Physiotherapy in Huntsville for Ankle

 

Welcome to ProActive Rehab's patient resource about ankle sprain and instability.

An ankle sprain is a common injury and usually results when the ankle is twisted, or turned in (inverted). The term sprain signifies injury to the soft tissues, usually the ligaments, of the ankle.

This guide will help you understand:

• how an ankle sprain occurs
• how the condition is diagnosed
• what can be done to treat a sprain

What part of the ankle is involved?

Ligaments are tough bands of tissue that help connect bones together. Three ligaments make up the lateral ligament complex on the side of the ankle farthest from the other ankle. They are the anterior talofibular ligament (ATFL), the calcaneofibular ligament (CFL), and the posterior talofibular ligament (PTFL). The common inversion injury to the ankle usually involves Two ligaments, the ATFL and CFL. Normally, the ATFL keeps the ankle from sliding forward, and the CFL keeps the ankle from rolling inward on its side. 

Ankle Ligaments

    

 

 

 

Related Document: ProActive Rehab's Guide to Ankle Anatomy

Why do I have this problem?

A ligament is made up of multiple strands of connective tissue, similar to a nylon rope. A sprain results in stretching or tearing of the ligaments. Minor sprains only stretch the ligament. A tear may be either a complete tear of all the strands of the ligament or a partial tear of only some of the strands. The ligament is weakened by the injury; how much it is weakened depends on the degree of the sprain.

Connective Tissue

The lateral ligaments are by far the most commonly injured ligaments in a typical inversion injury of the ankle. In an inversion injury the ankle tilts inward, meaning the bottom of the foot angles toward the other foot. This forces all the pressure of your body weight onto the outside edge of the ankle. As a result, the ligaments on the outside of the ankle are stretched and possibly torn.

A severe form of ankle sprain, called an ankle syndesmosis injury, involves damage to other supportive ligaments in the ankle. This type of injury is sometimes called a high ankle sprain because it involves the ligaments above the ankle joint. In an ankle syndesmosis injury, at least one of the ligaments connecting the tibia and fibula bones (the lower leg bones) is sprained. Recovering from even mild injuries of this type takes at least twice as long as from a typical ankle sprain.

Related Document: ProActive Rehab's Guide to Ankle Syndesmosis Injuries

What does an ankle sprain feel like?

Initially the ankle is swollen, painful, and may become bruised. The bruising and swelling are due to ruptured blood vessels from the tearing of the soft tissues.  The ankle swells as extra fluid continues to leak into the tissues over the 24 hours following the sprain.

People who have sprained an ankle often end up spraining the ankle again. If the ankle keeps turning in with activity, the condition is called ankle instability. Patients who have ankle instability lose confidence in their ankle to support them, especially on uneven ground. They often have swelling around the ankle that doesn't go away. Pain and swelling in a joint can cause a reflex where the body turns off the muscles around the joint. This can cause times when the ankle feels like it is going to give way, meaning it may have a tendency to twist again very easily.

Following an assessment your physiotherapist at ProActive Rehab will advise you of the findings and  create an individualized treatment plan.

She, or he,  may request additional testing to help define the true nature of your injury. Below is a guideline of what you might expect during rehabilitation for an ankle injury.

When you visit ProActive Rehab, we will do a physical examination to evaluate the injury and determine which ligament has been injured.

Our physiotherapist will move your ankle in different positions in order to check the ligaments and other soft tissues around the ankle.

Some of our tests involve placing stress directly on the ankle ligaments to see if the ankle has become unstable and to find out if one or more ligaments have been partially or completely torn. If a complete rupture of the ligaments is suspected, our therapist may refer you to a doctor for stress X-rays.

Non-surgical Rehabilitation

Even if you don't need surgery, you will likely need to follow a program of rehabilitation and exercise for your ankle injury. When you visit ProActive Rehab for physiotherapy in Huntsville, we can create a program to help you regain ankle function. It is very important to improve strength and coordination in the ankle.

