Articles on sprained ankle

Why Is My Ankle Sprain Not Getting Better?

Dr. G K Sudhakar Reddy, Orthopedist
Most ankle injuries get better with rest, ice packs, painkillers and physiotherapy with no long-term problems. However, in about 5-10% the pain and instability may continue beyond the usual healing time of 6 to 12 weeks. The ligaments may fail to heal properly and become weak, or there may be damage to the joint itself or some other structure nearby. Ankle instability is when there is a tendency for the ankle to "give way", often with minor stresses making one prone to repeated ankle sprains. This is more commonly due to damage to the proprioceptive nerves than actual weakness of the ligaments. These are small nerve endings in the joint and ligaments which tell the brain where the ankle is and what position it is in.  If these nerve endings are not working properly, the brain does not get reliable information and the muscles around the ankle may not work together properly. How is the problem diagnosed? It is important to be examined by a specialist to look for any signs that you have some other problem around your ankle, such as damage to the joint surface. Ankle examination will reveal if the ligaments are lax. Investigations may be required like special stress X-ray views, MRI scans to look for ligament damage and other causes of painWhat can be done about ankle instability? The first treatment is a physiotherapy programme to re-train the proprioceptive nerves which are not working properly, by doing various exercises and activities. Exercises are also shown to stretching and  strengthening of the muscles around the ankle. A moulded insole may be advised for your shoe to reduce extra stress on the ankle ligaments. An ankle brace may help to tighten up or replace the ligaments. Many people will find their ankle much more stable and comfortable with physiotherapy.Will I need an operation? If problems continue like pain and instability despite other measures an operation might be required. A keyhole surgery (Arthroscopy) may be required to smoothen scar tissue, remove loose joint pieces and assessing ligament status. An operation to reconstruct the ankle ligaments may be needed if tests show that the ligaments are weak/lax.Consult an Orthopaedic/Sports specialist surgeon for further advice.

Ankle Sprain Exercises

Dr. Vishwas Virmani, Physiotherapist
Once your sprain has completely healed, a program of ankle exercises will also help prevent re-injury by making the muscles stronger, which provides protection to the ligaments. Try the following exercises:Ankle CirclesSit on the floor with your legs stretched out in front of you. Move your ankle from side to side, up and down and around in circles. Do 5 to 10 circles in each direction at least 3 times per day.Alphabet LettersUsing your big toe as a "pencil," try to write the letters of the alphabet in the air. Do the entire alphabet 2 or 3 times.Toe RaisesPull your toes back toward you while keeping your knee as straight as you can. Hold for 15 seconds. Do this 10 times.Heel RaisesPoint your toes away from you while keeping your knee as straight as you can. Hold for 15 seconds. Do this 10 times.In and OutTurn your foot inward until you can't turn it anymore and hold for 15 seconds. Straighten your leg again. Turn it outward until you can't turn it anymore and hold for 15 seconds. Do this 10 times in both directions.Resisted In and OutSit on a chair with your leg straight in front of you. Tie a large elastic exercise band together at one end to make a knot. Wrap the end of the band around the chair leg and the other end around the bottom of your injured foot. Keep your heel on the ground and slide your foot outward and hold for 10 seconds. Put your foot in front of you again. Slide your foot inward and hold for 10 seconds. Repeat at least 10 times each direction 2 or 3 times per day.Step UpPut your injured foot on the first step of a staircase and your uninjured foot on the ground. Slowly straighten the knee of you injured leg while lifting your uninjured foot off the ground. Slowly put your uninjured foot back on the ground. Do this 3 to 5 times at least 3 times per day.Sitting and Standing Heel RaisesSit in a chair with your injured foot on the ground. Slowly raise the heel of you injured foot while keeping your toes on the ground. Return the heel to the floor. Repeat 10 times at least 2 or 3 times per day. As you get stronger, you can stand on your injured foot instead of sitting in a chair and raise the heel. Your injured foot should always stay on the ground.Balance ExercisesStand and place a chair next to your uninjured leg to balance you. At first, stand on the injured foot for 30 seconds. You can slowly increase this to up to 3 minutes at a time. Repeat at least 3 time a day. To increase the difficulty, repeat with your eyes closed.

