If you didn’t happen to read my last Newsletter, I wrote about my recent trip to Italy and my stumble in Venice which altered my trip slightly, but luckily No fraturra! I thought I would take the opportunity to thank you for all the comments and give you a little further ankle education, both on my own rehab and what I tend to do for others that present to my office with an acute ankle sprain.
I previously mentioned something called the Ottawa Ankle Rules. These are a set of rules to follow about whether or not an xray needs to be done on an ankle injury.
The Ottawa Ankle Rules helps you identify the painful areas. If pain is present in the shaded areas, an xray should be performed. A copy of my ankle xray is also shown below.
With any acute injury, I follow the PRINCE protocol.
Protect the area. This may mean splinting, or wrapping with gauze if there are cuts, pillows to help prevent bending, etc..
Rest the area by stopping the activity and diminishing the contractions of certain muscles
Ice to diminish swelling and encourage blood flow away from the area during the first 24-72 hrs
NSAIDS (over the counter, as long as you are able to take these), will also help with inflammation and pain
Compress to encourage blood flow away from the area when there is inflammation
Elevate to help drain the inflammation/swelling
I wasn’t able to ice until later in the evening, but I was able to wrap my ankle almost right away. Use a tensor or stretchy bandage that is 4-6” wide. This size allows for a bit more overlap of the bandage and is a bit more accomodating to going around your heel or other non-cylindrical bony shapes. Use crutches or a cane if available to you. Our family in Italy, brought me ice packs, arranged for a physiotherapist to make a “house call” and left crutches at my door when I returned from the hospital. As much as I am stubborn and push through pain, I was very happy to use the crutches so I could still move around and continue to enjoy my vacation.
Once I returned to Canada, I put the laser on my ankle covering all the structures on the lateral side. At this point the swelling was pretty much gone, but my first 2 days back at work, I continued to wear the tensor bandage and used the laser about 4x over the first week. Other modalities like ultrasound, electric stimulation, or TENS units are sufficient. The research isn’t clear if they really do anything, but there are claims that they stimulate your body’s natural pain relieving chemicals. So they may help with pain, or maybe it is the placebo effect!
Once the swelling was gone and I could weight-bear with no difficulties, I started working on increasing my pain-free range of motion and some light resisted exercise. I started with writing the alphabet with my toes almost immediately after the injury, working within my pain-free motion. But now, the pain was only at the end ranges, and there was stiffness. Using a band, I worked on the following to stretch my ankle muscles and help increase the range of motion.
Seated with legs straight banded dorsiflexion (pulling toes towards you)
Seated with legs straight plantar flexion (pointing toes away from you)
Medial rotation using mini band
Lateral rotation using mini band
Use this diagram to help you work on increasing your ranges of motion in all the directions the ankle moves.
Then use the band to pull in the opposite direction you are trying to strengthen. Start with a few sets of a small number of repetitions and work on increasing this number.
When you are feeling stronger and range of motion is back to normal you can begin with some weight-bearing, loaded exercises to further push the strength development in the leg while continuing to work on ankle maintaining adequate ankle motion. In addition, this is a good time to start working on balance. The exercises below go through clockwise from upper L and include: single leg squat clocks, double leg lateral hops, single leg hops (skater hops) and balance exercises single leg or double leg on different surfaces (hold with eyes open for 10sec, then try closing your eyes always making sure you are close to a wall to catch yourself shall you lose balance).
In addition to addressing the range of motion and strength and conditioning aspects of recovery, you should address your nutrition to ensure you are taking in adequate nutrients for proper healing. An excellent source of nutrients is a bone broth. When made correctly your bone broth will be full of collagen and minerals and other nutrients which will provide you with the building blocks for strong cartilage and bones. See my recipe further down in the newsletter.
If you have questions about any of the exercises above, please contact us for further instructions. Or, if you have suffered from a recent ankle sprain, use the button below to book in and have it assessed.