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Chronic ankle sprain
Ankle sprains are common sports injuries, especially in basketball, soccer, football, and running. This document provides treatment guidelines for both acute and chronic ankle sprains. The rehabilitation process involves regaining range of motion, strengthening muscles through exercises of increasing difficulty, training proprioception and balance, and returning to activity-specific training. Preventing relapses is important and can be aided by sports-specific and injury prevention exercises.
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Chronic ankle sprain
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- 2. Ankle Sprains inSports 53% - Basketball 19% - Soccer 9.3% - Football 7.2% - Running
- 3. physical therapy guidelinefor an chronic ankle complaint.
- 4. Impaired ankle function Acute Chronic POST TRAUMATIC SYSTEMIC TRAUMATIC A TRAUMATIC INFECTION OSTEOARTHRITIS
- 5. ACUTE ANKLE FUNCTIONAL WITH NEW SPRAIN INSTABILITY DAMAGE GUIDELINES WITHOUT NEW SUBTALAR DAMAGE INSTABILITY CHRONIC ANKLE SPRAIN DISTAL GUIDELINES TIBIOFIBULAR POST SYNDESMOTIC TRAUMATIC RUPTURE WITH SOFT TISSUE OSTEOCHONDRAL IMPINGEMENT LESIONS & DISCUSS WITHOUT SOFT WITH OSTEOPHYTE TISSUE REFERRING IMPINGEMENT PHYSICISN LOOSE SINUS TARSI BODIES/OCD SYNDROME
- 6. Factors involved functional instability Mechanical instability Disturbed Proprioception and balance Reduced muscle strength Slow muscle reaction times Reduced mobility Inappropriate complaint-related behaviour Inadequate acute ankle sprain rehab
- 7. Physical therapy treatmentgoals To achieve optimal functional recovery. The highest achievable or desired level of activities. To prevent relapses, exacerbations and further dysfunction.
- 8. Functional Rehabilitation Prolonged immobilization of ankle sprains is a common treatment error. Functional stress stimulates the incorporation of stronger replacement collagen. The four components of rehabilitation are: 1. Range-of-motion rehabilitation 2. Progressive muscle-strengthening exercises 3. Proprioceptive training 4. Activity-specific training
- 9. Range of Motion •Range of motion must be regained before functional activity is initiated. • Regardless of weight-bearing capacity, Achilles tendon stretching should be instituted within 48 to 72 hours after the ankle injury because of the tendency of tissues to contract following trauma.
- 10. INCREASING THE RANGEOF MOTION Achilles tendon stretch,
- 11. Range of Motion ABCs Inversion / Eversion Ankle Pump Alphabet exercises, Move ankle in multiple planes of motion by drawing letters of alphabet (lower case and upper case). Repeat four to five times a day. Exercises can be performed in conjunction with cold therapy.
- 12. PROGRESS ONCE ROMIS REGAINED Once range of motion is regained, and swelling and pain are controlled, the patient is ready to progress to the strengthening phase of rehabilitation.
- 13. Training strength Strengthening of weakened muscles conditioning of the peroneal muscles Strengthening begins with isometric exercises and progresses to dynamic resistive exercises
- 14. Muscle Strengthening Isometricexercises, Plantar flexion, Dorsiflexion, Inversion, Eversion, For each exercise, hold 1 second for concentric component and perform eccentric component over 4 seconds; do three sets of 10 repetitions; repeat two times a day.
