When she came in, you could see the pain on her face.
Wincing with each step toward the treatment room, her limp was noticeable as she was protecting the ankle.
As I helped her sit down, of course, my first aid protocols popped into my head first, so I ran through the typical questions:
“Did you hit your head at all?”
“Did you hear a pop in your ankle?”
“How are your pain levels?”
Fortunately, she didn’t hit her head and there was no “pop.”
She had just rolled her ankle and had a pretty typical inversion sprain, the swelling was already noticeable. What made it worse for her was the stress and worry of whether she could run as it was her favourite thing to do.
She wanted to get that ankle back to her normal activities ASAP.
Helping Protect The Injury
As I mentioned, the first thing I thought of was the first aid protocols when it comes to an injury.
This particular incident was obviously in the acute stage, so all the RICE protocols are the first thing I thought of. While there has been lots of debate online about using ice and rest, I still believe that in the acute stage it’s the best way to go.
Where I have changed my opinion is how long to use RICE.
In the past, we would use ice and rest for way longer (at least I did) than was probably appropriate. During the inflammation phase, (which is the first 48 hours) it is important to rest and support the tissues involved in the injury but still, keep up with some movement and continue to load the tissue within pain tolerances.
Since most of you probably already know how to rest, ice, and elevate I thought we would go over the compression portion and demonstrate how to properly wrap and inversion sprain, to give it some support and help control swelling over that first 48 hours.
Properly wrapping an ankle like this can give it that little bit of extra support (and confidence) in order to help the patient continue to move and also help with pain management.
Loading The Tissue
More and more over the past few years, we have been hearing and seeing more research on the importance of loading tissues post injury.
I’m sure we’ve all heard the stories about how they get patients up and moving almost immediately after surgeries.
Research is showing that loading the tissue or causing mechanical tension (muscular force) is actually a way to help influence wound healing. As the injury enters into the repair phase we can start to load the tissue even more.
This, of course, depends on pain and weight bearing abilities. If the patient can do full weight bearing pain-free you should be able to load the tissue more than if they can’t do full weight bearing. If they can’t bear full weight, giving the patient something to hold for balance will help decrease the amount of weight we are loading into the tissue and help with a decrease in pain, but still have the ability to move and load the tissue.
Here is an example of how you can begin some weight bearing exercises and load for an inversion sprain.
Once the patient feels more comfortable and pain has decreased, you can then progress them to this kind of exercise in order to load the tissue more:
As the patient continues to progress, here is a 3rd progression you can use to load into the injury more:
It is important to work within your patients pain tolerance when doing any kind of exercise, but one study showed that doing isometric contractions actually helped to decrease pain in patients with a tendinopathy. While an inversion sprain isn’t a tendinopathy, we can use it as a reminder that it is okay to load the tissue early in the healing process. So, in addition to doing some massage therapy, actually loading the tissue will not only help strengthen the area but also assist in decreasing pain for the patient. However you decide to set up your treatment plan, these are movements that can be taught in the clinic and incorporated into your treatment but also given as homecare exercises to help the patient progress. For those of you who don’t have “exercise” in your scope of practice, let’s just call it “therapeutic movement!”