|
Ankle
Injury: Prevention The First Priority!
A guide for the prevention and treatment of ankle injuries
Part 2
In part
1, we took a look at exactly what a sprained ankle is. We
had a look at the structures that make up the ankle joint; what
happens when an ankle injury occurs; the symptoms associated
with an ankle injury; and the major causes and risk factors
that contribute to ankle injury.
In part 2, we're going to start off by looking
at the risk factors and common causes of ankle injury, and then
look at a number of prevention strategies to help reduce those
risk factors.
Then we're going to outline a detailed strategy
for the complete treatment and rehabilitation of an ankle sprain.
Firstly, we'll look at the importance of the immediate treatment
(the first 48 to 72 hours). Secondly, we'll outline the ongoing
treatment necessary for a full recovery, and finally we'll look
at the rehabilitation and conditioning exercises needed to get
your ankle joint back to 100%.
Prevention should be your First Priority!
In part 1 we outlined a number of common causes
and risk factors associated with ankle sprains. They included:
a lack of conditioning; inadequate warm up and stretching; inadequate
footwear; training on uneven ground; and the big one, a previous
history of ankle sprains.
So what are some of the things you can do to
help prevent an ankle sprain?
Warm Up properly
A good warm up is essential in getting the
body ready for any activity. A well structured warm up will
prepare your heart, lungs, muscles, joints and your mind for
strenuous activity. If you'd like to know more about the warm
up, visit http://www.thestretchinghandbook.com/archives/warm-up.htm.
Plyometric Training
Plyometric drills include jumping, skipping,
bounding, and hopping type activities. These explosive types
of exercises help to condition and prepare the muscles, tendons
and ligaments at the ankle joint.
Balancing Exercises
Any activity that challenges your ability to
balance, and keep your balance, will help what's called proprioception:
- your body's ability to know where it's limbs are at any given
time.
Stretch and Strengthen
I'll cover these in a lot more detail a little
later on when I discuss rehabilitation and conditioning exercises.
Footwear
Be aware of the importance of good footwear.
A good pair of shoes will help to keep your ankle stable, provide
adequate cushioning, and support your foot and lower leg during
the running or walking motion.
Strapping
Strapping, or taping can provide an added level
of support and stability to weak or injured ankles. For a detailed
description of how to strap an ankle properly, visit http://www.smartplay.net/ouch/injury_manage/taping.html.
Immediate Treatment
The immediate treatment of any soft tissue injury
is vital. Proper care and treatment now will go a long way towards
a full recovery later.
Without a doubt, the most effective, initial
treatment for ankle sprains is the R.I.C.E.R. regime. This involves
the application of (R) rest, (I) ice, (C) compression, (E) elevation
and obtaining a (R) referral for appropriate medical treatment.
Where the R.I.C.E.R. regime has been used immediately
after the occurrence of an injury, it has been shown to significantly
reduce recovery time. R.I.C.E.R. forms the first, and perhaps
most important stage of injury rehabilitation, providing the
early base for the complete recovery of injury.
When an ankle injury occurs and the ligaments
have been damaged there is a large amount of uncontrolled bleeding
around the injury site. This excessive bleeding causes swelling,
which puts pressure on nerve endings and results in increased
pain. It is exactly this process of bleeding, swelling and pain
that the R.I.C.E.R. regime will help to alleviate.
R.I.C.E.R.
R:
(rest) It is important that the injured ankle be kept as still
as possible. This will help to slow down blood flow to the
ankle and prevent any further damage.
I:
(ice) By far the most important part. The application of ice
will have the greatest effect on reducing bleeding, swelling
and pain. Apply ice as soon as possible after the injury has
occurred.
How
do you apply ice? Crushed ice in a plastic bag is usually
best. However, blocks of ice, commercial cold packs and bags
of frozen peas will all do fine. Even cold water from a tap
is better than nothing at all.
When
using ice, be careful not to apply it directly to the skin.
This can cause "ice burns" and skin damage. Wrapping
the ice in a damp towel generally provides the best protection
for the skin.
How
long? How often? This is the point where few people agree.
Let me give you some figures to use as a rough guide, and
then I'll give you some advice from personal experience. The
most common recommendation is to apply ice for 20 minutes
every 2 hours for the first 48 to 72 hours.
These
figures are a good starting point, but remember, they're only
a guide. You must take into account that some people are more
sensitive to cold than others. Also be aware that children
and elderly people have a lower tolerance to ice and cold.
Finally, people with circulatory problems are also more sensitive
to ice. Remember to keep these things in mind when treating
yourself or someone else with ice.
Personally,
I recommend that people use their own judgement when applying
ice to themselves. For some people, 20 minutes is way too
much. For others, especially well conditioned athletes, they
can leave ice on for much longer. The individual should make
the decision as to how long the ice should stay on.
My
personal recommendation is that people should apply ice for
as long as it is comfortable. Obviously, there will be a slight
discomfort from the cold, but as soon as pain or excessive
discomfort is experienced, it's time to remove the ice. It's
much better to apply ice for 3 to 5 minutes a couple of time
an hour, than not at all.
