Ankle Sprain HUB 

GENERAL ANKLE SPRAIN INFORMATION FROM THE LEG TEAM

Ankle Sprain - What is it?


blah An ankle sprain occurs when the ligaments that support the ankle stretch beyond their limits and tear. Ankle sprains are one of the most common injuries that occur among people of all ages. An Ankle sprain can range from mild to severe, depending upon how much damage there is to the ligaments. Approximately 95% of these injuries occur to the outside ligaments of the ankle. If you need more information or would like a consultation please click below and we can organise one for you right away. These consults can be done in clinic or online via our state of the art software that runs our business and rehab programs. Also, just so you know we offer a 6 week online program for the rehabilitation of Ankle Sprains. This program is amazing!!! You receive the exact rehab you will need is delivered right to your smart device in video format each day. It will guide you through the exercises you will perform and enable you to begin to successfully manage Ankle Sprains.








Ankle Sprain - Anatomy, function and Facts


blah First some brief anatomy. The human ankle is made up up three bones: The Tibia, the fibula and the Talus. These bones form the Ankle mortice. This joint is surrounded by numerous ligaments - Ligaments are strong, fibrous tissues that connect bones to other bones. They have a certain range of flexibility or stretch but once this limit is superseded then they can tear. The ligaments in the ankle help to keep the bones in proper position and stabilise the joint. The Ankle has three main ligaments on the outside of the ankle. And 5 main ligaments on the inside. There are more ligaments higher up the ankle referred to as the higher ankle ligaments and these will be covered in a later course. Further more the 3 main lateral ligaments are as follows: 1) The anterior talo-fibular ligament (ATFL) connects the talus to the fibula bone. It is normally the weakest of the three lateral ligaments and subsequently seen as the most frequently injured. 2) The posterior talo-fibular ligament (PTFL) connects the talus to the fibula bone 3) The calcaneo-fibular ligament (CFL) connects the fibula to the calcaneus bone. The main functions of the Ankle joint are: The main movements of the ankle joint are accomplished by complex musclutarure. These movements are referred to as dorsiflexion (toes moving toeardsknee), and Plantar Flexion (toes moving away from knee) There is also some amount of other planer movements but these movements are more pronounced from the joint under the ankle - the Sub-talar joint. These movement enable the human body to ambulate and adapt to the ground.




Ankle Sprain - Some Simple Facts!


blah Some simple facts: Ankle sprains are the most common lower leg injury. 95% of ankle sprains occur to the lateral or outside ligaments of the ankle. Ankle sprains have. High incidence of re-occurrence - hence it is very important to participate in an evidence based rehabilitation plan. If you need more information or would like a consultation please click below and we can organise one for you right away. These consults can be done in clinic or online via our state of the art software that runs our business and rehab programs. Also, just so you know we offer a 6 week online program for the rehabilitation of Ankle Sprains. This program is amazing!!! You receive the exact rehab you will need to perform is delivered right to your smart device in video format each day. It will guide you through the exercises and enable you to begin to successfully manage Ankle Sprains.




Ankle Sprain - Why did ! sprain my ankle?


blah Why did I sprain my Ankle? The cause of Ankle Sprains can be many different factors: The most commonly reported cause of Ankle Sprains in the Lower Extremity group Clinic are a sudden and unexpected twisting of the ankle. Your foot can twist unexpectedly during many different activities, such as: Walking or exercising on an uneven surface. Falling. Participating in sports that require repetitive change of directions or cutting actions or rolling and twisting of the foot—such as trail running, basketball, tennis, football. During sports activities, someone else may step on your foot while you are running, causing your foot to twist or roll to the side. At the Lower Extremity Group we also see a trend that correlates weakness in particular foot musculature. More specifically latency or delay of contraction - specifically the lower leg outer muscle groups like the Peroneal muscle group.




