16Functional TestsWhile weight bearing the following should be performedWalk on toes (plantar flexion)Walk on heels (dorsiflexion)Walk on lateral borders of feet (inversion)Walk on medial borders of feet (eversion)Hops on injured anklePassive, active and resistive movements should be manually applied to determine joint integrity and muscle functionIf any of these are painful they should be avoided
17Prevention of Injury to the Ankle Stretching of the Achilles tendonStrengthening of the surrounding musclesProprioceptive training: balance exercises and agilityWearing proper footwear and or tape when appropriate
18Grading Scales for Sprained Ankles Most common ankle sprain.Mild pain, still weight baring.More painful, report popping sound.Can not bear weight.Stretching of lateral ligaments of the ankle.Extreme pain. Usually complete tear of one of the ankle ligaments.Sometimes fracture occurs also.GRADE IGRADE IIGRADE III
19Grade 1 Inversion Ankle Sprain EtiologyOccurs with inversion plantar flexion and adductionCauses stretching of the anterior talofibular ligamentSigns and SymptomsMild pain and disability; weight bearing is minimally impaired; point tenderness over ligaments and no laxityManagementRICE for 1-2 days; limited weight bearing initially and then aggressive rehabTape may provide some additional supportReturn to activity in 7-10 days
20Grade 2 Inversion Ankle Sprain EtiologyModerate inversion force causing great deal of disability with many days of lost timeSigns and SymptomsFeel or hear pop or snap; moderate pain w/ difficulty bearing weight; tenderness and edemaPositive talar tilt and anterior drawer testsPossible tearing of the anterior talofibular and calcaneofibular ligamentsManagementRICE for at least first 72 hours; X-ray exam to rule out fx; crutches 5-10 days, progressing to weight bearing
21Management (continued) Will require protective immobilization but begin ROM exercises early to aid in maintenance of motion and proprioceptionTaping will provide support during early stages of walking and runningLong term disability will include chronic instability with injury recurrence potentially leading to joint degenerationMust continue to engage in rehab to prevent against re-injury
22Grade 3 Inversion Ankle Sprain EtiologyRelatively uncommon but is extremely disablingCaused by significant force (inversion) resulting in spontaneous subluxation and reductionCauses damage to the anterior/posterior talofibular and calcaneofibular ligaments as well as the capsuleSigns and SymptomsSevere pain, swelling, hemarthrosis, discolorationUnable to bear weightPositive talar tilt and anterior drawer
23ManagementRICE, X-ray (physician may apply dorsiflexion splint for 3-6 weeks)Crutches are provided after cast removalIsometrics in cast; ROM, PRE and balance exercise once outSurgery may be warranted to stabilize ankle due to increased laxity and instability
24Rehab/Treatment Plan for Sprained Ankles RICEModalitiesExercises
25RICE Rest- stay off the Ankle, crutches may be needed Ice- 15 minutes a 4 to 5 times a dayCompression- ace wrap with horseshoe keeps the swelling downElevation- keep ankle above heart level when possible, allows gravity to pump out swelling
26Goals of RICE Limit Swelling Reduce pain Return to sport/activity quicker
27Modalities Used COLD WHIRLPOOL- 15 minutes a couple times a day Vasoconstrictors vessels around ankleStimulates pain killing receptorsSlows cell metabolismAids in reducing swelling
28Modalities Used HIGH VOLTAGE- Assists in activating pain killing receptors.Assists in muscle stimulation around ankle joint to aid in edema removal.ULTRASOUND-Assists in edema removal.Assists in bringing digestive enzymes to clean debris cells of the injured ankle.
29Rehab Exercises Range of Motion ABC’s One leg Stands BAPS Board Towel CurlsToe PickupsToe RisesTheraband
30Taping Vs. Wrapping TAPING- Psychologically better feeling to the athleteTight fitting at firstTape looses a large percentage of its support within the first minutes of competition
31Taping Vs. Wrapping WRAPPING- Purpose in wrapping is injury prevention.Wrapping will not eliminate sprained ankle, but it does minimize the severity of the sprain.
32Ankle Braces ANKLE BRACES- Many varieties and types. Lace Up Hinged Air CastsAll offer different levels of support.Large and competitive business market for ankle braces.