Sprained ankle rehabilitation

AS and A Level Physical Education (Sport & Coaching)

Sports Injuries

Sprained ankle – of a football player

Phase 1- the first thing to do when an athlete sprains an ankle is to make sure any footwear is not removed and that they do not attempt to put weight on the ankle as this could just make the injury worse.

SALTAPS is a protocol that would help diagnose and treat the injury. It should be used as soon as the injury has happened

See – the injury occur, look at the mechanism of the injury.

Ask – the player what is wrong, where they are injured, where the pain is and how it happened.

Look – at the injury, and look for redness, deformity, bleeding or inflammation.

Touch – the injury or area around injury to see if you can feel heat, ask the injured person If thy feel pain or any other sensations.

Active Movement – see if the injured person can move the injured area

Passive Movement – try to move the injured area

Strength – if both passive and active movements are performed with no pain try a resistance movement to see if any pain occurs.

If any bleeding has occurred covering and compressing the cut with a sterile cloth/bandage must treat this.

The RICE protocol should now be used:

REST - the injured part immediately, this will stop the injury be further aggravated and there will be more pain if this is the case

ICE – the injured area should be cooled, using something such as a cold compress or freeze spray, this will close the blood vessels meaning blood will not be able to get to the injured area so well and this in turn reduces swelling

COMPRESS - the injured site should be compressed using strapping, this also restricts blood flow into the injured area as it makes the blood vessels constrict, meaning swelling and will be controlled/reduced, whilst also bringing out the bruise.

ELEVATE - the injured limb should be elevated, which drains the blood from the injured area, meaning swelling will be reduced, when the leg is elevated it should be elevated above the level of the heart and held by a support of some kind.

This protocol will reduce swelling and pain as well as helping reduce injury time if performed correctly and quickly.

When using cold application the skin should go through four stages. These sensations are coldness, burning, pain/ache and finally numbness. When the forth sensation of numbness sets in the application should be removed.

Exercise is not recommended after these two stages have been performed as the main aim is to protect the injury from any further damage and prevent further swelling or bleeding if this has occurred.

Within three to ten days after the injury, this is when ...

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This protocol will reduce swelling and pain as well as helping reduce injury time if performed correctly and quickly.

Exercise is not recommended after these two stages have been performed as the main aim is to protect the injury from any further damage and prevent further swelling or bleeding if this has occurred.

Within three to ten days after the injury, this is when the ankle would be in the early stages of its recovery process. At this stage the swelling around the injury should go down as it will start being absorbed, new blood cells should have started growing and scar tissue should start developing if there was a cut. Techniques that should be used to treat the injury at this stage should concentrate mainly on getting blood flowing into the area. The best way to do this would be by heat treatment. This is because heat makes the blood vessels dilate so more blood can flow through them, bigger blood vessels help absorb swelling while it also removes dead cells from the injury site faster and the growth of new blood cells will increase as well. Heat treatment will help the muscles relax and it will ease any pain. When no treatment is being done to the ankle it should be supported and protected by either a bandage or a tubi-grip. Doing this means any unwanted joint movement is limited and stability of the ankle is increased.

Exercise in this stage should concentrate on moving the ankle through a pain free range of movement. This will help lengthen the muscles whilst strengthening them. Strengthening the area will improve stability around it meaning the rehabilitation process will be speeded up. To do this walking aids may be a good safe and necessary way to get the ankle joint moving comfortably and static stretching will also be a good safe way to get the muscles strengthened and lengthened. Stretches when doing this should be held for around 15 – 20 seconds and should be done frequently throughout the day.

After around ten days after the injury has occurred active rehabilitation should be started. Before starting though some important checks should be made to make sure that the injury has recovered enough. These checks are as follows:

the inflammation around the injury has gone down significantly
the swelling around the injury has gone down significantly
the is a significant range of pain free movement when using the ankle joint
the ankle should be able to take some amount of weight baring

The two best types of exercises that should be used in this stage of the injury are: mobilisation exercises – these must aim to improve the range of movement and reduce stiffness around the joint and strengthening activities should be done so that the joint becomes more stable and the muscle which have become weak due to the lack of movement are strengthened back to their original state.

The best ways to do this are to start by using isometric contractions followed by concentric contractions and then finally eccentric contractions.

Isometric contractions should be performed first, this is so that the muscles around the joint are contracting and working but the ankle joint itself is being put under no or very little strain or pressure. Three activities, which should be used, in this case of a sprained ankle are standing one on leg, with this leg being the leg with the sprained ankle. This is because the ankle joint is not moving but its muscles have to contract to support it, another would standing on your tip toes and a third being standing with your toes and ball of your foot on a raised platform with your heel hanging of the edge of this platform lower than the rest of the foot. Each of these should be held for around 20 seconds and then a recovery time of around 1 minute should be aloud before repeating the process.

Now isometric concentric have been performed, concentric contractions can take place, these are when the muscles shortens while contracting. Activities, which should be used to give the ankle a concentric contraction, are: flexion and extension, abduction and adduction and rotation of the ankle joint. Another way to make the ankle give a concentric contraction is by using a certain piece of gym equipment where you stand on a platform raised around six inches from the floor with a variable amount of weight on the shoulders, the ankle muscle and the calf muscles then contract to push this weight up, thus strengthening the muscles.

Eccentric contractions can now be used. This is where the muscle contracts while lengthening. An activity, which the person with the sprained ankle should do, is, using the same piece of gym equipment as described for using while doing concentric contractions, they should this time lower their body using the ankle and calf muscles giving them an eccentric contraction. They can also do the same type of exercise as they used in when doing concentric contraction such as abduction and adduction, rotation and flexion and extension. This is because muscles come in pairs and when on performs a concentric contraction the other performs an eccentric contraction.

In the final phase of this rehabilitation program the injured person should start doing basic elements that are used in sport. The aim of this phase is to improve the persons balance, movement and co-ordination, restore to them specific skills and movement patterns they had before the injury took place and provide them with psychological reassurance, so that they can carry on with no worries about the injury.

The best activity, which should be done with a sprained ankle, is to start with jogging and running in a straight line. This will get the person back used to this type of free movement. It will strengthen the muscles further and help them get back co-ordination and balance, which they may have lost when they could not move or move properly and frequently. When the person is confident and running well, they should progress to running up and down hills or sloped areas. This further progresses what they were doing when running in a straight line. When the person has again mastered this they should begin changing direction when running this will start flexing the ankle in different ways and again it is a progression of what this phase aims to improve. The next progression to this should be the player running diagonally up and down the hill; this will further improve what this phase aims to improve as it puts extra pressure on the ankle making it stronger and more agile.

When the person has completed these activities freely and well they can then move on to skill training exercises. These as the player is a football player should include: passing, shooting, jumping and tackling as well as fitness based skills such as sprinting, and agility exercises. When the player can perform and complete these skills to a good standard they can then join back up for full training, and then eventually competitive competition/play.