Ankle Sprain - Grades of Sprain or tear


blah Grades of Ankle Sprains After the examination, your doctor will determine the grade of your sprain to help develop a treatment plan. Sprains are graded based on how much damage has occurred to the ligaments. Grade 1 Sprain (Mild) Slight stretching and microscopic tearing of the ligament fibres Mild tenderness and swelling around the ankle Grade 2 Sprain (Moderate) Partial tearing of the ligament Moderate tenderness and swelling around the ankle If the doctor moves the ankle in certain ways, there is an abnormal looseness of the ankle joint Grade 3 Sprain (Severe) Complete tear of the ligament Significant tenderness and swelling around the ankle If the doctor pulls or pushes on the ankle joint in certain movements, substantial instability occurs





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GOLD STANDARD ANKLE SPRAIN TREATMENT

Online Rehabilitation for Ankle Sprains


The Lower Extremity Group offers World Class rehabilitation for your Ankle Sprain. Follow our easy to use evidence based plan to rehab your ankle and prevent Crhonic Ankle instability. We deliver our evidence-based daily Ankle Sprain management program via our amazing app is very easy for you to follow and includes 28 days of;

  • Progressive neuromuscular isometric, concentric, and eccentric strengthening exercises
  • 5 levels of pregressive proprioceptive balance trianing that does not need any expensive equpiment
  • Passive and dynamic stretching exercises
  • ​Myofascial massage exercises
  • Plus more
We also offer online consultations as a part of the rehabilitation precess to help you rehabilitate your ankle. ​Our experienced therapists have taken these technical modalities and simplified them into easy to watch videos for you to follow.




In Clinic rehabilitation


Our in clinic rehabilitation is no different than our online experience aside from the hands on soft tissue massage The Lower Extremity Group offers World Class rehabilitation for your Ankle Sprain. Follow our easy to use evidence based plan to rehab your ankle and prevent Chronic Ankle instability. We deliver our evidence-based daily Ankle Sprain management program via our amazing app is very easy for you to follow and includes 28 days of;

  • Progressive neuromuscular isometric, concentric, and eccentric strengthening exercises
  • 5 levels of pregressive proprioceptive balance trianing that does not need any expensive equpiment
  • Passive and dynamic stretching exercises
  • ​Myofascial massage exercises
  • Plus more
​Our experienced therapists have taken these technical modalities and simplified them into easy to watch videos for you to follow.




GOLD STANDARD TREATMENT FOR ANKLE SPRAINS


The Lower Extremity Group offers to you the Gold Standard in Lower extremity injury rehabilitation. We utilise a World Class rehabilitation program for Ankle Injury, and this is deilvered to you online in the comfort of your own home. All you have to do is follow our easy to use evidence based plan to treat and manage your Ankle Injury. This online program contains 4 complete weeks of revolutionary rehabilitation guides to help you manage and treat your Ankle Injury every single day. We deliver our evidence-based daily Ankle Injury injury management program via our amazing app, which is very easy for you to follow and includes;

  • Progressive neuromuscular exercises that will strengthen the muscles around the foot and ankle and help reduce the pain associated with Ankle Injury.
  • 5 progressive levels of evidence based rehabilitation that do not require expensive equpiment
  • Passive and dynamic mobility exercises to increase range of motion and tissue extensibility of mucles and fascia
  • ​Myofascial massage exercises
  • Using the app will enable you to understand when to apply the various exercises to help manage Ankle Injuries
  • Plus more
We offer online consultations as a part of the rehabiliation precess to help you rehabilitate and manage your Ankle Injury. ​Our experienced therapists have taken these aforementioned technical modalities and simplified them into easy to watch videos for you to follow and complete. These are delivered daily to your smart device within our Ankle Injury injury management program. Book in today - Online or in clinic





RECOMMENDED MEDICAL LITERATURE HUB

Treatment and prevention of acute and recurrent ankle sprain: an overview of systematic reviews with meta-analysis Cailbhe Doherty 1, Chris Bleakley 2, Eamonn Delahunt 3 4, Sinead Holden 3


Br J Sports Med. 2017 Jan;51(2):113-125. doi: 10.1136/bjsports-2016-096178. Epub 2016 Oct 8. https://pubmed.ncbi.nlm.nih.gov/28053200/ Abstract Background: Ankle sprains are highly prevalent with high risk of recurrence. Consequently, there are a significant number of research reports examining strategies for treating and preventing acute and recurrent sprains (otherwise known as chronic ankle instability (CAI)), with a coinciding proliferation of review articles summarising these reports. Objective: To provide a systematic overview of the systematic reviews evaluating treatment strategies for acute ankle sprain and CAI. Design: Overview of intervention systematic reviews. Participants: Individuals with acute ankle sprain/CAI. Main outcome measurements: The primary outcomes were injury/reinjury incidence and function. Results: 46 papers were included in this systematic review. The reviews had a mean score of 6.5/11 on the AMSTAR quality assessment tool. There was strong evidence for bracing and moderate evidence for neuromuscular training in preventing recurrence of an ankle sprain. For the combined outcomes of pain, swelling and function after an acute sprain, there was strong evidence for non-steroidal anti-inflammatory drugs and early mobilisation, with moderate evidence supporting exercise and manual therapy techniques. There was conflicting evidence regarding the efficacy of surgery and acupuncture for the treatment of acute ankle sprains. There was insufficient evidence to support the use of ultrasound in the treatment of acute ankle sprains. Conclusions: For the treatment of acute ankle sprain, there is strong evidence for non-steroidal anti-inflammatory drugs and early mobilisation, with moderate evidence supporting exercise and manual therapy techniques, for pain, swelling and function. Exercise therapy and bracing are supported in the prevention of CAI.




