Modern treatment and physiotherapy of sprained ankle

In this article we will show you an example from our experience and the process and effectivity of modern physiotherapy of sprained ankle.

CLnohavazy (1)

OCCURRENCE OF INJURY AND TREATMENT ON ORTHOPEDY

A student who is playing basketball had sprained his left ankle 6.11.2012, while he was landing from a jump. That led to immediate significant pain in the area of the outer ankle, formation of swelling and consequent formation of hematoma. X-ray images performed the same day in the evening didn't show any fracture or any damage of the bone at all, however examination that would show the condition of the tendons and ligaments wasn't performed, neither was there any examination of the stabilizing functions of the ankle ligaments. On orthopedy they put his ankle in a cast for four weeks. After taking the cast down, the ankle was still very painful, restricted in mobility and significantly swelled in comparison to the right ankle, however from a medical point of view was the ankle without any problem and in order. The client had to go to a check up again in another 3 weeks, in case he would have to be prescribed with rehabilitation.

PHYSIOTHERAPEUTIC EXAMINATION

The client visited FYZIOklinika 14.12.2012, after nearly six weeks since the injury from his own initiative, because he didn't observe any improvement after the cast fixation was taken down. It was a young man who wanted to play his favorite sport again as soon as possible, and in the best possible condition.

When we measured the circumference of the swelling above the ankle, it was 2 cm larger than on the other leg, across the outer ankle and instep the circumference was 3 cm larger. Hematoma remained as well, which was visible from the outer side of the ankle to the instep and it was painful on touch.

The attachments of m. tibialis anterior and m. peronei were also painful on touch (group of muscles that flex the foot). M. tibialis anterior was on touch painful in all its length. Muscles of the left leg were slightly hypotonic compared to the right lower limb, especially m. quadratus femoris (quadriceps) and calf muscles. Dysfunction of the muscles, tendons and ligaments led to a change of the walking stereotype.

The ultrasound showed numerous small leaks on the outer and front side of the ankle joint and partial rupture of the lateral talocalcaneal ligament - partly ruptured ligament between the heel bone and ankle bone on the outer side of the ankle.

During an examination of the podoscope was revealed collapse of the transverse arches, bigger part of the weight was carried by the right foot. The left foot wasn't burdened as much which also helped to secure the instability in the ankle joint due to the damage of local ligaments.

SHOCK WAVE WITHIN EFFECTIVE PHYSIOTHERAPY

First therapy

During the first visit we applied focused shock wave therapy (ESWT) to the painful areas. We combined it with radial shock wave therapy and deep vibration massage with V-Actor headpiece, which was also applied on the muscles and tendons that have a relation to the damaged ankle. After that we performed mechanical lymphatic drainage which lowers the swelling and improves that way blood circulation, metabolism and speeds up healing of the damaged soft tissues. In the end we secured the ankle with a functional tape in order to increase the stability in the ankle joint and lower the pain.

Second therapy

The client was invited for a second lymphatic drainage and shock wave therapy after five days. During this visit, the client described minimal sensitivity in the movement range in the toes (plantar flexion or dorsal flexion). Hematoma was not visible at all, ankle seemed on touch (palpation) normal, and the swelling was significantly lower given to the regeneration of the overloaded attachments of the mentioned muscles. The leg was subjectively more free, and nearly without any problems. Therefore we applied instead of the focused shock wave, the radial shockwave therapy and and massage with V-Actor headpiece on all the soft tissues that have a functional relationship to the affected ankle joint.

Third therapy

Third visit was again after five days. Since the last time, there was a significant improvement, the ankle was without any pain. The client mentioned only smaller swelling, which restricted the full range of movement. The client tried to join in lighter training session in the last three days. With joy he had to note that the leg is painless and functioning normally. He began to train normally after eight week since the injury.

FINAL EVALUATION OF THE EFFECTIVITY OF THE THERAPY

Therapy of the sprained ankle with the help of focused and radial shock wave in combination with mechanical lymphatic drainage is very effective and fast in comparison to standard rehabilitation, magnetotherapy, ultrasound or nonsensically prescribed laser therapy. Unfortunately shockwave therapy is not funded by any health insurance company, the client is therefore forced to pay the therapy by himself. However the effectivity and speed of this treatment is without a doubt worth the money, which would be otherwise caused by long term working indisposition.

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Author: Mgr. Iva Bílková, FYZIOklinika fyzioterapie Ltd, Prague, Czech Republic
Source: Clinical experience from a private practice in a physiotherapeutic field, FYZIOklinika

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