| The treatment of sprained ankles using physiotherapy |
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| Health and Fitness - Health Issues |
| Written by Jonathan Blood-Smyth |
| Tuesday, 16 September 2008 04:22 |
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Ankle sprains and ankle fractures are a common part of physiotherapy practice. A repeated sprain can give difficulty walking on uneven surfaces or a chronic ankle pain problem. The subjective examination from the physio explores how the injury occurred, the amount of trauma involved, how much pain developed and whether the patient walked about afterwards. They may have attended an accident emergency department and been reviewed with an x-ray.
Ankle sprains and ankle fractures are a common part of physiotherapy practice. A repeated sprain can give difficulty walking on uneven surfaces or a chronic ankle pain problem. The subjective examination from the physio explores how the injury occurred, the amount of trauma involved, how much pain developed and whether the patient walked about afterwards. They may have attended an accident emergency department and been reviewed with an x-ray. The amount of pain the patient suffered after the injury is extremely important and if the level of pain is very high or if it doesn't settle, there might be a fracture. Pain should settle with time and if not the physio will refer the patient back to the orthopaedic doctor. The areas of pain should match the mechanism of injury, indicate which structures might be injured and should be tested by the physiotherapist later. Special questions are asked about the past medical history and previous injuries, any drugs the patient is taking, their appetite level, whether they are losing weight, their sleep quality and pain in the morning, their bladder and bowel normality and any relevant family history. This is to clear the patient of any serious underlying condition so that treatment can be safely performed. Examination protocols The physiotherapist will note any oedema, change of colour or abnormality of circulation. Ankle movements when not weight bearing are assessed by the physio, dorsiflexion is pulling the ankle upwards, plantarflexion involves pushing the foot down, eversion is turning the foot outwards and inversion turning the sole of the foot inwards. The physiotherapist assesses movement of the ankle as pain can limit movement and the readiness of the patient to engage in rehabilitation. Manual testing of the ankle muscle strength by the physiotherapist indicates any muscle damage around the ankle. The physio tests the patient up on a couch or gets the patient to perform exercises up on their feet. Passive movement of the joint, where the physio moves the ankle and uses gentle stretching of the joint in each direction to test the structures of the joint. Palpation of the joint structures is used to find which structure is to blame. Treatment protocols for Physiotherapy For pain and swelling ice is used to reduce swelling, with range of motion exercises, a compression dressing such as an ankle sleeve and gait correction. If the problem is severe, a walking aid may be useful. If stiffness is the problem, with some pain, joint mobilizations may be used to loosen the joint. The physio may use manual therapy for joint stiffness or pain and this allows the physiotherapist to improve the joint gliding movements and allow more normal joint mechanics. This reduces joint stiffness, loosens up the joint and eases pain, allowing weight bearing exercises to start. Static exercises are used initially whilst holding on, progressing to active exercises without support. Joint position sense tells the brain where the ankle is in all situations and the brain can quickly correct the ankle position and stop it getting into dangerous situations. The patient practices standing on one leg, progressing to standing on the wobble board, an unstable balance device. Balancing on a wobble board is hard work and retrains the joints and the brain to improve balance and coordination. Once the ankle has good range of motion, minimal pain, good strength, good gait and balance, the rehabilitation job is done and the patient's ankle is likely to recover. About the Author: Jonathan Blood Smyth is a Superintendent Physiotherapist at an NHS Hospital in the South-West of the UK. With over 15 years experience of managing orthopaedic conditions and looking after joint replacements, he specializes in managing chronic pain. Visit his site if you are looking for Physiotherapists in Chiswick or throughout the UK. |