Ankle Wrap for Sprained Ankle

Dr. Vishwas Virmani, Physiotherapist
Pick your bandage. For most people, the best choice of wrapping for a compression wrap is a cloth elastic bandage, sometimes colloquially known as an “ACE bandage,” after a common brand of elastic bandage.Any brand of elastic bandage will work. However, wider bandages (between one-and-half and three inches wide) are usually easier to use.Cloth elastic bandages are comfortable, since they're made of stretchy cloth. They are also reusable. (When you're finished, you can wash it and use it again when you need it.)Some bandages come with metal clips for fastening the end of the wrap. If yours does not include metal clips, medical tape can also be used to secure the end of the bandage when the wrap is complete.Prepare the bandage. If your elastic bandage is not already wrapped, roll the bandage into a tight coil.[4]Compression wraps should fit against the foot and ankle snugly, so it helps to have the cloth wrap coiled tightly from the beginning, making it less likely that you will need to stretch and readjust the bandage as you go.Position the bandage. If you are wrapping your own ankle, it may be easier to position the rolled bandage on the inside of your foot. If you are wrapping someone else’s ankle, it may be easier position the rolled bandage on the outside of the foot.In either case, it’s crucial that coil face away from the foot, so that the coiled portion of the bandage is on the outside of the foot as you wrap it.For example, if you think of the coiled bandage as a roll of toiled paper and the foot as a wall, the coiled bandage should be in an “under” orientation.[5]Add extra padding, if necessary. For extra support, you can place a gauze pad on either side of the ankle before wrapping. Horseshoe-shaped padding cut from foam or felt is also used for extra stability in compression wraps.

R. I. C. E. Treatment of Ankle Sprains

Dr. A Mohan Krishna, Orthopedist
Ankle sprains or injuries are one of the commonest sports injuries in young individuals. Sprain is term used for torn ligament around any joint. Severity of injury depends on degree of ligament tear. Mechanism of injury is sudden twist of the leg over ankle on a completely rested foot on the ground. Most of the Grade I and Grade II are simple to treat if you follow a strict regimen described below.  The main aim of treatment is to rest the ankle for a period of 2 to 3 weeks immediately after injury.American Foot and Ankle society suggests R.I.C.E treatment for all grade I and II ankle sprains.R: Rest(R) Rest the injured ankle by not putting weight while walking. Use of crutches or walker can help to move around without keeping the injured limb on the ground. Rest for 2 to 3 weeks is compulsory for complete cure of ankle sprains.I:  Ice (I) Local ice pack application may help to reduce swelling and also the pain. Do not bring direct contact of ice on the skin. Use an ice pack or thin piece of cloth rolled on to the ice cubes for local application. This should be done intervals of 2 to 3 hours for 3 to 5 minutes.C: Compression(C) Compression with help of brace or crepe bandage may help to prevent swelling and also helps to support the injured ankle.E: Elevation(E) Elevate the injured ankle with a pillow. This can help to reduce the swelling.If the above mentioned steps are followed properly you can prevent the long term effects of ankle sprain like recurrent pain, instability and swelling of ankle.

Cheer for Team India, Play Like Team India- Let Us Help You Avoid Injuries!