Diagnosis, treatment and prevention of ankle sprains: update of an evidence-based clinical guideline Gwendolyn Vuurberg et al


Br J Sports Med. 2018 Aug;52(15):956. doi: 10.1136/bjsports-2017-098106. Epub 2018 Mar 7. https://pubmed.ncbi.nlm.nih.gov/29514819/ Abstract This guideline aimed to advance current understandings regarding the diagnosis, prevention and therapeutic interventions for ankle sprains by updating the existing guideline and incorporate new research. A secondary objective was to provide an update related to the cost-effectiveness of diagnostic procedures, therapeutic interventions and prevention strategies. It was posited that subsequent interaction of clinicians with this guideline could help reduce health impairments and patient burden associated with this prevalent musculoskeletal injury. The previous guideline provided evidence that the severity of ligament damage can be assessed most reliably by delayed physical examination (4-5 days post trauma). After correct diagnosis, it can be stated that even though a short time of immobilisation may be helpful in relieving pain and swelling, the patient with an acute lateral ankle ligament rupture benefits most from use of tape or a brace in combination with an exercise programme. New in this update: Participation in certain sports is associated with a heightened risk of sustaining a lateral ankle sprain. Care should be taken with non-steroidal anti-inflammatory drugs (NSAIDs) usage after an ankle sprain. They may be used to reduce pain and swelling, but usage is not without complications and NSAIDs may suppress the natural healing process. Concerning treatment, supervised exercise-based programmes preferred over passive modalities as it stimulates the recovery of functional joint stability. Surgery should be reserved for cases that do not respond to thorough and comprehensive exercise-based treatment. For the prevention of recurrent lateral ankle sprains, ankle braces should be considered as an efficacious option.




Clinical assessment of acute lateral ankle sprain injuries (ROAST): 2019 consensus statement and recommendations of the International Ankle Consortium - Eamonn Delahunt et al


Br J Sports Med. 2018 Oct;52(20):1304-1310.doi: 10.1136/bjsports-2017-098885. Epub 2018 Jun 9.
https://pubmed.ncbi.nlm.nih.gov/29886432/
Abstract Lateral ankle sprain injury is the most common musculoskeletal injury incurred by individuals who participate in sports and recreational physical activities. Following initial injury, a high proportion of individuals develop long-term injury-associated symptoms and chronic ankle instability. The development of chronic ankle instability is consequent on the interaction of mechanical and sensorimotor insufficiencies/impairments that manifest following acute lateral ankle sprain injury. To reduce the propensity for developing chronic ankle instability, clinical assessments should evaluate whether patients in the acute phase following lateral ankle sprain injury exhibit any mechanical and/or sensorimotor impairments. This modified Delphi study was undertaken under the auspices of the executive committee of the International Ankle Consortium. The primary aim was to develop recommendations, based on expert (n=14) consensus, for structured clinical assessment of acute lateral ankle sprain injuries. After two modified Delphi rounds, consensus was achieved on the clinical assessment of acute lateral ankle sprain injuries. Consensus was reached on a minimum standard clinical diagnostic assessment. Key components of this clinical diagnostic assessment include: establishing the mechanism of injury, as well as the assessment of ankle joint bones and ligaments. Through consensus, the expert panel also developed the International Ankle Consortium Rehabilitation-Oriented ASsessmenT (ROAST). The International Ankle Consortium ROAST will help clinicians identify mechanical and/or sensorimotor impairments that are associated with chronic ankle instability. This consensus statement from the International Ankle Consortium aims to be a key resource for clinicians who regularly assess individuals with acute lateral ankle sprain injuries.




