One of the most common injuries that most all of us have had at one time or another, an ankle sprain. We’ve all been there. Whether it be playing sports while growing up, stepping ever so slightly wrong off of a stair step, or any one of the ridiculous ways we have found to injure ourselves, the ankle is a very common injury. Most of us end up with what is known as an inversion sprain of the ankle, when we roll over onto the outside of our foot.
As a lifelong soccer player, I have had more ankle injuries than I care to recall. This makes me a perfect candidate to walk through the excellent rehabbing strategy that we offer here at Integrated Health Solutions. While you might not immediately think of a chiropractor being a doctor to turn to for problems away from the spine, at IHS we treat a plethora of injuries including but not limited to: shoulders, hips, headaches, knees and even ankles. The four main components to any ankle sprain/strain rehabbing process include: inflammation control, regaining confidence, increasing mobility and range of motion, and increasing stability and proprioception. In this month’s blog we will be going over these main components and walking you through the proper rehabbing of an ankle injury here at IHS.
I. Inflammation Control:
Understanding the Inflammatory Process: When an ankle is sprained, the body initiates an inflammatory response as a natural defense mechanism. Inflammation helps protect the injured area and promotes the healing process. This is similar to when your body is sick, and it generates a fever. It is seen and used as a defense mechanism and an internal treatment, however uncomfortable it may feel. However, excessive or prolonged inflammation can impede recovery and cause additional discomfort. This is often seen as the immediately acute process of discoloration/bruising and large increase of size in the ankle joint. The most common way to fight excessive inflammation is with the R.I.C.E. (rest, ice, compression, elevation) method.
The rest process simply involves avoiding weight-bearing activities to prevent further damage and allow the body to focus fully on the healing process. While it may seem tedious, spending the initial days after the injury off of your feet using crutches or sitting for long periods of the day, this is imperative to allow the healing process to begin. The icing process will reduce inflammation and manage short term pain control by numbing the region. This should be done for 12-15 minutes every 2-3 hours in the first few days. Icing a small joint like the ankle for too long (20+ minutes), can lead to degeneration of cellular activity at that level and actually slow down the healing process. Compression with a simple wrap further prevents swelling in the ankle and also provides added stability to the ligaments in the joint. This can also be seen in forms like a brace or a boot to add stability and prevent too much loading. Finally, elevation of the ankle above the heart will promote proper fluid drainage and improve overall circulation. This is mostly seen by laying or sitting down with the entire leg elevated with pillows/blankets to effectively move the blood back towards the heart.
Two additional ways to control the inflammation process are done with dry needling/medical acupuncture and soft tissue manual therapy. The dry needling process into a sprained ankle will relieve tension and muscle spasm in the surrounding musculature which inhibits proper blood flow and circulation. This is minimally invasive to allow for further healing, without having to apply large amounts of pressure to the ankle which can be uncomfortable at times. Soft tissue manual therapy (typically in the form of Graston, IASTM [instrument assisted soft tissue massage] or ART [active release therapy]) is performed later on, beginning at the far end of the leg and forcing the pooled blood back up the leg towards the heart for proper circulation and oxygenation. This process is done to allow the ankle to return to normal size, and begin to function as it was prior to the injury.
II. Regaining Confidence:
Mental and Emotional Recovery:
An ankle sprain not only affects the physical aspect but also has an impact on mental and emotional well-being. Regaining confidence is a crucial aspect of the healing process. Patience and Acceptance: Understanding that healing takes time is the first step in regaining confidence. Patience is key, as rushing the recovery process can lead to setbacks and further injury. Accepting the injury and its limitations allows individuals to focus on constructive rehabilitation and getting back to their normal daily activities without limitation. Psychological Support: Seeking support from friends, family, or mental health professionals can help individuals cope with the emotional challenges of an ankle sprain. A positive mindset contributes to a more successful recovery.
Gradual Return to Activity:
As confidence builds, it’s essential to reintroduce physical activities gradually. Following a structured rehabilitation plan under the guidance of a healthcare professional or physical therapist ensures a safe return to normal activities. Functional Exercises: Incorporate functional exercises that mimic daily activities or specific sports movements. These exercises help rebuild strength, balance, and coordination, fostering confidence in the ankle’s stability. Goal Setting: Setting realistic and achievable goals provides a roadmap for recovery. Breaking down large goals into smaller milestones allows individuals to celebrate progress and stay motivated throughout the healing process.
III. Increasing Mobility:
Range of Motion Exercises: Restoring ankle mobility is crucial for a complete recovery. Gradual introduction of range of motion exercises helps prevent stiffness and promotes flexibility. Alphabet Exercises:Performing ankle circles or writing the alphabet with the toes encourages movement in various directions, promoting flexibility and mobility. Towel Stretches: Sit on the floor with legs extended and a towel looped around the ball of the foot. Gently pull the towel towards the body, stretching the ankle and calf muscles.
