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Straight Talk About Injuries

Ankle Sprains

Ankle sprains are among the most common problems faced by active people. All of us have probably had to deal with them at one time or another. Ankle sprains, at their simplest, can be broken down into two categories; acute and chronic.

An acute ankle sprain is a sprain that has happened within the last two to three days. The most troublesome results of an ankle sprain are usually the swelling, pain and our inability to use the ankle correctly any more. If we can walk, we usually limp (which, to use to technical term, is BAD!) potentially causing a host of other problems. While most of us instinctively take care of the problem correctly and eventually go about our merry way no much the worse for wear, there are a few tricks of the trade, which can speed recovery and help prevent future sprains. First, don't limp! If you can't walk normally without limping, get a pair of crutches and use them to help you go through the normal walking motion. You will probably only have to use them for a few days before you are walking normally on your own again, so suck it up and use some crutches.

When dealing with ankle sprains, it helps to remember RICE: Rest, Ice, Compression and Elevation.

Rest simply means, don't play any basketball for a few days! While this may seem to be a no-brainer, you would be amazed at how many people throw some tape or brace on their ankle and go hobble through a game. Fortunately, professional and college athletes have athletic trainers to prevent such insanity. The rest of us our left to our own devices, which are often contrary to our best interests. Playing, "through the pain," is not the appropriate measure and will delay healing by days or weeks. Knit a sweater or something, just take a break.

Athletic trainer's go to school for four years to learn that if something swells, put ice on it. (I'm a certified athletic trainer, so I can say that. In good humor of course.) Ice is a tremendously useful tool, and while it doesn't remove the swelling that's already there, it will prevent more swelling from accumulating. Much of the pain and loss of function of the sprained ankle is a result of the out of control inflammatory response. This response is necessary for healing and the body is excellent at getting it geared up, but not so good at stopping it or getting rid of it once it's there. Ice prevents the swelling from getting too out of hand. Wrap the ankle in ice for twenty to thirty minutes every two hours, or as close to that as you can get. Even once or twice a day for half an hour is better than nothing, and will provide some excellent benefits. If ice is too inconvenient, get a gel ice pack. There is a common misconception that the gel ice packs are not as cold as ice. The truth is just the opposite. Since gel doesn't freeze solid until extremely low temperatures, it is able to absorb more cold energy and get colder than ice, which is able to reach only 32 degrees. Since the gel packs get so cold, just remember to put a small cloth between the pack and your skin, or you may find yourself with a nasty ice burn. A pillowcase is an excellent cover for the gel ice packs.

Compression picks up where ice takes off. An ace wrap applied to the ankle, starting at the toes and working up to mid calf, will help the body get rid of the swelling. Gravity is a powerful force, and unless you're adept at using a bedpan, you must get up and walk around at least once or twice every day. Gravity will pull the swelling from the ankle down into the foot and in really bad sprains, down into the toes. A good compression wrap helps to push the swelling up the leg so your circulation system can pick it up and carry it away. The most common mistake in applying a compression wrap is to make it too tight. When applying the wrap, only take out about half of the elasticity. If you don't want to bother with the wrap, you can purchase a good compression sleeve. It will cost more, but be easier and more comfortable. Keep the ankle wrapped all the time for the first few days.

Elevation is an essential compliment to ice and compression. As we said before, gravity is a powerful force. If your ankle is below your chest, gravity is working against you. If your ankle is above your chest, gravity is working for you. Keeping your ankle elevated as much as possible will help keep the swelling from pooling in your ankle, foot and toes. The less swelling you have, the sooner you will get back in action, so while you're knitting your sweater, keep your foot elevated.

Rehabilitating Ankle Sprains

You thought you could just sit around knitting sweaters while your ankle healed, didn't you? Well, that's not exactly right. The sooner you start rehabilitation, the sooner you'll get back to the courts, so quit being a lazy bones, put down the knitting needles and get going.