Effect of early supervised physiotherapy on recovery from acute ankle sprain: randomised controlled trial -  Robert J Brison et al


BMJ. 2016 Nov 16;355:i5650.doi: 10.1136/bmj.i5650. https://pubmed.ncbi.nlm.nih.gov/27852621/ Abstract Objective: To assess the efficacy of a programme of supervised physiotherapy on the recovery of simple grade 1 and 2 ankle sprains. Design: A randomised controlled trial of 503 participants followed for six months. Setting: Participants were recruited from two tertiary acute care settings in Kingston, ON, Canada. Participants: The broad inclusion criteria were patients aged ≥16 presenting for acute medical assessment and treatment of a simple grade 1 or 2 ankle sprain. Exclusions were patients with multiple injuries, other conditions limiting mobility, and ankle injuries that required immobilisation and those unable to accommodate the time intensive study protocol. Intervention: Participants received either usual care, consisting of written instructions regarding protection, rest, cryotherapy, compression, elevation, and graduated weight bearing activities, or usual care enhanced with a supervised programme of physiotherapy. Main outcome measures: The primary outcome of efficacy was the proportion of participants reporting excellent recovery assessed with the foot and ankle outcome score (FAOS). Excellent recovery was defined as a score ≥450/500 at three months. A difference of at least 15% increase in the absolute proportion of participants with excellent recovery was deemed clinically important. Secondary analyses included the assessment of excellent recovery at one and six months; change from baseline using continuous scores at one, three, and six months; and clinical and biomechanical measures of ankle function, assessed at one, three, and six months. Results: The absolute proportion of patients achieving excellent recovery at three months was not significantly different between the physiotherapy (98/229, 43%) and usual care (79/214, 37%) arms (absolute difference 6%, 95% confidence interval -3% to 15%). The observed trend towards benefit with physiotherapy did not increase in the per protocol analysis and was in the opposite direction by six months. These trends remained similar and were never statistically or clinically important when the FAOS was analysed as a continuous change score. Conclusions: In a general population of patients seeking hospital based acute care for simple ankle sprains, there is no evidence to support a clinically important improvement in outcome with the addition of supervised physiotherapy to usual care, as provided in this protocol.Trial registration ISRCTN 74033088 (www.isrctn.com/ISRCTN74033088).




Effects of proprioceptive training on the incidence of ankle sprain in athletes: systematic review and meta-analysis -  Gabriela Souza de Vasconcelos et al


Clin Rehabil. 2018 Dec;32(12):1581-1590. doi: 10.1177/0269215518788683. Epub 2018 Jul 12. https://pubmed.ncbi.nlm.nih.gov/29996668/ Abstract Objective:: To investigate how dynamic neuromuscular control, postural sway, joint position sense, and incidence of ankle sprain are influenced by balance training in athletes compared with the control group in randomized clinical trials. Data sources:: The search strategy included MEDLINE, Physical Therapy Evidence Database, Cochrane Central Register of Controlled Trials, and Latin American and Caribbean Center on Health Sciences Information. Randomized controlled trials (RCTs) were published by June of 2018. Methods:: RCTs that evaluate the effectiveness of proprioception in these outcomes: dynamic neuromuscular control, postural sway, joint position, and the incidence of ankle sprains in athletes aged between 18 and 35 years. Two reviewers independently screened the searched records, extracted the data, and assessed risk of bias. The treatment effect sizes were pooled in a meta-analysis using the RevMan 5.2 software. Internal validity was assessed through topics suggested by Cochrane Collaborations. Results:: Of the 12 articles included ( n = 1817), eight were in the meta-analysis ( n = 1722). The balance training reduced the incidence of ankle sprains in 38% compared with the control group ( RR: 0.62; 95% CI: 0.43-0.90). In relation to the dynamic neuromuscular control, the training showed increase in the distance of reach in the anterior (0.62 cm, 95% CI: 0.13-1.11), posterolateral (4.22 cm, 95% CI: 1.76-6.68), and posteromedial (3.65 cm, 95% CI: 1.03-6.26) through the Star Excursion Balance test. Furthermore, training seems to improve postural sway and joint position sense. Conclusion:: Balance training reduces the incidence of ankle sprains and increases dynamic neuromuscular control, postural sway, and the joint position sense in athletes.