Progressive Strengthening: Once mobility improves, incorporating progressive strengthening exercises is vital for rebuilding muscle strength around the ankle joint. Calf Raises: Start with simple calf raises, gradually progressing to single-leg calf raises. This exercise targets the muscles in the calf and helps improve overall ankle stability. Resistance Band Exercises: Utilizing resistance bands for exercises like dorsiflexion and plantarflexion helps strengthen the ankle in different planes of motion, enhancing overall stability.
The mobility portion of rehabilitation must be timed properly and if begun too early, can lead to re-injury. It is imperative to begin this portion with simple, light range of motion from a seated or supine position to take all load bearing weight off of the ankle and allow for motion to enter the joint. As the range of motion returns, the ligament stability will begin to recover and the more aggressive portion of exercise and rehab can begin, proprioception.
III. Proprioception:
Proprioception by definition, refers to the body’s ability to determine its location in time and space. In other words, it is imperative for your balance. When an ankle is sprained, the ligaments that surround the bones in the ankle are stretched and injured. This inhibits the structural integrity of the ankle and leads to a combination of compensation and discomfort. The first thing done to help improve coordination and proprioception is balance based exercises.
Using things like a wobble board or a foam balance pad are crucial to create a sense of imbalance in the body. What these items do is create a shaky and unstable foundation that the foot stands on. This forces a plethora of small movements in the foot and ankle, which in turn forces the ligaments to attempt to stabilize and create a point of structural integrity.
The difficulty of proprioceptive exercises, just like the other segments of recovery, begins on a minor level. Starting from simply standing on the foam pad for short periods of time, ranging to hand-eye coordinated exercises catching objects thrown at changing levels of height and speed. As the ligaments around the ankle joint begin to generate stability, the surrounding musculature will then be able to regain their strength and allow for a fuller range of function within the ankle.
A secondary form of proprioceptive rehabilitation given is known as proprioceptive neuromuscular facilitation, or PNF exercises. These exercises involve a series of contractions and relaxations to target a specific group of muscles to improve coordination and overall proprioception. This also helps improve range of motion. The exercises are an extended stretch contraction beginning at 50-60%of a max stretch which is held for 4-5 seconds and then relaxed. Each subsequent stretch is pushed to a further extent until the maximum range of motion is obtained in the joint. This will help give added motion and coordination to the balance that the proprioceptive exercises give to the ankle.
The final piece to proprioceptive work is coordination drill work. This incorporates hand-eye coordination drill work on a balance pad, agility ladders, etc. Being the final piece to the rehab component, it is important for this to simulate a more aggressive type of motion to ensure that the ankle is in a place of stability and confidence. This simulates activities like exercise, sports and other quick motions which the ankle is not entirely used to. Overall, these exercises improve neuromuscular control and enhance proprioceptive feedback to help bulletproof the ankle joint.
CONCLUSION:
In conclusion, the ankle is a vulnerable joint and is one of the most commonly injured joints in the body. These injuries can range from aggressive to mundane tasks, but the result can be staggering either way and lead to a long road of recovery. The treatment protocol for ankle rehabilitation consists of inflammation control, regaining confidence, improving range of motion and inducing proprioception. The treatment at Integrated Health Solutions targets this injury with our patented treatment protocol consisting of dry needling/medical acupuncture, soft tissue manual therapy, chiropractic adjustments/mobilizations and dynamic/functional rehabilitation.
Controlling inflammation is managed through the R.I.C.E. protocol, anti-inflammatory medication like N.S.A.I.D.S., and dry needling with soft tissue manual therapy to release built-up muscle tension and allow for the circulatory system to properly move excessive blood flow and inflammation away from the region. Regaining confidence comes from acknowledgment of a present injury, time for the injury to begin to heal, psychological awareness and assistance, and gradual easing into physical activity. Next is increasing range of motion. Immediately following an ankle injury there will be extreme tightness within the joint as well as restricted motion. Once inflammation is reduced and confidence begins to improve, the ankle must begin to move and regain the lost range of motion. This is done with exercises and mobilizations beginning with simple range of motion and continuing with added difficulty until full confidence is obtained. The final piece is adding in proprioceptive work. This is the most important and most time consuming piece of recovery due to its slow nature. Proprioception is added with balance pads to create more feedback into the ankle and stimulate the ligaments and muscles in the joint to finalize the healing and recovery process.
While it is not always an instant thought in the field of chiropractic, we are able to assist with a wide variety of injuries away from the spine that most would not think of. Here at Integrated Health Solutions, we pride ourselves on an integrated approach that allows us to widen our scope and assist with a plethora of conditions. If you or someone you know is struggling with an obscure injury, has made several attempts through many different doctors and is getting frustrated, please reach out to our staff and we would be happy to assist in any way we can.
Content provided by Dr. Jordan Miller
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P: 317-449-2020
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