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1 Ankle Injuries & Treatment The easiest way to remember this is: R.I.C.E. Each of these letters stands for: Rest. Rest your ankle. Do not place weight on it if it is very tender. Avoid walking long distances. Ice. Ice helps to decrease pain and swelling. Ice therapy is also known as crytherapy or cold therapy. Do not apply ice directly to your skin for more than five (5) minutes as it can cause burns. Use Clingfilm around the foot first then the ice pack to cool your foot, ankle and heel, this can be used for longer periods, as long as you carefully follow the directions and discontinue its use if you have pain or a burning sensation. Compression. Compression involves using a wrap of some sort to help manually squeeze out the fluid from your ankle; this helps relieve pain and improve function. A compressive dressing that you apply around your ankle, and Be sure not to apply any compressive device too tightly and discontinue use if you are experiencing worsening of symptoms. Elevation. Elevate the ankle above the level of your heart to help reduce the fluid in the ankle after a sprain. Just like the old bad joke about the patient that told the doctor, "Doc, every time I do this, my knee hurts" and the doctor replies, "Well, don't do that!" Although this may seem humorous, there is some truth to the joke. Avoid such activities as squatting, kneeling, heavy lifting, climbing, and even running. Listen to your body and make a list of activities or movements that increase your pain and DON'T DO THESE THINGS. Also, make a list of activities and movements that reduce your pain and DO THESE THINGS. For example, many doctors recommend the following (be sure to check with yours to make sure he/she agrees). DON'T DO these if you have an ankle sprain: Avoid walking with poorly designed shoes Avoid walking on uneven surfaces such as beaches, trails and lawns. Avoid using the stairs, ladders, or any unprotected heights where you must balance yourself on one foot. Avoid allowing your ankle to hang down below your knee as this may increase swelling and pain.

2 DO these if you are recovering from a sprain: Keep you ankle elevated above your heart level. For example, lie on your back and elevate your ankle on a few pillows to keep it above your heart. Keep your ankle stable with an ace wrap. Keep your ankle cool with an ice bag, frozen vegetables (peas work best) After your swelling is reduced, do the exercises instructed by your Doctor or physiotherapist to help regain the motion of your ankle. Wear proper fitting, well-constructed shoes Have a positive attitude. Remember that most people with acute ankle pain recover within 2-6 weeks. Rehabilitate your ankle The key to this step is to remember controlled motions. This means you have complete control of these motions through a structured rehabilitation program. Most rehabilitation programs can be done in the convenience and privacy of your own home. The basic philosophy of rehabilitation for a simple ankle sprain is to strengthen and gently stretch the muscles around your ankle to help support the injured or strained muscles, tendons or ligaments. This may include stretching your heel cord and gently moving your ankles in and out to expedite the healing of your ankle ligaments. Remember that keeping your ligaments absolutely still for a prolonged period of time will actually starve your ligaments of the nutrition they need to repair themselves. In specific cases, your doctor may prescribe formalized physical therapy, with a therapist or trainer. The keys to rehabilitation include: Motivation to actually do the exercises. Correct exercises for your problem. See your doctor or physical therapist if you need advice in this regard. Proper equipment. This equipment can either be at your therapist's office; at your health club; or items that you purchase for use at home. We have found that people who do their exercises at home are much more likely to benefit from the program as they more frequently perform the exercises.

3 Sprained Ankle Injury Explained A sprained ankle is one of the most common injuries caused by participation in sports. It refers to soft tissue damage (mainly ligaments) around the ankle, usually caused by an inversion injury (where the ankle is twisted inwards) or an eversion injury (where the ankle is twisted outwards). Because of the position of the bones around the ankle, the inversion injury is far more common. This injury causes damage to the lateral ligaments on the outside of the ankle. The most commonly injured ligament is the Anterior Talo Fibular (ATF) ligament which, as the name suggests, joins the fibular and talus bones together. If the force to the ankle is more severe, the Calcaneo Fibular ligament (between the Calcaneus and Fibula) is also damaged. The Posterior Talo Fibular (PTF) ligament is very rarely damaged in comparison to the other two ligaments. In the case of an eversion injury the damage occurs on the medial (inside) of the ankle. The ligament on the inside of the ankle is called the Deltoid ligament and is very strong. It is so strong in fact that the bone on the inside of the ankle can be pulled off, in what is called an avulsion fracture, before the ligament is damaged. As well as damage to the ligaments, the capsule which surrounds the ankle joint is also damaged. The damage causes bleeding within the tissues and the ankle begins to swell up and can be extremely painful.