Dr. Meeta Nanda (P.T.), Physiotherapist
As they say, “Cricket is a religion in India” which makes World Cup a mega festival. Looking at Team India’s such a Brilliant and hard working performance, lets talk about the probable injuries that may occur as a side effect of this hard work-Top 5 Cricket InjuriesHamstring StrainWhat is a Hamstring Strain?A Hamstring Strain is a tear in the muscle tissue. Hamstring strains tend to affect all cricketers regardless of position and account for around 15% of all cricket injuries. Hamstring strains occur during explosive sprinting activities such as bowling, taking a quick single or fielding a ball.What should you do if you suffer a Hamstring Strain?If you have a Hamstring Strain follow the RICE protocol - rest, ice and compression and elevation (never apply ice directly to the skin). If you have to apply ice at home, an Ice Bag is recommended. This is a safe method of ice application to avoid the risk of an ice burn.Seek advice from a doctor or Chartered Physiotherapist regarding rehabilitation . Most Hamstring Strains will be fully healed by 6 weeks, but recurrent problems can occur when a return to play is attempted too early.Low Back PainWhat can you do to prevent Low Back Pain?Fast bowling in cricket requires a combination of bending backwards together with rotation and side bending of the trunk. When repeated continuously this puts excessive stress on an area of the vertebra called the Pars Interarticularis and this is where a stress fracture develops.What should you do if you suffer Low Back Pain?A soothing Heat pack can reduce back pain and back muscle spasm. Once diagnosed, stress fractures of the lower back usually require 6 weeks of rest to allow the bone to heal. During this period, an exercise programme under the supervision of a Chartered Physiotherapist can be started . This focuses on exercises to increase the muscular stability in the lower back.Research has shown that poor muscular stability in the lumbar region can lead to low back pain. Core stability exercises target certain specific muscles which give the spine much better support. This prevents postural faults which can cause low back pain.Side StrainWhat is a Side Strain?A Side Strain is fairly common in cricket, where it typically occurs in bowlers. A Side Strain refers to a tear of the Internal Oblique, the External Oblique, or the Transversalis fascia at the point where they attach to the four bottom ribs.In cricket the bowlers suffer the Side Strain on the non bowling arm side as a result of a forcible contraction of the muscle on that side while they are fully stretched as the bowling arm is cocked for bowling.What can you do to prevent a Side Strain?Core strength exercises on an Exercise Mat using a Swiss Ball and Resistance Bands can improve muscle function across the trunk and pelvis and this can help to reduce the risk of a Side Strain.The number of overs bowled per session should be increased gradually and adequate rest periods should be provided to prevent fatigue.What should you do if you suffer a Side Strain?In the early stages an Ice Pack can be applied for twenty minutes every two hours. A Cohesive Compression Bandage can be applied to help to limit bleeding in the tissues. More active rehabilitation can be started under the supervision of a Chartered Physiotherapist, once the immediate pain resolvesShoulder PainWhat is Shoulder Pain?Shoulder pain is common in cricket because of the repeated actions of throwing and bowling. The Rotator Cuff muscles are small muscles situated around the shoulder joint, which can become damaged due to overuse during cricket.Rotator Cuff injuries often begin as inflammation caused by repeated irritation. If the cause of the inflammation is not addressed, partial tears may develop in the cuff that could eventually become a tear all the way through one or more of the Rotator Cuff muscles.What can you do to prevent Shoulder Pain?Correct throwing and bowling technique can help to reduce injury risk. Shoulder stabilization exercises under the supervision of a Chartered Physiotherapist can also help prevent damage to the Rotator Cuff tendons.It is important that any increase in the amount of training or competition must be gradual in order to prevent overload of the Rotator Cuff muscles. In particular, bowling and fielding practice should be increased gradually to allow the Rotator Cuff tendons to adapt.What should you do if you suffer Shoulder Pain?Physiotherapy treatment can reduce acute (short-term) inflammation and chronic (long-term) degeneration of the cuff where a tear is not present. The objective of physiotherapy treatment is to limit inflammation using Ice Therapy. Anti-inflammatory medication prescribed by a doctor is often helpful.Sprained AnkleWhat is a Sprained Ankle?A Sprained Ankle is damage to the ligaments and soft tissues around the ankle, usually as a result of the ankle being twisted inwards. The ankle ligament and soft tissue damage produces bleeding within the tissues and an extremely painful, swollen ankle.What can you do to prevent a Sprained Ankle?Research has shown that bracing or taping the ankle can help to reduce the risk of a Sprained Ankle.What should you do if you suffer a Sprained Ankle?Immediately following a Sprained Ankle you can follow the PRICE protocol - Protection with an Aircast Walker, Rest, Ice Therapy, Compression with a Cohesive Bandage and Elevation of the ankle to reduce swelling.Rehabilitation with a Chartered Physiotherapist significantly improves the outcome following a Sprained Ankle. Wobble Board training improves balance and proprioception.

