnose your ankle sprain.

                                          Grades of Severity for Sprained Ankles:

Sprained ankles, as with all ligaments sprains, are divided into grades.

Grade 1 sprain:

• Some stretching or perhaps minor tearing of the lateral ankle ligaments.
• Little or no joint instability. 
• Mild pain.
• There may be mild swelling around the bone on the outside of the ankle.
• Some joint stiffness or difficulty walking or running.

Grade 2 sprain:

• Moderate tearing of the ligament fibres.
• Some instability of the joint.
• Moderate to severe pain and difficulty walking.
• Swelling and stiffness in the ankle joint.
• Minor bruising may be evident.

Grade 3 sprain:

• Total rupture of a ligament.
• Gross instability of the joint.
• Severe pain initially followed later by no pain.
• Severe swelling.

                                                          

                                                         Treatment of a Sprained Ankle

Immediate First Aid for a sprained ankle:

Aim to reduce the swelling by PRICE as soon as possible.

P is for PROTECTION. The injured ankle should be protected with utmost care to prevent any further injury.

R is for REST. It is important to rest the injury to reduce pain and prevent further damage. Use crutches it necessary. Many therapists advocate partial weight bearing as soon as pain will allow. This is thought to accelerate rehabilitation.

I is for ICE or cold therapy. Applying ice and compression can ease the pain, reduce swelling, reduce bleeding (initially) and encourage blood flow (when used later). Apply an ice pack or similar immediately following injury for 15 minutes. Repeat this every 2 hours.

C is for COMPRESSION - This reduces bleeding and helps reduce swelling.

E is for ELEVATION - Uses of gravity to reduce bleeding and swelling by allowing fluids to move away from the site of injury.

Further treatment

In cases of severely injured ankle (grade 2 and 3) cast can be applied for 3-6 week as per the orthopaedics decision. At times surgical intervention may be needed.

Following the initial painful stage in grade 1 treated with PRICE and after removal of cast in severe cases, physiotherapy treatment can help the ankle return to normal as soon as possible.

Physiotherapeutic modalities like LASER therapy, Ultrasonic therapy and TENS can help reduce pain further and promote healing. Hot fomentation can increase the circulation of the area which further promote healing and increase the pliability of the tissues. Wax bath instead of hot fermentation can be used in cases where cast was applied. 

To strengthen the soft tissues around the ankle start with gentle isometric (tension building without movement) exercises, followed by range of motion exercises within the painfree limits. As for e.g.. writing the alphabets A-Z with the great toe on the floor, heal raises in sitting etc. Approach your physiotherapist to learn more.

Strength can be further developed though resisted exercises with the help of therabands.

The techniques like cross frictional massage and ligament stretching can be implemented to prevent adhession formation and to maintain the flexibility of the ligaments. This helps to reduce the chances of recurrent ankle sprain problems.

The calf muscles often tighten up to protect the joint following a sprained ankle, and so gently stretching the calf muscles can also help to maintain movement at the joint.

A wobble balance board is an important part of rehabilitation of ankle sprains to improve the proprioception (joint sense) which generally gets hampered after any injury.

Contact Pain Free Physiotherapy Clinic for Physiotherapy treatment of ankle sprain.

Dr. Roshan Jha (PT)

Sr. Physiotherapist 

Pain Free Physiotherapy Clinic

31 A, DDA Flats, Pocket 2, Sector 6, Dwarka

Ph. No. 8800299652

KNEE JOINT AND ASSOCIATED CONDITIONS

                    KNEE JOINT

The knee is a hinge-joint formed between the tibia (lower bone) and femur (upper bone), also called Tibiofemoral joint, which is dived into medial and lateral compartment. The patella glides over the front of femoral condyles to form a patellofemoral joint. In addition, there is superior tibiofibular joint between the tibia and the head of fibula(outer leg bone).

                                                                                                                                                                         The knee joint is particularly susceptible to traumatic injury because it depends more on the ligaments due to less musculature around it for its strength and stability.  

The space between the tibia and femur is partially filled by two menisci (inner and outer sides) that are attached to add congruency. They aid in lubrication and nutrition of the joint and act as shock absorbers.

The functions of different ligaments of the knee are:

LIGAMENT	FUNCTION
Medial Collateral (inner side ligament)	Prevents medial (inner side) opening up
Lateral Collateral (outer side ligament)	Prevents lateral (outer side) opening up
Anterior Cruciate (within joint on the front side)	Prevents anterior (front) translation of the tibia on the femur
Posterior Cruciate (within joint on the back side)	Prevents posterior (back) translation of the tibia on the femur.

It must also be remembered that the lumbar spine (lower back), hip, and ankle may refer pain to the knee, and these joints must be assessed if it appears that joints other than the knee may be involved.

