physiotherapy management after ankle injuries

1. - D R . K R U PA L M O D I ( M P T )
2 0 / 9 / 2 0 1 8
ANKLE REHABILITATION

2. 1) GASTROCNEMIUS STRAIN
• Aims
• to reduce pain and swelling with the use of ice and
electrotherapeutic modalities (e.g. TENS, magnetic field
therapy, interferential stimulation).
• Crutches may be necessary if the patient is unable to
bear weight.
• A heel raise should be used on both the injured and
uninjured side.

3. • Gentle stretching of the
gastrocnemius to the level of
a feeling of tightness can
begin soon after injury.

4. • Muscle strengthening should start after 24 hours.
• Concentric bilateral calf raise, followed by unilateral calf
raise with the gradual addition of weights and,

5. • Eccentric calf lowering
over a step gradually
increasing speed, then
adding weights. Low-
impact cross-training such
as stationary cycling or
swimming can be
commenced as soon as
pain allows.
• A progressive eccentric
strengthening program
that required patients to
perform three sets of 15
heel drops(15*3) twice a
day, seven days a week.

6. • Sustained myofascial tension
should be performed on the
muscle belly with digital
ischemic pressure to focal
areas of increased tone
and/or tenderness.
• Athletes should undergo a
graduated return to weight-
bearing, progressing through
walking, easy jogs and, as
eccentric strength returns,
include sprint and change of
direction drills.
SOFT TISSUE
THERAPY

7. • Transverse friction and longitudinal gliding soft
tissue therapy at the site of excessive scar tissue and
along the entire musculotendinous unit.
• Stretching serves to restore normal muscle length and
stretches should be held for at least 15 seconds.

8. 2) SOLEUS MUSCLE STRAIN
• Treatment of soleus
muscle strains involves
the use of heel raise and
stretching (lunge).
• Soft tissue therapy is
directed at the site of the
lesion as well as tissue
proximally and distally.

9. • Strengthening exercises
are prescribed for the
soleus muscle.

10. 3) ACHILLES TENDON RUPTURE
• Initial Phase:
• Adjustable boot locked out at 30degrees of plantar
flexion.
• Nonweightbearing for 3 weeks--no push off or toe-touch
walking.
• Pain and edema control (i.e. cryotherapy, electric
stimulation, soft tissue treatments)

11. • Exercises
• Toe curls, toe spreads, gentle foot movement in boot,
straight leg raises, knee flexion/extension.
• Well-leg cycling, weight training, and swimming for
cardiovascular.
• Gradually increase weight bearing from toe-touchdown
to partial as tolerated and as able per range of motion
(heel contact once partial weight bearing).
• After 6 weeks, progress to full weight bearing.

12. • Manual
• Soft tissue mobilization to ankle, foot, effleurage for
edema.
• Initiate gentle passive range of motion dorisflexion (not
past neutral), inversion, eversion per tolerance.
• Tendoachillis strengthening.

13. LCL(ANKLE SPRAIN)REHABILITATION
1) Initial management
• RICE treatment.
• Limits the hemorrhage and subsequent edema that would
otherwise cause an irritating synovial reaction and restrict joint
range of motion.
• The injured athlete must avoid factors that will promote blood
flow and swelling, such as hot showers, heat rubs, alcohol or
excessive weightbearing.
• Gradually increased weight-bearing will, however, help
reduce the swelling and increase the ankle motion, and
enhances the rehabilitation.

14. 2) Reduction of pain and swelling
• Analgesics may be required.
• After 48 hours, gentle soft tissue therapy and
mobilization may reduce pain.
• By reducing pain and swelling, muscle inhibition around
the joint is minimized, permitting the patient to begin
range of motion exercises.

15. 3) Restoration of full range of motion
• The patient may be non-weight-bearing on crutches
for the first 24 hours but then should commence partial
weight-bearing in normal heel–toe gait.
• This can be achieved while still using crutches or, in less
severe cases, by protecting the damaged joint with
strapping or bracing.
Lunge stretches and accessory and physiological
mobilization of the ankle , subtalar and midtarsal joints
should begin early in rehabilitation.

16. 4) Muscle conditioning
• Active strengthening exercises,
including plantarflexion, dorsiflexion,
inversion and eversion, should begin
as soon as pain allows.
• They should be progressed by
increasing resistance.
• Strengthening eversion with the
ankle fully plantarflexed is
particularly important in the
prevention of future lateral ligament
injuries.

17. • Weight-bearing exercises
(e.g. shuttle, wobble board
exercises) are encouraged
as soon as pain permits,
preferably the first or second
day after injury.

18. 5) Proprioception
• Assessment of proprioception - Single-leg standing with
eyes closed may demonstrate impaired proprioception
compared with the uninjured side.
• Proprioceptive retraining should begun early in
rehabilitation and these exercises should gradually
progress in difficulty.
• An example : balancing on one leg, then using the rocker
board or minitrampoline, and ultimately performing
functional activities while balancing.

20. 6) Functional exercises
• e.g. jumping, hopping, twisting, figure-of-eight
running can be prescribed when
the athlete is pain-free, has full range of motion and
adequate muscle strength and proprioception.

21. • Any athlete who has had a significant lateral ligament
injury should use protective taping or bracing while
playing sport for a minimum of six to 12 months
post-injury.
• There are a number of methods to protect against
inversion injuries.
• The three main methods of tape application are stirrups
(Fig. 33.8a), heel lock (Fig. 33.8b) and the figure of six
(Fig. 33.8c). Usually at least two of these methods are
used simultaneously.

24. • Braces have the
advantage of ease of fitting
and adjustment, lack of
skin irritation and reduced
cost compared with taping
for a lengthy period.
• There are a number of
different ankle braces
available. The laceup
brace is popular and
effective.