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Know your Injuries – Part 1: Ankle Strain Injury Management

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Dr Meenakshi (P. T.) with a Master’s Degree in Sports Physiotherapy is Gāyo Fitness Academy’s Hon. Senior National Faculty and Assessor in Sports Medicine, Sports Medical Rehabilitation and Exercise Therapy. Her impressive work experience includes working her Asst. Professorship in Department of Physiotherapy, P.D.M University Bahadurgarh (Haryana) and practice as Sports Physiotherapist in Sports Authority of India National Boxing Academy, Rohtak. She has attended to India’s world-class women’s boxing teams. She can be contacted at meenaxidhaka133@gmail.com. Dr Meenakshi writes and speaks regularly on exercise and sports injuries management.

Regular exercisers and keen sportspeople will always come across certain injuries suffered during the physical activity. A medical expert may not be available to render first aid and help in rehab. Nevertheless, the “victim” and his / her trainer or coach should be able to identify the injury, render first aid and if safely possible, start with basic rehab exercises.

Here, Dr. Meenakshi takes up ankle sprains and explains –

  • symptoms,
  • causes
  • prevention
  • first aid
  • basic rehab movements.

Ankle joint sprains are graded as –

  • 1st degree or Grade 1: mild ankle sprain
  • 2nd degree or Grade 2: moderate ankle sprain
  • 3rd degree or Grade 3: severe ankle sprain

Symptoms

  • Ankle pain at time of injury
  • A “popping” or tearing sensation in the outer part of the ankle
  • Tenderness or soreness around the injury site
  • Initially after injury, the victim is able to bear weight and walk without aid for about 30 to 45 minutes; however, depending on the grade of the sprain, swelling starts and victim beings lose capacity for weight bearing loads.
  • Swelling in the ankle joint

Initially there may not be any bruising which mat set in later, several hours after injury

Causes

  • Normally, stress applied from either side of the ankle joint shifts the ankle or heel bone out of its socket; the ligaments that usually hold the joint in place are stretched abnormally.
  • Risk increases with earlier ankle sprains
  • Any physical movement in which lateral displacement of the ankle is likely also increases the risk of sprain. This is not uncommon in running and walking on unstable or uneven surfaces as also sports like basketball, football, volleyball and long / high jumps in which the person accidentally lands on the side of the foot.
  • Poor tone or strength of the muscles in the ankle joint
  • Use of shoes that offer weak or zero lateral support to prevent sideways displacement

Prevention

  • It is very important to warm the ankle joints up before starting physical activities that risk lateral stress on the ankle joint, be it aerobic dance exercises or a sport like football.
  • It is equally important to strengthen the muscles in the joint. Quite often, exercisers and sportspersons focus on the larger muscles like quadriceps and hamstrings but neglect the crucial ankle joints.
  • If the person has history of ankle sprain, tape the ankle from midfoot to midcalf before warm up and activity. If tapes not available, a crepe bandage will also suffice.
  • Use appropriate, protective shoes and socks.
  • Provide the ankle adequate support for nine to 12 months after any significant ankle injury.

First Aid

Management will follow P.R.I.C.E. drill –

  • Protect the injured part, not allowing any further damage
  • Rest the injured part
  • Apply ice or cold treatment for 15-20 minutes (cold spray or direct application of ice, ice massage, cold gel packs, ice immersion, etc)
  • Compression: use of mild to moderate pressure to the injured area with bandages / crepe bandages is advisable.
  • Elevate the injured part against gravity to help reduce swelling

Current international standards have replaced P.R.I.C.E. with P.O.L.I.C.E.

  • P – Protection of injured part
  • O/L – Application of Optimal load (local injury factors) / Training load
  • C.E. – as mentioned earlier (ice + compression+ elevation)

EXERCISES TO PREVENT AND TO STRENGTHEN THE MUSCLES AROUND ANKLE JOINT AFTER SPRAIN

Watch Dr Meenakshi demonstrate and explain these movements

  1. Calf muscle stretch
  2. ROM exercise in pain free range(without bodyweight
  3. Standing dorsiflexion
  4. Towel crunches & marble pickup
  5. Isometric exercises (hold and press)– inversion, eversion, dorsiflexion, planter flexion we can use manual resistance or with help of rubber bands
  6. Strengthening exercises with the help of rubber bands.
  7. Heal and toe raises first with both feet and single leg (injured one)
  8. Balance exercises (star excursion test , single leg balancing on foam surface and balance board)
  9. Agility ladder exercises and many more

Finally, remember! Prevention is better than cure! Warm up and strengthen the ankle joint and at the same time, work on increasing its flexibility.