Swelling and pain are treated with modalities like elevation and gentle movement. If swelling in the ankle is severe, our therapist may also apply massage strokes from the ankle toward the knee with your leg kept in an elevated position. This helps get the excess tissue fluid moving out of the ankle and back into circulation. Your physiotherapist may issue a compression wrap and instruct you to wrap your ankle and lower limb and to elevate your leg.

Many of the specific nonsurgical treatment options that we use at ProActive Rehab depend on whether your problem is an ankle sprain or ankle instability.

Ankle Sprain

The best results after an ankle sprain come when treatment is started right away. Our physiotherapists will use treatments to stop the swelling, ease pain, and protect the injured ankle from further injury. A simple way to remember the essential steps of treatment is by the letters in the words PEACE & LOVE. These stand for Protection, Elevation, Avoid anti-inflamatories, Compression, Educatio; Load, Optimism, Vascularization, Exercise

• PROTECTION - protect from further injury for 1-3 days and up to 10 days maximum.  DUring this phase it is important to change what you do and how you do it to avoid producing pain.
• ELEVATION - elevating the injury above your heart has been shown to help reduce swelling and aid your body in removing excess fluid.
• AVOID ANTI-INFLAMATORIES - this includes ice!  We now know  that the use of anti-inflammatory agents in an acute injury will  contribute to delayed healing, leaving the tissue more fragile and susceptible to repeat injury.
• COMPRESSION - wrapping a swollen joint helps to remove excess fluid
• EDUCATION - knowledge is power.  It is important for you to understand what is going on and why.
• & in the second phase 3-10 days post injury
• LOAD - using pain as your guide, it is important to start to load the tissue
• OPTIMISM - we now understand how important it is to be optimistic about your recovery.
• VASCULARIZATION - bloodflow to the injured tissue isvery important for the healing process there for pain free cardiovascular exercise is a key piece of the healing puzzle.
• EXERCISE - specific exercises to address mobility, strength and proprioception are imperative.

When the time is right, our physiotherapists may also apply specific hands-on treatment called joint mobilization to improve normal joint motion. These treatments help to restore the natural gliding motion between the ankle bones that may be restricted following injury. This form of treatment improves function after an ankle sprain. It may also help clients to return more quickly to their activity or sport.

Small nerve sensors inside the ligament are injured when a ligament is stretched or torn. These nerve sensors give your brain information about the position of your joints, a sensation called proprioception or position sense. For example, nerve sensors in your arm and hand give you the ability to touch your nose when your eyes are closed. The ligaments in the ankle work the same way. They send information to your nervous system to alert you about the position of your ankle joint. Our physiotherapist will help you retrain your position sense as a way to steady the ankle joint and protect you from spraining your ankle again.

Another effective treatment for ankle sprains is disc training using a circular platform with a small sphere under it. While sitting or standing, patients place their feet on the platform and work the ankle by tilting the disc in various directions. This form of exercise strengthens the muscles around the ankle, and improves balance and joint position sense.

When you get full ankle movement, your ankle isn't swelling, and your strength is improving, our physiotherapist will help you gradually get back to your work and sport activities. We may issue an ankle brace for athletes who intend to return quickly to their sport.

Although the time required for recovery is different for each patient, healing of the ligaments usually takes about four to six weeks.  Full functional redovery can take up to 12 weeks.

Physiotherapy for Ankle Instability in Huntsville

If the rehabilitation process is incomplete, you may end up with ankle instability. This can cause the ankle to give way and feel untrustworthy on uneven terrain. If your ankle ligaments do not heal adequately following an ankle sprain, your physiotherapist may suggest several things.

Physiotherapy treatments at ProActive Rehab will likely be initiated to help restore strength, and joint stability. Many people who have ankle instability have weakness in the muscles along the outside of the leg and ankle. These are called the peroneal muscles. Our physiotherapist can teach you strengthening exercises for these muscles to help you control the ankle joint and improve joint position sense.