During the first few days after an ankle sprain, your activities should revolve around preventing and removing the swelling. Moving helps to pump fluids around the body and moving the ankle is no exception. Get a bucket and fill it with water and some ice. Put your foot and ankle in the bucket, (I know it's cold, it's supposed to be!) and move it around. The best thing to do is to spell the alphabet with your toes in capital letters while your foot is immersed in the ice water. While the cold may be very uncomfortable for the first two or three minutes, your foot will go numb allowing you to push how much you can move your foot without too much pain. After eight to ten minutes in the ice bucket, take your foot out (it should be good and numb by now) and work your range of motion. Point your foot down as far as possible then bring your foot up as much as possible. If you can do this without pain, use a towel or some sort of strap to help pull your foot up as far as it will go. Don't cause yourself any pain during all of this; just go as far as you can while staying relatively pain free. When the feeling in your ankle returns, wrap it in a good compression wrap and elevate it. Working the range of motion may aggravate things a little, so putting an ice pack on it for twenty to thirty minutes after these exercises is always a good idea.

After a few days you should be walking pretty normally on your own, if your not getting better within a few days, get in to see your doctor. Remember, don't limp! You may half to walk slowly in order to keep from limping, but don't limp. As the swelling and pain subsides, you will be able to use the ankle more normally. Many people believe at this point that their ankle is healed, they are wrong. Spraining your ankle involves damage and stretching to ligaments, which take six to eight weeks to heal, and never return to their original length. You need to continue with a good program of rehabilitation. If you have access to a physical therapist, that would be best. If not, we will give you some good suggestions as to how to do a fair job of it yourself.

After recovering from a sprained ankle, the muscles that act on the ankle may no longer function correctly. The muscles become de-trained and fail to work to prevent the ankle from spraining again. There are basically two aspects that need to be addressed in getting your ankle back to peak condition: strength and proprioception.

Theraband elastic bands are an excellent tool for strengthening the muscles that act on the ankle.

Theraband comes in varying grades of resistance to provide you with the resistance level you need for whatever condition you are starting from. Your foot can basically perform four motions. Your foot goes down, up, in and out. You want to perform all of those motions against the resistance that Theraband offers. When determining how fast to move your rehabilitation, listen to what your body tells you. If you feel worse the next day, you've done too much. If you feel better the next day, you've probably done enough. If you feel nothing the next day, try doing more. Start out by performing 25 repetitions in each direction the foot moves and see how you feel the next day. Work up to where you are doing 100 repetitions in each direction.

Proprioception is knowing where your body is in space without having to look at it. The best way to demonstrate this is to keep your arm straight and raise it out until it is perpendicular to your body. Do this without looking at it. After you have your arm perpendicular, look at it to see how close you are. How did you know your arm was perpendicular without looking at it? Proprioception. You have sensors in your joints that tell your brain where those joints are; this allows us to walk without having to look at our feet. When we sprain our ankle, those sensors may fail to function normally. Fortunately, you can retrain them. A wobble board is an excellent tool to retrain your sensors and teach your muscles when they need to fire to keep your ankle from spraining again. Use the wobble board in conjunction with the strengthening program in rehabilitating your ankle. Balance yourself on the wobble board for fifteen to twenty minutes a day. When you can balance without any problem, make it more difficult by balancing on one foot. (The one you sprained not the healthy one!) Then balance on one foot while playing catch or bouncing a ball off a wall. When you can do all this without any problem, you are probably ready to get back in action. For a more entertaining wobble board session, you can get a wobble board that has a maze carved into it and work marbles through the maze. This really works your ankles and is more fun that bouncing balls off walls. To attain peak performance, the Pro Fitter or the Bongo Board will both offer a very challenging work out to even the most elite athlete.

Ankle Braces

Ankle sprains cause a permanent lengthening of the ligaments. Strengthening the muscles that act on the ankle is necessary for full recovery, but you still may find yourself with a chronically unstable ankle, especially after a particularly bad sprain. Also remember that the ligaments don't heal for six to eight weeks and don't attain full strength for quire some time after that. Some physicians feel that after spraining an ankle, you have a one-year period where you are going to be more prone to doing it again, even if you have completed a successful ankle rehabilitation program. Bracing is always a good idea to reduce the risk of re-spraining the ankle. In fact, most division I universities require that all athletes in particular sports be either taped or braced regardless of past ankle injuries as a preventative measure. If you have problems with ankle sprains or just want to do all you can to prevent them, a good ankle brace is a great idea. Visit the ankle section in The Sports Medicine Shop's web site for some excellent choices.

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