4 Ankle sprains can be classified as follows: First degree, where only a few ligament fibres are damaged Second degree sprain refers to more extensive damage to the ligament with associated swelling Third degree sprain refers to a complete rupture of the ligament with swelling and a possible joint dislocation In the more severe injuries there may be associated bone injury and it is wise to get an x-ray to determine whether there is a fracture. Sprained Ankle Injury Signs & Symptoms With a first degree sprain there is pain when turning the foot in or out and also pain when the damaged area is touched. With a second degree sprain the pain is more severe, there is swelling all around the area and it is painful to walk. With a third degree sprain the pain is excruciating and walking is impossible. There is gross swelling and there may be deformity if the ankle is dislocated. Sprained Ankle Injury Treatment In the first hours following the injury it is important the follow the PRICE protocol - protection, rest, ice, compression and elevation (never apply ice directly to the skin). Ice Packs for a period of twenty minutes every couple of hours may help with the pain but pain-relieving medication may also be necessary. The Aircast Ankle Cryocuff is the most effective method of providing ice therapy, whilst protecting the injured tissues from further damage, and is the professional's choice. It can provide continuous ice cold water and compression for 6 hours and significantly reduce pain and swelling. It is important not to put too much weight on the damaged ankle, so walking should be avoided if possible. Ankle injuries can be protected using a Reusable Plastic Cast Walker and these are regularly used by Premier League football players. Where a fracture is suspected an x-ray should be carried out at an accident and emergency department. If a fracture is found or a Grade Three sprain is diagnosed, the advice of the attending doctor should be followed. It should be borne in mind that some hairline fractures do not show up on x-ray until about days after the injury, so if the pain persists medical attention should be sought. What you can do In the case of a Grade Two sprain, crutches should be used to protect the injured ankle. However, it is important not to be on the crutches for longer than necessary and as soon as the pain allows the patient should begin to gently put weight through the ankle by walking. Reusable Plastic Casts can be very helpful as they protect the injured area and help to resolve ankle swelling.

5 In the early stages of the injury, ultrasound treatment is effective in encouraging the healing process and encouraging the formation of scar tissue to repair the ligament. Ligament Damage and Repair Explained Once the player is able walk on the ankle, more active rehabilitation can be started. In ankles that have been repeatedly sprained there is an inherent weakness which may require surgery. This can now be done arthroscopically where a camera is inserted into the ankle and flakes of bone and excess scar tissue can be removed. Sprained Ankle Injury Prevention What you can do Ankle instability is characterised by ankle weakness and giving way, even though the ankle ligaments are intact and the joint is mechanically stable. It is due to an impairment of proprioception, which leads to a lack of balance and ankle joint position sense. Proprioception is the mechanism by which nerve receptors in skin, muscle, ligament and joint tissue relay information to the brain about body position sense, where this information is quickly processed and movement strategies are formulated and executed using nerve signals to muscles. This mechanism can help you 'catch yourself' when you are about to turn your ankle. In the unstable ankle these receptors may have been damaged directly during an ankle sprain. This impaired proprioceptive ability may, therefore, lead to a delay in protective muscle activity and the resultant loss of postural awareness and stability around a joint. This may explain why recurrent ankle sprains are so common. The Wobble Board together with Ankle Braces is commonly used in the rehabilitation of ankle instability. Wobble Boards are designed to assist the re-education of the proprioceptive system by improving sensory receptor function. Previous research has also shown that wobble board training improves single leg stance ability and balance; while other studies have suggested that patients with ankle instability who underwent wobble board training experienced significantly fewer recurrent sprains during a follow-up period than those who did not follow the training programme. Taping and Bracing the ankle can also help to reduce recurrent ankle injury. Previous research has shown the injury incidence in students with taped ankles was 4.9 ankle sprains per 1000 participant games, compared with 2.6 ankle sprains per 1000 participant games in students wearing ankle braces. This compared with 32.8 ankle sprains per 1000 participant games in subjects that had no taping or bracing.

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