Hey guys, Jas and Luke here! Welcome to the first of a three part series for busting myths of the lower limb. Over the next few weeks we’ll be running you through a couple of myths for the ankle, knee and hip.
For those of you who don’t know, Jas is a physiotherapist at Terrace Physio Plus (TPP). Here at Hunter Podiatry we are lucky to work very closely along side the TPP team to ensure our patient care is second to none.
Lockdown has hit us once again and I’m sure there are a few of us that have decided now is the time to start running or exercising again. I’m also quite sure that there’s a fair chance everyone has rolled their ankle at least once, but for a few of us it happens on the regular. We’re going to chat about a few of the common myths about managing acute or chronic ankle sprains… and debunk a few in the process. We’ll start with summarising everything you need to know about lateral ankle sprains.
Let’s break it down first… Lateral. A fancy way of describing the outside aspect of the ankle. Think of the knobbly bone that sticks out at the bottom of the leg. These ankle sprains are typically caused by acute trauma – either by rolling your ankle on an uneven surface, or a direct blow to the inside of the ankle. We tend to roll our ankle that way because, quite simply, we have more range of motion and less ligaments on that side of our ankle.
Now from the top, make it drop… that’s a weak ass ankle.
I should be using ice and anti-inflammatories as soon as I roll my ankle
RICE (and not the type of rice you put your phone in if you drop it in the toilet)… stands for rest, ice, compression and elevation. I’m sure most of you reading this have followed these guidelines for previous injuries.
For a long time ice and/or anti-inflammatory medications were the ‘go to’ treatment for the first 48-72 hours. Although they’re handy for pain relief, there’s new evidence to suggest that we should avoid using medications such as Nurofen to reduce swelling. Swelling produces natural chemical mediators that help with the healing process. Ice is still useful in reducing pain or discomfort during the acute phase of pain, so pull out your favourite bag of frozen peas and pop that around your ankle for 20 minutes every 2 hours.
I need to rest my ankle completely
Small rest good, big rest bad. We commonly use the ‘goldilocks’ theory – somewhere right in the middle of keeping it moving but giving the ankle some time to recover. By completely resting the ankle we start to lose our proprioception (proprioception is our ability to detect our body in space). We like to keep you moving with simple tasks, like drawing the alphabet with your foot – if you don’t know your alphabet this would be a good time to brush up on it. It’s extremely important to book in with your physio or podiatrist soon after your injury so that we can assess the level of injury, and then prescribe activities suitable to your injury.
I’ve rolled my ankle heaps and I’ve never done rehab before… Why should I do it now?
The answer is in the question! Recurrent ankle sprains happen because… you guessed it! Ineffective or no rehabilitation of the original injury. It’s important to understand what happens inside the ankle when we roll it that will contribute to future recurrent sprains.
Let’s break it down.
There are some really important soft tissue structures that hold all of our bones and joints together called ligaments. I’m sure you’ve heard of them, but what are they and what else do they do? Ligaments actually play a vital role in something called proprioception. We touched on it before – but essentially it’s your body’s ability to understand where your limbs are in space. The ankle, being such an important part of our mobility, is chock full of ligaments. When we roll our ankle it is common to do a partial tear in some of these big ligaments. This then impairs our proprioceptive ability. Without adequate rehab, the proprioceptive ability of these ligaments will remain damaged. This might mean that the next time you’re on a run your brain won’t be able to choose an appropriate foot placement and before you know it…. splat.
Back at square 1.
I’ll be right to return to sport when the pain is gone
Otherwise known as the ‘she’ll be right’ approach. Just because the pain is gone doesn’t mean that we are strong enough to return to full training or competition straight away. Before we head back to sport there’s a few things you need to iron out. After we sprain our ankle we lose strength through tendons and muscles of the lower limb and foot, therefore we need to retrain those fibres to be as strong, if not stronger than before. How do we do that you might ask?
We’ve spoken about proprioception and range of motion exercises before, but we harp on about it because it’s extremely important. The next big ticket item to cover is restrengthening and sports specific exercises. There is a progression from non-weight bearing activities to weight bearing exercises and then to functional, power based movements – similar to those movements you would do during sport. This is different from person to person and sport to sport, so have a good old fashioned chin-wag with either of us for the best approach.
I need to immobilise my ankle immediately
Another common myth with pesky ankle sprains is that they should be managed in a moon boot for the first couple of days. The reality is, this is actually the opposite of what we should do. It is imperative to introduce small amounts of weight bearing immediately to help avoid complications. We find the only circumstances in which we will utilise moon boots is when there is a fracture present, or the ligaments of the ankle have completely ruptured.
Immobilisation can be effective when weaning back into sport via sports taping. This can help reduce the forces on the ankle that are responsible for ankle sprains and instill some more confidence in the player. Check out the how-to video below!
I don’t need an Xray
Another common misconception amongst those of us who consistently roll their ankles. The reality is that yes – a great deal of the time there will be no fracture evident. This being said, it is important to rule out fractures in acute sprains as they can present very similarly to damaged ligaments. If you’re unsure whether an x-ray is necessary for you, see your podiatrist who will be able to write you a referral if need be.
There you have it folks! We hope that gives you some up to date information on most things ankle sprain related. As always, please feel free to reach out if you have any further questions.
Keep safe and you’ll hear from us soon.
Jas Whitelaw Luke Webster
Terrace Physio Plus Hunter Podiatry Services