C:
(compression) Compression actually achieves two things. Firstly,
it helps to reduce both the bleeding and swelling around the
ankle joint, and secondly, it provides support for the ankle.
Simply use a wide, firm, elastic, compression bandage to cover
the entire ankle and lower leg.
E:
(elevation) Simply raise the injured ankle above the level
of the heart at all possible times. This will further help
to reduce the bleeding and swelling.
R:
(referral) If the injury is severe enough, it is important
that you consult a professional physical therapist or a qualified
sports doctor for an accurate diagnosis. They will be able
to tell you the full extent of the injury.
Before we finish with the initial treatment
and move onto the next phase of the rehabilitation process,
there are a few things that you must avoid during the first
72 hours.
Be sure to avoid any form of heat at the injury
site. This includes heat lamps, heat creams, spas, Jacuzzi's
and saunas. Avoid all movement and massage of the injured area.
Also avoid excessive alcohol. All these things will increase
the bleeding, swelling and pain of your injury. Avoid them at
all costs.
After the first 48 to 72 hours?
So what happens after the first 48 to 72 hours?
Lets first take a quick look at how damaged ligaments repair
themselves.
When any sort of damage occurs to the ligaments,
the body immediately goes into a process of repair. Where the
individual fibres have been ruptures, or torn, the body begins
to bind the damaged fibres together using a fibrous protein
called collagen. Or, as it's more commonly known, scar tissue!
You see, when a ligament is torn, you would
expect that the body would repair that tear with new ligament.
In reality, this doesn't happen. The tear, or rupture, is repaired
with scar tissue.
Now this might not sound like a big deal, but
if you have ever suffered an ankle injury, (or any soft tissue
injury) you'll know how annoying it is to keep re-injuring that
same old injury, over and over again.
Scar tissue is made from a very brittle, inflexible
fibrous material. This fibrous material binds itself to the
damaged ligaments in an effort to draw the damaged fibres back
together. What results is a bulky mass of fibrous scar tissue
completely surrounding the injury site. In some cases it's even
possible to see and feel this bulky mass under the skin.
When scar tissue forms around an injury site,
it is never as strong as the ligaments it replaces. It also
has a tendency to contract and deform the surrounding tissues,
so not only is the strength of the tissue diminished, but flexibility
of the tissue is also compromised.
So, how do we get rid of that annoying formation
of scar tissue?
Firstly, you must keep active! Don't listen
to anyone who tells you to do nothing. Now is the time to start
active rehabilitation. Most of the swelling will have subsided
after the first 48 to 72 hours and you are now ready to start
light activity.
Light activity will not only promotes blood
circulation, but it will also activate the lymphatic system.
The lymphatic system is vital in clearing the body of toxins
and waste products, which can accumulate in the body following
a sports injury. Activity is the only way to activate the lymphatic
system.
Before we move on, a quick word of warning.
Never, Never, Never do any activity that hurts the injured area.
Of course you may feel some discomfort, but NEVER, NEVER push
yourself to the point where you're feeling pain. Listen to your
body. Don't over do it at this stage of the recovery, you've
come too far to blow it now.
To remove most of the unwanted scar tissue,
you now need to start two vital treatments. The first is commonly
used by physical therapists (or physiotherapists), and primarily
involves increasing the blood supply to the injured area. The
aim is to increase the amount of oxygen and nutrients to the
damaged tissues.
You see, ligaments receive very little blood
supply, as compared to a muscle for example. So it's vitally
important to increase the blood flow to the injured ligaments.
This will help supply the ligaments with the oxygen and nutrients
they need for a speedy recovery.
Physical Therapists accomplish this aim by using
a number of activities to stimulate the injured area. The most
common methods used are ultrasound and heat.
Ultrasound, or TENS (Transcutaneous Electrical
Nerve Stimulation) simply uses a light electrical pulse to stimulate
the affected area. While heat, in the form of a ray lamp or
hot water bottle, is very effective in stimulating blood flow
to the damaged tissues.
Secondly, to remove the unwanted scar tissue
it is vital that you start to massage the injured ankle ligaments.
While ultrasound and heat will help the injured area, they will
not remove the scar tissue. Only massage will be able to do
that.
To start with, the ankle will be quite tender.
So start with a light stroke and gradually increase the pressure
until you're able to use firm strokes.
Concentrate your effort at the direct point
of injury, and use your thumbs to get in as deep as possible
to break down the scar tissue.
Just a few final points before we move on. Be
sure to drink plenty of fluid during your injury rehabilitation.
The extra fluid will help to flush a lot of the waste products
from your body.
Also, I recommend you purchase a special ointment
to use for your massage called "Arnica". This special
ointment is extremely effective in treating soft tissue injuries,
like ligament sprains and tears. You can purchase this ointment
at most health food shops and pharmacies.
Click
here for Part 3: Sprained Ankle: Active Rehabilitation
Article
by Brad Walker. Brad is a leading stretching and sports injury
consultant with over 15 years experience in the health and
fitness
industry. For more articles on the prevention & treatment
of sports injury, subscribe to The Stretching & Sports
Injury Newsletter by visiting http://www.thestretchinghandbook.com
|