6 Ways to Avoid Sports Injuries

Mr. Kaleem Mohammed, Physiotherapist
Most of us like to play some or the other sports. As long as we are injury free, it is always great fun, but sometimes sports injuries may take place, which can be a bummer!Sports injuries are commonly classified into trauma/acute injuries and overuse/stress injuries. The difference between the two is simple. Trauma injuries are due to a sudden twist or pull, or any other impact. Stress or overuse injuries occur when a part of our body is over-exercised without enough rest in between.Many lists describe the most common sports injuries in men. These lists have minor disagreements, but in general, they agree that the most frequent sports injuries are sprains (tearing of ligaments) and strains (over-stretching or tearing of muscles or tendons). Bruises or contusions are also a common result of trauma, but bruises rarely cause serious complications.Most common sports injuries include:BruisesKnee joint injuries: Pain, swelling, and stiffness ligaments or tendons injuriesAnkle sprain: Sprain, strains, fractures.Cuts and abrasionsDehydration: Excessive fluid loss causes heat exhaustion and heat stroke.Groin pull/strain: Symptoms include pain and swelling.Hamstring strain: Symptoms are a pain, swelling and bruising.Stress fractures: The impact of repeated jumps or running on hard surfaces can stress and break bones.Playing sports is much fun. Getting hurt is not.Follow these 6 steps to prevent injuries so you can stay in the game:1. Warm UpIt is not a good concept to just bolt on to the field and start playing. You should not even start stretching until you are a little warmed up. So take a light jog to get loosened up and ready to play. Increasing the heart rate and circulation; this loosens the joints and increases blood circulation to the muscles. Full-Body Stretch helps muscles to prepare them for physical activity and prevents injuries.2. Wear Protective GearProtective gears are anything you wear that helps keep you from injuries. The gear you use depends on the type of sports.The helmet is a most frequently used protective shield. It keeps you safe from head injuries when you are playing football, cricket, ice hockey, or baseball. Make sure you are wearing the right and comfortable helmet for your sport. Other sports require eye protection, mouth guards, pads, wrist, elbow, and knee guards, and a protective cup (for boys only). Moreover, don't forget your feet. Shin-guards are a must have gear for preventing trauma induced fractures in sports such as soccer and hockey.3. Proper healthy nutritionHealthy nutrition can enhance sporting performance because protein rich diet should provide enough protein to promote muscle mass growth and injury repair. Water is an excellent choice of fluid for athletes to help performance and prevent dehydration. Foods rich in unrefined carbohydrates, like whole grain bread and cereals, should form the basis of the diet.4. Early intervention and restMost of the sports injuries such as painful pulled muscle or sprains and strains are treated immediately with R.I.C.E. (rest, ice, compression, and elevation) protocol.Many sports physical therapists and athletes remember this short-form to help with sports injuries.Rest (minimizes motion and pressure over of the injured joint)Icing (apply an ice pack) to reduce pain and swelling and decrease blood flow to injured areaCompression (light pressure wrap to stop bleeding and swelling)Elevation (to drain the fluids from injured area to prevent swelling)5. Slow-fast-slow RhythmDuring physical activities, adding interval (slow-fast-slow) training into your exercise routine helps to improve your heart’s ability to beat at a high rate for prolonged periods. That is a real plus for your aerobic fitness. Moreover, oxygen is circulated in your body at a slower rate, so it increases your ability for a longer stay during workouts. The simple rule is that always warm up before any sports or exercise, and always cool down at the end by gently stretching your muscles and breathing out slowly.Further, when starting any weight bearing exercise after a while, always take precaution that you do not start off with a heavyweight, but a much lighter one that you can easily exercise with. Don’t worry if anyone is looking!If you manage to follow these simple five rules, you can easily avoid most types of sports injuries and continue to enjoy the sports you like.6. Do not over-stretch yourselfIt is critical to take part in physical activities, to listen to your body and know your physical limits. When you begin a new sport, begin steadily and slowly to avoid muscle pull. If you have not undertaken a strenuous exercise for some time, it is especially crucial to building up your endurance and strength gradually to avoid injury. It is essential when taking part in physical activities, to listen to your body and know your physical limits.

