Rehabilitation Rehabilitation after ankle sprainafter ankle sprain

Dr. Ali Abd El-Monsif ThabetDr. Ali Abd El-Monsif Thabet

Introduction Introduction

The LCL is composed of three separate The LCL is composed of three separate bands that are commonly referred to as bands that are commonly referred to as separate ligaments. These are the separate ligaments. These are the anterior and posterior talofibular anterior and posterior talofibular ligaments and the calcaneofibular ligaments and the calcaneofibular ligament. ligament.

Introduction Introduction

The MCL is most commonly called the The MCL is most commonly called the deltoid ligament. As its name implies, the deltoid ligament. As its name implies, the deltoid ligament is a fan-shaped. deltoid ligament is a fan-shaped.

Kinematics Kinematics

The LCL helps control varus stresses The LCL helps control varus stresses that result in lateral distraction of that result in lateral distraction of the joint and helps check extremes the joint and helps check extremes of joint ROM, particularly calcaneal of joint ROM, particularly calcaneal inversion. inversion.

KinematicsKinematics

This ligament helps control medial This ligament helps control medial distraction stresses on the ankle distraction stresses on the ankle joint and also helps check motion at joint and also helps check motion at the extremes of joint range, the extremes of joint range, particularly with calcaneal eversionparticularly with calcaneal eversion

Pathomechanics Pathomechanics

Acute ankle trauma is responsible for 10 Acute ankle trauma is responsible for 10 to 40 percent of sports-related injuries to 40 percent of sports-related injuries and sprains account for 75-85 percent of and sprains account for 75-85 percent of ankle injuries. ankle injuries.

Injury mechanism Injury mechanism The most common mechanism of The most common mechanism of

injury in ankle sprains is a injury in ankle sprains is a combination of plantar flexion and combination of plantar flexion and inversioninversion

A twisting injury or going over on A twisting injury or going over on the ankle usually results in an the ankle usually results in an inversion of the foot and ankleinversion of the foot and ankle

Tackling to the medial aspect of the Tackling to the medial aspect of the foot (varus stress)foot (varus stress)

A medial ligament sprain is rare but A medial ligament sprain is rare but can occur particularly with a can occur particularly with a fracture. This happens when the fracture. This happens when the ankle rolls with the sole of the foot ankle rolls with the sole of the foot faces outwards, damaging the faces outwards, damaging the ligaments on the inside of the ankle. ligaments on the inside of the ankle.

Diagnosis Diagnosis

Tenderness along the joint, pain in Tenderness along the joint, pain in weight bearingweight bearing

Severe swellingSevere swelling

Diagnosing Ankle Sprains testsDiagnosing Ankle Sprains tests Anterior drawer testAnterior drawer test Talor tilt testTalor tilt test

Anterior drawer testAnterior drawer test

Perform the anterior drawer test with Perform the anterior drawer test with the ankle at 90° to the leg. Grasp the the ankle at 90° to the leg. Grasp the heel and pull forward while, with the heel and pull forward while, with the other hand, placing posterior force on other hand, placing posterior force on the tibia. If the test is positive, the so-the tibia. If the test is positive, the so-called suction sign occurs. Dimpling is called suction sign occurs. Dimpling is observed at the anterolateral aspect of observed at the anterolateral aspect of the ankle, indicating compromise of the the ankle, indicating compromise of the anterior talofibular ligament. A firm anterior talofibular ligament. A firm endpoint will be absentendpoint will be absent

Talar tilt testTalar tilt test The talar tilt test is used to examine the The talar tilt test is used to examine the

integrity of the calcaneofibular or the deltoid integrity of the calcaneofibular or the deltoid ligament. The patient is seated comfortably on ligament. The patient is seated comfortably on the end of an exam table. Possible alternate the end of an exam table. Possible alternate positions can be side lying or supine. The positions can be side lying or supine. The examiner grasps the foot with the ankle at 90° examiner grasps the foot with the ankle at 90° to the leg, while stabilizing the tibia and fibula. to the leg, while stabilizing the tibia and fibula. To test the calcaneofibular ligament the To test the calcaneofibular ligament the examiner will adduct and invert the calcaneous examiner will adduct and invert the calcaneous into a varus position. The deltoid ligament is into a varus position. The deltoid ligament is examined by abducting and everting the examined by abducting and everting the calcaneous into a valgus position. A positive test calcaneous into a valgus position. A positive test will result in laxity and/or painwill result in laxity and/or pain

FIGURE. Inversion stress test to assess the integrity of the calcaneofibular ligament.