Post-surgical Rehabilitation

Patients usually take part in formal physiotherapy after surgery. Rehabilitation after surgery can be a slow process. Although the time required for recovery varies, as a general guideline you should expect to attend physiotherapy sessions for two to three months, and should expect full recovery to occur over six months.

Rehabilitation proceeds cautiously after reconstruction of the ankle ligaments. Most patients are prescribed an ankle brace to wear when they are up and about, and they are strongly advised to follow the recommendations about how much weight can be borne while standing or walking.  You may be restricted to non-weight bearing for a period of time. We will also provide you with instructions to make sure you are using crutches safely and only bearing the recommended amount of weight on your foot.

Your first few physiotherapy treatments are designed to help control pain and swelling from the surgery. Our physiotherapist may use electrical stimulation treatments during your first few therapy sessions, progressing to massage and other hands-on treatments to ease muscle spasm and pain. Our physiotherapist will use treatments to help improve your ankle range of motion without putting too much strain on the healing ligaments.

After about six weeks we may have you begin doing more active exercise. Exercises are used to improve the strength in the peroneal muscles. Our physiotherapist in Huntsville will also help you retrain position sense in the ankle joint to improve the stability of the joint.

At ProActive Rehab, our goal is to help you keep your pain under control, improve range of motion, and maximize strength and control in your ankle. When your recovery is well under way, regular visits to our office will reducee and eventually come to an end. Although we will continue to be a resource, you will be in charge of doing your exercises as part of an ongoing home program.

ProActive Rehab provides physiotherapy in Huntsville.

If a complete rupture of the ligaments is suspected, you may need to see a doctor for stress X-rays. These X-rays are taken while the ligaments are placed in a stretched position. The X-ray will show a slight tilt in the ankle bone if the ligaments have been torn.

Surgeons will occasionally do procedures right away in athletes who tear a lateral ankle ligament. In most other cases of torn ankle ligaments, surgeons will try nonsurgical treatments before doing reconstructive surgery of the ligaments.

Ligament Tightening Procedure

Chronic ankle instability can happen when the lateral ankle ligaments are stretched or torn and the ankle keeps giving way. Surgery can be done to tighten the stretched ligaments and improve the stability of the ankle. The surgery usually involves the ATFL and the CFL.

In this procedure, an incision is made in the skin that lies over the lateral ligaments. Using a scalpel, the surgeon cuts the ATFL and CFL in half.

Holes are drilled along the lower end of the fibula bone, the small bone of the lower leg. The two ends of the cut ligament are overlapped and sewn together. The surgeon uses the drill holes in the fibula to hold the stitches to the bone.

A large band of connective tissue crosses the front of the ankle just below the lateral ligaments. This band, called the ankle retinaculum, holds the tendons in place. The surgeon pulls the top edge of the ankle retinaculum upward and sews it into the fibula. This helps reinforce the reconstructed ligaments.

The following images show each step of the ligament tightening procedure:

Step 1

Step 2

Step 3

Step 4

Tendon Graft Procedure

Another type of reconstruction is done using a tendon graft. If your surgeon feels that the stretched and scarred ligaments are not strong enough to simply repair in a ligament tightening procedure, then the ligaments must be reinforced with a tendon graft.

In this procedure, the surgeon removes a portion of one of the nearby tendons to use as a tendon graft. The tendon most commonly used attaches the peroneus brevis muscle to the outside edge of the small toe. A section of this tendon is put in place of the torn lateral ligaments.

After making the skin incision, the surgeon drills a hole in the fibula near the attachment of the original ligament. A second drill hole is made in the area where the ligament attaches on the talus (the anklebone).

The tendon graft is then removed (or harvested) and woven between these holes to recreate the ligament complex.

After surgery, you will probably be placed in a cast or brace for about six weeks to allow the tendon reconstruction to heal. Following removal of the cast, physiotherapy will be required to regain full use of the ankle.

 

Portions of this document copyright MMG, LLC.