CLINICAL SIGNIFICANCE:

§              

     Chondromalacia patella (also called patellofemoral syndrome): Irritation of the cartilage on the underside of the kneecap (patella), causing knee pain. This is a common cause of knee pain in young people.

§        Knee osteoarthritis: Osteoarthritis is the most common form of arthritis, and often affects the knees. Caused by aging and wear and tear of cartilage, osteoarthritis symptoms may include knee pain, stiffness, and swelling.

Knee effusion: Fluid buildup inside the knee, usually from inflammation. Any form of arthritis or injury may cause a knee effusion.

§      Meniscal tear: Damage to a meniscus, the cartilage that cushions the knee, often occurs with twisting the knee. Large tears may cause the knee to lock.

§       ACL (anterior cruciate ligament) strain or tear: The ACL is responsible for a large part of the knee’s stability. An ACL tear often leads to the knee “giving out,” and may require surgical repair.

§   PCL (posterior cruciate ligament) strain or tear: PCL tears can cause pain, swelling, and knee instability. These injuries are less common than ACL tears, and physical therapy (rather than surgery) is usually the best option.

§      MCL (medial collateral ligament) strain or tear: This injury may cause pain and possible instability to the inner side of the knee.

Patellar subluxation: The kneecap slides abnormally or dislocates along the thigh bone during activity. Knee pain around the kneecap results.

§     Patellar tendonitis: Inflammation of the tendon connecting the kneecap (patella) to the shin bone. This occurs mostly in athletes from repeated jumping.

PAIN CHARACTERISTICS AND THE POSSIBLE LESION

1	Sharp catching pain	Mechanical defect (trauma)
2	Aching type pain with morning stiffness which eases with movements but gets worst with exertion	Degenerative changes
3	Night pain	Degenerative changes, lateral cystic cartilage, Meniscal tear
4	Pain on weight bearing	Mechanical or arthritic lesion
5	Pain while climbing up or down the steps or rising from chair	Patellofemoral origin
6	Pain on twisting	Meniscal origin
7	Pain over bony eminence below knee in young adults	Osgood Schlatter’s disease

                                           Physiotherapy & Exercise

                     

We all know that your physiotherapist is an expert in the prescription of exercise appropriate to you and your injury or fitness level. As a part of their physiotherapy training, your physiotherapist not only is educated in injury diagnosis but also in exercise physiology or the science of exercise. This enables your physiotherapist to not only assess and diagnose your injury but also to prescribe injury, fitness or age-appropriate exercises targeted to you at that point in time.

What Exercises Should You Do?

It is important that your exercises should not be painful. While some personal trainers believe that the more painful the better, this is not the best for your body or injury. 

In fact, research does inform us that pain inhibits muscles from performing to their optimum. This argues the case that painful exercise is actually counter-productive.

You'll find that your physiotherapist will thoroughly examine you and prescribe a series of exercises suitable for you in quantities that will not injure you further. Please seek an exercise expert, such as your physiotherapist, when you are planning your rehabilitation.

What Happens When You Stop Exercises?

Without some simple exercises, we know that certain muscles can become weak. When these supporting muscles are weak, your injured structures are inadequately supported and predispose you to lingering symptoms or further injury. You can also over-activate adjacent muscles that may lead to further injury.

It is also important to understand that even if you are "in good shape," you may have weak localised or stability muscles.

When you have an injury, you should perform specific exercises that specifically strengthen the muscles around your injury and the adjacent joints. Your physiotherapist will assess your muscle function and prescribe the right exercises specific for your needs.

The exercises prescribed will usually be relatively simple, and do not require any special weights equipment, and can be performed safely at home.

Would You Stop Your Daily Prescribed Drugs?

When your physiotherapist prescribes your individualised dose or exercises, they are using their professional expertise to optimise your exercise dose. 

Would you just stop taking your regular blood pressure medication because you were too busy or didn't think it was working?  I would hope not!

Exercise when prescribed by an expert such as your physiotherapist should be treated as your mandatory dose as prescribed by your physiotherapist. Just like when you don;t take your blood pressure medication, you can't expect the drugs to work of you don't take it as prescribed by your health professional!

So, next time you skip your "exercise dose" just remember that you are not putting your health first.

If you have any questions, please contact PAIN FREE PHYSIOTHERAPY CLINIC.

Dr. AMITA VARSHNEY (PT)

BPT, DCPT, Mulligan Practitioner

PAIN FREE PHYSIOTHERAPY CLINIC

31-A, DDA Flats,Pkt II, Sector 6, Dwarka, New Delhi 110075

Ph. no. - 011-45020554, +918800299652