Ankle Pain
The main goals of physiotherapy for any ankle injury is pain and symptom management as well as facilitating a return to normal function.
Typical Ankle Injuries
Ankle sprains
Often happen when the ligament keeps the joint from moving too far from side to side (either over- inversion or eversion). Mild ankle sprains are minor in general and will heal with rest and ice. However, moderate and severe sprains that are left untreated can weaken the ankle over time and may cause repeated sprains and lead to other ankle injuries (arthritis).
Plantar fasciitis
Planter fasciitis occurs when the fascia band of tissue in the arch of the foot becomes inflamed, causing sharp pain in the heel of the foot with the first few steps after waking up or after resting for a prolonged period of time. Once the band has time to stretch, the pain will often subside significantly.
Stress fracture
Stress fracture of the foot results from repetitive impact, accumulating over time. When the bones and the supporting muscles do not have time to heal between exercise sessions, tiny cracks in the bone can occur. This can cause chronic pain.
Fracture
A fracture of the ankle is a fracture in one or more of the bones of the ankle and is often the result of a traumatic impact or injury.
Achilles’ tendonitis
Inflammation of the tendon that runs at the back of the ankle due to overuse. Those who have achilles tendonitis are also more prone to tendon tear or total rupture after repetitive inflammation and damage over the time (chronic condition).
Ankle Condition Physiotherapy
The main goals of physiotherapy for any ankle injury would be pain and symptom management as well as facilitating a return to normal function.
- The principle of first aid applies in the acute phase of any ankle condition. Initial management involves unloading and protecting the structure to avoid aggravating the injury as well as preventing further injury.
- Once the initial few days have passed, the use of cryotherapy is warranted if inflammation has not subsided.
- Electrical muscle/nerve stimulation is used to relieve pain by sending electrical impulses gently through the skin in order to block the pain signal.
- Soft tissue mobilization helps to relax the muscle spasms that may be caused by the injury. In conjunction, heat therapy may also be used in the absence of inflammation, which helps in promoting blood circulation and also aids in muscle relaxation.
- Joint mobilization involves different graded pressures and movement. Gentle graded pressure helps lubricate joint surfaces, easing stiffness and help the patient to move the ankle with less pain.
- After the pain starts to reduce and symptoms are less, the patient will start with exercises. The exercises will start with ankle mobilization exercises and gradually progress to non weight bearing strengthening exercises.
- Pain scale, ankle range of motion, gait and ankle strength are the main determinants of whether the ankle condition is progressing.
- It would be safe to say that the ankle is back to pre injured state if all the determinants are checked off the list
Ankle Sport Therapy
The goal in sports therapy is to reeducate the ankle in terms of proprioception and improve on mobility (especially active mobility), strength, reactivity, and explosive power. In physiotherapy, the therapists aim to reduce pain, swelling and inflammation and improve range of motion of the ankle. Once the patient is pain free, they will be able to progress to proprioceptional and strengthening exercise.
Aside from working on balance and proprioception, the musculature controlling the ankles has to be strengthened as well. Initially, the exercises will be injury specific but as the patient progresses and gets stronger, the exercises will then advance to strengthening both lower limbs as a whole. This is because the body works in a kinetic chain where every joint is connected. Depending on the goals and sport of the patient, plyometric exercises may also be incorporated into the exercise program once the patient is ready.
Throughout the entire duration of the sports therapy program, ankle mobility will be worked on, simultaneous to the balance and strengthening exercises. Initially, the therapist in charge will be assisting the mobilisation of the ankle with manual work. As the range of motion of the ankle improves, the patient can move on to mobility exercises, which can be continued long after they have fully recovered.
Prevention & Reconditioning
After an ankle injury, a conditioning program will help reduce risk of recurrent injury and facilitate a return to daily activities, sports and other recreational activities.
Flexibility and mobility are the first important components after an ankle injury. Stretching exercise can help to improve flexibility of muscle around the ankle, mobility exercise can help to prevent the ankle joint being tight and restricted.
Strengthening the intrinsic and extrinsic muscles of the foot and ankle can help to keep the ankle joint stable. Extrinsic muscles are generally more involved in generating force in order to create movement, while intrinsic muscles are important stabilizers of the arches of the foot and have an important role in static posture and control of foot during dynamic tasks. Barefoot strategy can be useful in ankle reconditioning.
Neuromuscular and proprioceptive training programs should be implemented as soon as possible after injury. Study has shown altered neuromuscular activation patterns after an ankle injury contribute to functional instability, alterations in gait, and elevate risk for recurrent injury. Proprioception and neuromuscular training enhance the sensorimotor system’s ability to adapt to a changing environment, improve sensation of joint position, and subsequently protect the body from injury. The ankle reconditioning program will be continued for 4 to 6 weeks depending on the severity of ankle injury.
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