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The Therapist Is In...Twist and Shout! An Overview of Ankle Sprains

The Therapist Is In...
Twist and Shout! An Overview of Ankle Sprains
by Shannon Murphy, MPT

With all of the recent snow, ice, rain and mud, conditions have been ripe for slips and falls. Most people consider themselves lucky if they avoid a broken bone, but soft-tissue injuries can be serious as well. One common culprit is the ankle sprain.
What is injured in an ankle sprain?
A sprain, by definition, is an injury sustained by overstretching one or more ligaments. Ligaments, in turn, are strong elastic bands that connect various tissues and help to make the body stable - particularly your joints. This is particularly true in the case of the ankle, where the foot and leg bones are held together by a number of small and fragile ligaments. While ligaments can lengthen slightly to accommodate normal movements (which is good), a sudden misstep, fall, or rolling of the ankle can stretch them beyond natural limits - creating pain, swelling, and instability that makes re-injury of the same area a real concern.
Even though ankle sprains are common--as many as 25,000 U.S. citizens twist their ankles every day-they can be inherently serious because humans are upright creatures. Changing the ability to walk affects our balance...whether because of a limp, or because of our unfamiliarity with walkers and crutches. Being off balance can create a number of problems, including
* increased risk of falls and fractures in people who may already be frail.
* compensatory gait mechanics that affect other joints like the knee, hip and spine (even years later)
* limited speed, agility and power that diminish athletic performance
What to do - basic first aid
Major sprains - anything with instant swelling, severe pain, or a loud popping noise - should be medically evaluated to rule-out fracture. Even if the bone isn't broken per se, muscles can sometimes pull bone fragments off the main bone, in an injury known as avulsion.
Minor sprains can heal themselves in a matter of days with proper management. Initially, the main goal is to reduce inflammation with the principles of RICE management (for rest, ice, compression, elevation). Applying ice as quickly as possible following the injury minimizes swelling, pain, redness, and warmth. Resting the ankle and elevating it above your heart also helps to reduce inflammation and promote healing. Once the inflammation is calmed, scar tissue can start to repair the torn tissue. Some first-aid manuals now prescribe RICER (vs. RICE) for acute injury, with the last "R" standing for rehab!
How can re-injury be prevented?
It is important to provide support to the injured ligaments, while they heal and scar down. In the case of a fresh ankle sprain, a brace or ace-wrap can often help to stabilize the foot while maintaining compression to limit swelling. As the injury heals, however, it becomes important to train the body's muscles and reflexes to do that job-rather than relying solely on passive support. Strength and balance exercises are particularly important for ankle injuries, since good feet are a first line of defense against falls (especially as you age). Ligament strains and joint injuries decrease the body's sense of position awareness...and while some of that may be permanently lost, much can be re-established through proper exercise. Proper footwear (meaning well-fit, stable, supportive--including custom and non-custom orthotics) is also critical for many people...and is a smart way of preventing injury in the first place!

This series of columns are by Shannon Murphy, MPT, Owner/Director of BodySense PT. 9 Saint Paul St, 3rd Floor, Boonsboro, MD 21713. 301-432-8585 phone, 301-432-1987 fax, smurphy@bodysensept.com.

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