Ankle Sprain and Everything That You Need to Know!

Dr. Vishwas Virmani, Physiotherapist
Will I need to wear a brace?This will depend on how serious your sprain is, if you have other ankle injuries and how your doctor thinks your sprain should be treated. You may need to wear a brace or padded plaster, plastic or fiber glass splint for 10 days to 6 weeks. A brace or splint keeps the bones and injured ligaments from moving, which provides protection, reduces pain and speeds healing.How long before I can use my ankle?This depends on how serious your sprain is. If your sprain is mild, your doctor may suggest that you start trying to use your ankle again fairly soon--from 1 to 3 days after your injury.Special exercises are sometimes needed to regain strength and to help reduce the chance of ongoing problems. Your ankle may need to be supported by taping or bracing to help protect it from re-injury.What about medicine for pain?If you need medicine to ease the pain, try acetaminophen (brand name: Tylenol) or ibuprofen (brand names: Advil, Motrin, Nuprin).What is the best way to use ice?Putting ice on your ankle can be very helpful, but you also need to be careful. The cold can damage nerves if the ice is left in place too long.Ice can be left on your ankle for up to 20 minutes at a time. When your skin feels numb, it's time to remove the ice. Use ice treatments every 2 to 4 hours for the first 3 days after your injury. Ice treatments can consist of ice packs, ice slush baths or ice massages.To use ice packs, partly fill a plastic bag with crushed ice. Wrap a thin, wet cloth around your injury. Place the ice pack over this and then wrap an elastic bandage around the ice pack to hold it in place.For ice slush baths, fill a large bucket with water and ice. Place your ankle in the bucket until the skin gets numb.Ice massages can work well for small areas. Freeze water in 4- to 8-ounce styrofoam (coffee) cups. Tear the top part of the cup away from the ice. Hold the covered end and slowly rub the ice over the sprained area with a circular motion. Don't hold the ice on one spot for more than 30 seconds.How do I wrap a sprained ankle?Start by cutting out a horseshoe-shaped pad from 1 x 4- to 3 x 8-inch-thick felt. Put this pad around the outside of your ankle joint on both sides of your foot, with the open end facing up.Then wrap an elastic bandage, such as an Ace bandage, in a basket-weave "figure-eight" pattern. Leave your heel exposed. Reinforce your wrap with 21 x 2-inch adhesive tape over the elastic bandage.Ask your doctor to show you how to do this. The ankle shouldn't be wrapped so tightly that the blood flow is cut off.How soon can I exercise or play sports?If you're an athlete, you'll probably be able to return to your sport in several weeks, depending on how serious your injury is and what sport you're involved in. When participating in sports, you may need to keep your ankle braced or wrapped for support and protection.Bicycling, swimming or even running are usually okay to return to right away if they don't cause pain during or after exercise. But you'll still need to avoid pivoting and twisting movements for 2 to 3 weeks.How can I prevent re-injury?When your doctor feels you're ready to exercise again, you can help prevent further sprains and setbacks by wearing a semi-rigid ankle brace when you exercise for another 1 to 2 months.Special wraps that use hook and loop fasteners, or air-filled or laced braces may also help prevent re-injury. Wearing high-top tennis shoes may also help prevent ankle sprains if your shoes are laced snugly and if you also tape your ankle with a wide, nonelastic adhesive tape. Elastic tape or braces are usually not helpful because the elastic gives too much around the joint.