Dr. Mathew Ullom, B.S., D.C.

2550 Stover St., Bldg.F

Fort Collins, CO 80525

p.970.491.9191 | f.970.223.2293

DrUllom@RockyMountainChiroCare.com

Ankle Injuries

Spring is here and when the weather warms up, that means more outdoor activities to do. Whether that means hiking your favorite trail, running just for fun, or playing with your kids at the park, this sudden increase in exercise leaves your deconditioned ankles at risk. You may have rolled your ankles multiple times before, but this time your ankle is really bothering you and you begin to wonder what is causing this to happen.

What actually happens to your ankle?

When you roll your ankle in the most common fashion, it happens like in the picture above. The tibia moves laterally over your talus, which is inverting, while your calcaneous moves medially, and your cuboid moves inferiorly. The severity of the injury can fall into a few different categories: strains, sprains, tears, or fractures.

Sprain or Strain: Is there a difference?

Simply described, strains are injuries of the muscle and fascia. In a mild strain only a few muscle fibers are injured, the fascia is intact, and little function is lost. A severe strain is very painful and accompanied by discoloration caused by blood vessel rupture. The fascia and many muscle fibers tear, and muscle function may be lost completely. Sprains result from overstretching or tearing of the connective tissues, ligament, and/or tendons.[i] In severe sprains the tendons can tear or pull away from the bone causing fracture. These two can occur simultaneously, as ankle injuries are notoriously complex.

Treatment Options for Ankle Injuries

Treatment plans for ankle injuries depend largely on the severity of the injury. The options for treatment range from conservative to invasive. By following proper treatment, most ankle sprains heal within two to six weeks, but may take longer depending on injury severity and patient compliance. You may need to use crutches to assist you during walking. Consult your healthcare provider to reduce the risk of re-injury or setbacks.

Swelling and pain are the body's way of making you take a time out and rest so that you don't injure yourself further. Applying ice In 20 minute intervals four to five times a day in the beginning stages is a good way to reduce swelling and control pain. Caution should be used when icing due to the potential of tissue damage, when icing for longer periods of time than directed.

Compression therapy is great for stabilizing the area and used to help your body to push the Inflammation from the affected area. Using elastic wraps, air casts, or splints not only help to reduce the edema but also protect the ankle by immobilizing it.

Elevation of the injured part helps to decrease the edema in the ankle due to pooling of blood as a result of gravity. Keeping the ankle elevated on a few pillows, ideally above heart level will decrease swelling and pain of your injury.

RICE Therapy: RICE is an acronym for Rest, Ice, Compression, and Elevation. This can be used to address the initial early signs of inflammation, edema, and swelling, which are present in most traumatic injuries.

Contrast Therapy: aka Hot/Cold Inversion Therapy is to speed up the process of reducing inflammation, by using the pumping action of vasoconstriction and dilation.[ii] This helps to break up fibrin plugs that formed from tissue damage, so that local lymphatic channels can reopen to reduce the swelling to the injured area.

This is performed by using two tubs, new trash cans work beautifully, with water filled to 12 to 14 inches of water in each tub. One will be an ice bath with cold water and one-third ice, and the other will be warm water about 100-degree Farenheight. You should then place the effected ankle in the Ice bath for one minute and then into the warm bath for one minute, alternate back and forth for 11 minutes being certain to finish with the ice bath. If at any time you feel nauseous, dizzy or experience chest pains stop and consult a health care professional.

Passive therapies: Passive therapies are those which the patient has no active part in and just has to relax while the therapy is performed. Therapies such as muscle stimulation, ultrasound, and cold laser have been proven effective to help with reducing painful symptoms, decreasing local swelling, retarding muscle wasting, and stimulating healing.[iii]

Ankle Supports: To provide temporary support and stability to the injured ankle, supports can be used as a short-term solution. They can prevent motions that may cause re-injury to the vulnerable joint. Bracing may include the use of air splints, lace-up ankle braces, elastic wraps, taping, or removable cast boots. Long-term use of braces is not advised because it deconditions the musculature surrounding the joint, weakens ligaments, and can cause bone density loss.i

Chiropractic Adjustments: Chiropractic care helps to restore function to joints of the foot and lower extremity that are "locked up", fixated, and not moving properly. Muscles, tendons, and ligaments depend upon proper joint movement to function at optimal levels. Normalizing joint function helps speed the healing of soft tissues and reduces the deconditioning effect of being immobilized.

Rehabilitaion: Mobilization of the ankle should be performed as soon as tolerated to avoid long-term stiffness and swelling of the joint. [iv] A physical therapy program consisting of range of motion exercises, stretching, muscle strengthening, and movement pattern retraining can be implemented for this purpose.

Another component of this rehabilitation process Includes retraining the ankle joint to protect against abnormal movements. Proprioception Is the body's ability to sense movement and position of body parts. Nerve endings In the ankle joint may be Injured during an ankle sprain, making this process more difficult. Retraining faulty movement and stabilization firing patterns will help train the body to protect itself from abnormal motion that can cause re-Injury. This Is accomplished by using physical therapy devices such as a wobble board and unstable surfaces to retrain the ankle for uneven terrain.

Footwear: Shoes worn after ankle injury should have greater support around the heel and may extend above the ankle joint to provide additional stability. Trained personnel at your local athletic store can direct you to the shoes that would best support your vulnerable ankle.

This article is not written for the purposes of diagnosing, treating, or rehabilitating any condition, symptom, or disease. This is written for informational purposes only. Please have your condition evaluated by a healthcare professional.