- 15. Muscle Strengthening Toecurls and marble pickups, Two sets of 10 repetitions; repeat two times a day. Toe curls can be done throughout the day, at work or at home. Toe raises, heel walks and toe walks,
- 16. Heel walk & Toe walk
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- 18. Training balance &proprioception
- 19. 747 Stable platform 747 Reverse 747 spokes
- 20. Reverse 747 Stableplatform 747 Reverse 747 spokes
- 21. spokes Stable platform 747 Reverse 747 spokes
- 22. Training balance andProprioception
- 23. Training balance andProprioception
- 24. Training on theDyna disc
- 25. Training on theBosu ball
- 26. Training on theBosu ball
- 27. Training on theBosu ball
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- 31. Complex activity trainingfor football player with chronic ankle sprain
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- 34. STRUCTURE OF REHABILITATION IN SPORTS INJURY A stepwise approach Increasing the level of difficulty Increasing the speed, duration and dynamic quality of practiced movements. Training of specific skills Reset Talus in Mortise Peroneal tendon friction massage fibular head mobility
- 35. Reset the Talusin the Mortise • Apply traction with dorsiflexion and eversion • Quick tug to reset the talus in the mortise
- 36. Peroneal Tendon FrictionMassage Direct pressure to tendon in perpendicular direction Increases blood flow to the tendon Increases activity of fibroblasts Decreases fibrosis/adhesions Most effective with stretching and functional exercise
- 37. Correct posterior fibularhead – Passive Motion •Patient supine, knee flexed •Sit on foot •Stabilize knee with hand •Pull fibular head anterolaterally and then push posteromedially repeatedly
- 38. Correct posterior fibularhead – Muscle Energy Remember “PIP AID” For a Posterior fibular head, Invert and Plantarflex For an Anterior fibular head, Invert and Dorsiflex
- 39. Correct posterior fibularhead - HVLA •Patient supine, knee flexed •Physician’s hand in popliteal fossa, 1st MCP joint behind fibular head •Flex knee, externally rotate leg at knee •Thrust patient’s ankle toward buttocks
- 40. Exercising functions andskills • A symmetrical and dynamic gait should be strongly encouraged. • All relevant daily life activities should be exercised.
- 41. Training for Returnto Activity • When walking a specified distance is no longer limited by pain, the patient may progress to a regimen of 50 percent walking and 50 percent jogging. • When this can be done without pain, jogging eventually progresses to forward, backward and pattern running. Circles and figure-eights are commonly employed for pattern running. • Although these routines are time-consuming, they represent the final phase and are essential for the recovery of ankle stability.
- 42. AQUA AEROBICS VERYUSEFUL IN EARLY RETURN TO ACTIVITY
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- 44. Relapses prevention TREAT WITHPRICER NO MORE RICE REGIMEN FOR ANKLE
- 45. P.R.I.C.E.R Protocols Protect Rest limit weight bearing, crutches if necessary, an ankle brace helps control swelling and adds stability Ice No ice directly on the skin, no ice more than 20 minutes at a time to avoid frost bite. Compression can be helpful in controlling swelling and is usually accomplished with an ACE bandage. Elevate above the waist or heart as needed Rehab AOFAS updated Jan 2008
- 46. Relapses prevention Afterfinishing therapy, to pay attention to sports specific as well as prevention training. Use new sports shoes
- 47. No tapingor braces during training sessions use only at high risk sports
- 48. Injury Prevention NeuromuscularControl is the ability to compensate for uneven surfaces or sudden change in surfaces. It is retrained by using balance and agility exercises such as a BAPS board or standing on one leg with eyes closed as well as using a single leg on a mini trampoline.
- 49. Take home message Treatment of ankle sprain should consist of an exercise program that is as varied and intense as possible to obtain optimal ankle functioning The target performance level should be achieved at the end of treatment Do evaluate the eversion “red-headed step child” Whirl Pool/AquaAerobics If Accessible Of course Neuromuscular control
- 50. Thank you for yourattention
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- 52. REFERENCES Immobilisation andfunctional treatment for acute lateralankle ligament injuries in adults (COCHRANE Review)Kerkhoffs GMMJ, Rowe BH, Assendelft WJJ, Kelly KD, Struijs PAA, van Dijk CN(2009) Clinical practice guidelines for physical therapy in patients with chronic ankle sprain RA de Bie PT PhDI, MAMB Heemskerk PTII, AF Lenssen PT MScIII, SR van Moorsel PTIV, G Rondhuis PTV,DJ Stomp PT MScVI, RAHM Swinkels PT MScVII, HJM Hendriks PT PhDVIII(ROYAL DUTCH SOCIETY GUIDE LINE FOR PHYSIO 2003)