Squeeze testSqueeze test

To perform the squeeze test, place the To perform the squeeze test, place the thumb on the tibia and the fingers on the thumb on the tibia and the fingers on the fibula at the midpoint of the lower leg; fibula at the midpoint of the lower leg; then squeeze the tibia and fibula together. then squeeze the tibia and fibula together. Consider pain along the length of the Consider pain along the length of the fibula, which indicates a positive test fibula, which indicates a positive test resultresult

The common causes of chronic The common causes of chronic ankle painankle pain

* Poor rehabilitation* Poor rehabilitation * A fracture that was not initially * A fracture that was not initially

diagnoseddiagnosed * Post traumatic arthritis* Post traumatic arthritis * Osteochondritis dissecans (loose bit of * Osteochondritis dissecans (loose bit of

bone in the joint)bone in the joint) * Syndesmotic ligament injury* Syndesmotic ligament injury * Functional instability (a feeling of * Functional instability (a feeling of

'giving way')'giving way') * Ankle impingement* Ankle impingement

Ankle sprain typesAnkle sprain typesThe sprained ankle is often classified as The sprained ankle is often classified as

to how severe it is:to how severe it is: First degree ankle sprain:First degree ankle sprain:

* Some stretching or mild tearing of * Some stretching or mild tearing of the ligament. the ligament. * Little or no functional loss - the joint * Little or no functional loss - the joint can still function and bear some weight can still function and bear some weight

* Mild pain * Mild pain * Some swelling * Some swelling * Some joint stiffness* Some joint stiffness

Second degree ankle sprain:Second degree ankle sprain:

*Moderate tearing of the ligament fibers *Moderate tearing of the ligament fibers

*Moderate instability of the joint *Moderate instability of the joint * Moderate to severe pain – weight * Moderate to severe pain – weight bearing is very painful (difficulty bearing is very painful (difficulty walking )walking )* Swelling and stiffness * Swelling and stiffness

A more effective means of immobilizing A more effective means of immobilizing the ankle (splints) may be neededthe ankle (splints) may be needed

Third degree ankle sprain:Third degree ankle sprain:

* Total rupture of a ligament - there is a * Total rupture of a ligament - there is a loss of motionloss of motion* Gross instability of the joint - joint * Gross instability of the joint - joint function is lostfunction is lost* Severe pain initially followed by no pain * Severe pain initially followed by no pain * Severe swelling * Severe swelling Cast immobilization is needed for at least Cast immobilization is needed for at least 2-3 weeks. 2-3 weeks.

  

Rehabilitation (sprained Rehabilitation (sprained ankle) ankle) All ankle sprains recover through three All ankle sprains recover through three

phases: phases: Phase 1Phase 1 includes resting, protecting the ankle includes resting, protecting the ankle

and reducing the swelling (one week). and reducing the swelling (one week). Phase 2Phase 2 includes restoring range of motion, includes restoring range of motion,

strength and flexibility (one week to two strength and flexibility (one week to two weeks). weeks).

Phase 3Phase 3 includes gradually returning to includes gradually returning to activities that do not require turning or activities that do not require turning or twisting the ankle and doing maintenance twisting the ankle and doing maintenance exercises. This will be followed later by being exercises. This will be followed later by being able to do activities that require sharp, sudden able to do activities that require sharp, sudden turns (cutting activities) such as tennis, turns (cutting activities) such as tennis, basketball or football (weeks to months). basketball or football (weeks to months).

Image 2 - Aircast gel ankle brace Ankle tape

Achilles tendon stretching using a towel.

Use of elastic tubing in strengthening exercises for eversion.

Single-leg toe raises done on a step

high-top shoes

Thank you