An ankle sprain patient walked limped into my office this week, approximately 2 weeks after rolling on the ankle while out for a walk (on day 1 of a 2 week vacation). Pain, bruising, and swelling immediately followed the injury (jeopardizing some of the plans for the vacation). Since this patient is already a Satori patient, he sent me a picture of his ankle:
Upon seeing the picture, I coached this patient (via electronic correspondence – okay, fine, “google chat”) through the initial rehab phase: R.I.C.E – Rest, Ice, Compression, Elevation. The idea behind R.I.C.E is to not further aggravate the injured tissue (joint, ligament, muscle, tendon), reduce the body’s overabundance of inflammation and swelling with ice & compression and to help the swelling fluid leave the area using gravity (thus the elevation). However, very quickly (almost immediately), I coached him to perform pain-free ankle CARs – Controlled Articular Rotations of his ankle – in order to promote movement of the affected tissue. This movement will accomplish a couple of goals: 1) The movement will use muscle contractions which will help pump the fluid back up the leg and out of the ankle and foot; And 2) The movement encourages all of the affected tissue to heal with ‘directionality’.
(OK: Stop here: What do I mean by directionality? When injured tissue (any tissue) heals, it will heal in a haphazard direction – ultimately leading to scar tissue. We want to encourage our injured tissue to heal in the straight lines that the tissue originally had, and thus avoiding as much scar tissue formation as possible. The best way to do this is to use the tissue in all of it’s ranges of motion to encourage the tissue to heal along those ranges of motion directions. Another way to encourage ‘directionality’ of healing is through the application of manual therapy forces in the direction the injured tissue is supposed to be.)
So, this patient iced, compressed, and elevated his foot and ankle. He rested, in terms of avoiding excessive walking, but did continue to use ankle CARs to keep the ankle moving, and encouraging directionality of his healing. He was able to walk around and enjoy his vacation thanks, in part, to this strategy. Fast forward to when he returned to Toronto and presented to my office: The swelling and bruising was significantly reduced. He still had pain, but has learned over the years, from me, that the presence or absence of pain is not necessarily indicative of the status of the injury.
(Some people have significant injury with little to no pain, and others can have significant pain with little to no tissue damage – Lesson: Don’t let pain be your guide through rehabilitation. Strength and functionality are king!)
So, now that he’s home and functional, his rehabilitation really kicks into gear. We’re going to use Cold Laser Therapy to promote tissue healing, inflammation and pain reduction. We’re going to use manual therapy forces to encourage proper directional healing of the affected tissue (in his case, tissue damage to the ligaments on the lateral aspect of his ankle – common inversion ankle sprain). We’re going to use series of ankle strengthening exercises, including CARs, isometric strength holds in various positions, and progress to more functional rehab strategies, including 1-legged standing (eyes open, closed, wobble board) and progress to 1-legged hopping. Then, we’re going to start training the ankle to prepare for the inevitable next inversion ankle sprain moment (it’s bound to happen – after all, the #1 cause of an ankle sprain is a previous ankle sprain!). In the video below I show my own ankle inverting to bear progressively more and more load, so that when that inevitable ankle sprain moment occurs, the tissue has been prepared and can withstand the forces that would otherwise cause a recurrence of the ankle sprain. Essentially, we/I use this protocol for every part of the human body: Make sure the joint functions as it should, through it’s entire range of motion with strength and control. If this is accomplished for each joint in the body, the body will be prepared to be a tremendous movement machine. Then, the sky is the limit for the types of movements, activities, and sports you can perform safely and well.
https://www.youtube.com/watch?v=TsWF7dF79mY