Ankle Sprain

Ankle Sprain

We have all had one - What Happened?

Ankle Sprain Anatomy

Everyone has suffered an ankle injury or sprain at some point in their life.  The most common form of an ankle sprain is an inversion mechanism of injury.  Inversion, meaning the inward twisting of the ankle, is most common because of the anatomy of the ankle joint comprised of the distal fibula and tibia.  The medial distal tibia, or medial malleolus, is much larger than the lateral malleolus and has stronger ligaments.  The medial ligament is call the deltoid ligament, which is a broad fanlike ligament.  On the lateral aspect of the ankle, there are mainly 3 ligaments:  anterior talofibular ligament, calcaneofibular ligament, posterior talofibular ligament.

A sprain is defined as partial tearing of a ligament.  Ligaments attached bone to bone and provide our skeletal system stability.  When the ankle is maximally inverted, when someone "rolls their ankle," the ligaments are stretched maximally.  One of 2 things will happen, either partial tearing of the ligaments, or indicates the ligaments are strong, the distal fibula will break.  If the force is great enough, the distal fibula will break and the medial deltoid ligament will pull strongly enough to fracture the medial malleolus.  Often this injury, called bimalleolar ankle fracture, require surgical repair.

Ankle sprains are graded on a scale of 1-3.  This refers to the severity of partial tearing of the ligament.  Generally, grade 1 is able to be "walked off," and involves less than 25% of the ligament.  Grade 2 requires some protected weightbearing with crutches and involves up to 50% of the ligament.  Grade 3, involves all of the ligaments being torn and the ankle will be unstable.

Sometimes a pop or snap was heard at time of injury.  It is very difficult to determine if there is an ankle fracture or sprain based on symptoms and a x-ray is required.  Once a fracture is ruled out, early rehabilitation is essential for return to function

Ankle pain, swelling, bruising are the most common symptoms after an ankle sprain.  Walking may be difficult but is encouraged as early as possible.  The traditional RICE treatment should be started initially.  Rice stands for rest-ice-compression-elevation.  I like to add a “N” to the end standing for NSAIDs – RICEN.

The initial treatment can be completed at home, physical therapy is definitely helpful because of their knowledge, ability is, equipment that the average person does not have available to them.  And important, often overlooked aspect of rehabilitation is massage.  Initially, in combination with elevation, light massage can help with edema and pain control.  Edema can slow down the healing process and removing it will improve healing.  After 7 days or so, deeper techniques can be implemented to increase blood flow.  After all, the foot and ankle is farthest from the heart, less blood supply means slower healing.

Cross friction massage is beneficial to break up scar tissue, increased blood flow to the ligament.  This should be done while the ligament is in a stretched position.  Pressure should be within limits of pain.  The movement should be across the tendon, back and forth like plucking a guitar string.  It will be uncomfortable but should not cause guarding.  Treatment length is advised to be 5 or 10 min. long.  Every other day versus every day is better for recovery.  If there is increased swelling, skip the next treatment to allow for the edema to resolve.

Bracing may be required to protect the ligament once returning to sport or activity.  Biking is a great initial activity because there is no lateral movements to the ankle.  Cutting sports should be the last activity to return.  Once you are able to walk in a straight line without pain, try jogging.  If able to jog, tried jumping and/or cutting activities.  Once you're able to pass these "functional" activities, he may return to her activity level.

It is very common for ankle swelling to persist for a couple of months.  Continue to treat conservatively with ice, anti-inflammatories, elevation.  Massage may be continued as needed.

There is essential to seek orthopaedic care immediately after the injury to rule out a fracture because this is very difficult to know without an x-ray.  However, it you're able to walk immediately after and his symptoms resolved after a couple of days, conservative treatment should be adequate.  It is any concern, please see your orthopaedic doctor.

Scar Massage

Scar massage is crucial to a full recovery after any surgical procedure or injury.  Scar tissue is how we heal.  Honestly, we heal quickly and messy.  Our body just wants to survive, and piecing itself back together quickly is essential.  When we heal, collagen knits us back together quickly and irregularly.  Whether it be our skin, fascia, muscle, or even bone a "scab" of cell building matrix begins the remodeling phase.  Our body heals that injury or insult over and over again for months and months.  This is why sometimes the area stays swollen or red for a long time; that is the healing process.
 

Scar after scar massage and remodeling

Sometimes, our body needs some help.  The collagen and healing matrix forms a messy pile or clump of fibers like a pile of pick-up-sticks.  One may remember that games of jumbled sticks on the ground.  In the same way, that how all those fibers are clumped.  Massage is a crucial therapy to help stress those fibers to get them to all line up in a line.  The act of massage disrupts that clump and will improve the remodeling of that scar.

The benefits are real.  Scar massage can improve the appearance of the scar and in some cases help it be invisible to a first glance.  It will also make the scar more supple and soft.  The tissue will move more naturally and freely.  Pain is usually reduced.  There are some topical products available at the drug store that can aid in scar remodeling.  But nothing beats trained hands.

There are a couple of different techniques and devices that can aid in scar massage.  Usually some time of lubricant is used.  Vitamin E containing products or lotions are known to aid in scar tissue reduction.  Stretching get muscles and tendons loose and supple.  Cross friction massage can be performed by rubbing one or two finger with mild to moderate pressure across or perpendicular to the scar to help those collagen fibers align.  Myofascial release (MFR) is used by massage and physical therapist to get the skin and deeper tissues, including the fascia to move freely as intended.  Finally, there are many devices and instruments that can aid in the massage and breaking up of scar tissue.  They can be used by professionals and at home alike.

All these methods and techniques can help scar tissue remodel after surgery or an injury.  This is essential for proper healing, scar appearance and pain reduction.  See your medical massage professional or physical therapist for scar management.  Check out these personal massagers that may aid in the massage of scar tissue.  Always check with a physician first to make sure scar massage is performed appropriately at the right time.