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Ankle Injuries: The Details on Sprains and Strains

February 11, 2018

I have ankle injuries on the brain right now! Not only did I just finish teaching the unit on rehab for sprains/strains, but I have also seen 3 new patients who have rolled their ankles in the past week. Ankle sprains are one of the most common injuries I see in my dancers, however, they are also very common in the general population (athlete or not). This post is specifically discussing ankle injury, but just note that sprains and strains can occur anywhere in the body and all follow a similar healing process. 

 

The most common type of injury to the ankle occurs from an inversion movement. This can be from landing a jump wrong, planting and twisting on your foot or (for my dancers) rolling the ankle while on pointe. The ligaments on the outside of the ankle are weaker and less stable than the ones on the inside, so they tend to get injured much easier.

 

When you roll your ankle it is possible to suffer a ligament sprain, muscle strain or both at the same time. Below is a quick reference to help you understand the difference between the 2 types of injuries. Ultimately, your best option for either injury is to seek medical attention from a qualified professional, such as a Physical Therapist, to ensure a proper diagnosis and subsequent treatment plan.

 

 

SPRAIN:

A sprain is an injury to a ligament. Ligaments are pieces of tissue that connect bone to bone and provide stability to our joints. They are not capable of contracting like a muscle, so once they are torn or stretched they cannot regain their previous level of tension. We need our ligaments to stay functioning properly to prevent excessive movement and instability in areas that we do not want it.

 

Sprains occur when excessive force is applied to a joint, such as landing a jump wrong causing the ankle to roll. If the stress is too high for the supportive tissues to handle, it will either stretch out too far or tear. This can then set off the inflammatory process which affects normal functioning.

 

Sprains are classified by 3 grades of injury. As you can imagine, the type of treatment and healing time for each grade will vary based on the extent of the injury.

 

Grade 1

  • What it means: The ligament is over stretched but the fibers remain intact

  • Symptoms: minimal pain and swelling, minimal loss of function so often still able to continue activity

Grade 2

  • What it means: At least half of the ligament fibers have been torn

  • Symptoms:  moderate pain, swelling, bruising and loss of function (things like walking or trying to balance on 1 foot become difficult and unsteady), unable to continue activity

Grade 3

  • What it means: The ligament is torn completely

  • Symptoms: Pain, severe swelling, bruising and full loss of function; will likely need surgical intervention

 

STRAIN:

A strain is an injury to the muscle. Muscle is tissue that is capable of contracting and producing movement, so when it is injured it will affect our strength and range of motion. Muscles can regain their strength and flexibility after injury, however, they will never return to 100%.

 

Muscle strains occur in 2 ways:

1) Excessive stretch is applied to the muscle. An example of this is going into an extreme movement, such as a split, too quickly or before you are properly warmed up.

2) A muscle contraction that is too forceful or excessive. An example would be trying to lift a box that is too heavy, resulting in tearing of the muscle fibers.

 

Just like sprains, there is a grading scale used for muscle strains. In general, healing times for muscle injuries are slower and lengthier than ligament injuries because of the type of tissue involved. 

 

Grade 1

  • What it means: One a few muscle fibers are irritated from being overstretched or may be minimally torn

  • Symptoms: pain, may only be minimal swelling present, minimal loss of function

Grade 2

  • What it means: Muscle fibers are partially torn

  • Symptoms:  pain, swelling, bruising and loss of function. Difficulty with walking, standing on your toes and jumping become difficulty and painful.

Grade 3

  • What it means: All muscle fibers have been torn causing muscle to rupture.

  • Symptoms: Pain, severe swelling, bruising and full loss of function. There may also be a visual deformity in the muscle. This grade of injury may require surgical repair.

 

WHAT TO DO IF YOU INJURE YOUR ANKLE:

 

No matter which type or grade of injury you have, one go-to that will always be the right thing to do is RICE: Rest, Ice, Compression, Elevation. This will help control the inflammation and allow your injury to start healing. Even low grade ankle injuries need at least 24-48 hours of complete rest to avoid making the injury worse. 

 

You should also consider making an appointment with a medical professional. A physical therapist is your best choice for who to see first. They will be able to assess your injury, diagnose which grade of injury has occurred and instruct you how to treat it accordingly. In VA, we have a direct access law, meaning you can see a PT without a doctors referral (make sure to check your own state laws). Typically, when you see the doctor they will instruct you to rest but not prescribe you any exercises. This is where a PT will be most helpful. If your injury requires any followup, such as diagnostic imaging, your PT will be able to refer you to the doctor as needed. 

 

It is usually obvious to most people with a grade 3 injury to seek medical attention, however often times with lower grade injuries people do not seek help. Let me be the first to tell you- that's a bad idea!! Depending on the grade of your injury, there are specific exercises you can perform for each to help along the healing. BUT there are definitely right and wrong exercises. It is important to have the correct exercises prescribed to you by a PT so that you do not cause further injury. Also, keep in mind that once you injure a muscle and ligament the stability of your ankle will be compromised for quite some time, which increases the chance of re-injury. Recurrent ankle sprains from instability are one of the most common things I see in dancers and athletes. It is important to go through an entire rehabilitation program so that you properly strengthen and stabilize the ankle for the long term. 

 

What about braces??

There is a lot of controversy surrounding the use of braces after ankle injury. Braces are great for the beginning phases of injury when the tissues need to be rested so they can heal. HOWEVER, when used long term they cause the muscles to become "lazy" because they do not need to work as hard to stabilize the joint. You need to strengthen and re-teach the muscles to do their job without the assistance of an external support. 

 

So, my recommendation would be that you should only be using a brace if you are actively involved in a strengthening/stabilization program AND only plan to use it short term. As soon as the muscles are capable of doing their job without help its time to ditch the brace. How do you know when your body is ready?? Simple- work with a trained PT and they will safely be able to wean you out of your brace when its time. 

 

 

HOW TO PREVENT ANKLE INJURIES:

 

Injury prevention is key!! Incorporating ankle/foot strength and stability exercises into your regular work out routine is crucial to preventing injury. It is easy to forget that we need to strengthen these smaller muscles, but they play an important role in stability, balance and maintaining proper alignment throughout the lower body during functional movements.

 

Along the same lines, incorporate balance activities. Balance exercises work on strengthening all the muscles in the lower extremity as well as helping

 

 

to build a stronger connection between the brain and muscle activation. This is called proprioception, or your bodies ability to know where it is in space. Improved balance and proprioception lowers your risk of all lower extremity injuries. 

 

Hip and core strength matters! The hips and core provide you with a base of support and stability, which carries down throughout the entire lower extremity. If you have poor hip strength it will cause alignment problems at the knee, which will cause alignment problems at the ankle and foot, which ultimately places you at increased risk of injury. Whenever I see a dancer who has acute or chronic ankle instability, I always check their hip strength. More times than not they are weak in these areas.

 

Contact a Physical Therapist BEFORE you get hurt!

Did you know that Physical Therapists don't just treat current injuries?? They do injury prevention programs as well! If you are interested in an ankle stabilization program for you or your dance studio contact me and I will be glad to help!!

 

 

Want to be prepared??  SHOP MY FAVORITE PRODUCTS FOR ANKLE INJURIES:

 

 

 

 

 

   

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