Lateral Ankle Sprain

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What is a lateral ankle sprain?

A lateral ankle sprain is an injury that causes a stretch or tear of one or more ligaments on the outer part of the ankle. Ligaments are tough bands of tissue that connect one bone to another and bind the joints together. In the ankle joint, ligaments provide stability by limiting side-to-side movement.
Some ankle sprains are a lot more serious than others. The severity of a sprain depends on whether ligaments are stretched, partially torn or completely torn, and if other structures inside the foot are also injured. Every ankle sprain should be taken seriously. Even small sprains can lead to functional instability of your ankle, and may cause a lot of problems in the future.
Ligaments on the inside of the ankle, and between the tibia and fibula, may also be injured in an ankle sprain. These cases are referred to as medial and high ankle sprain. They are less frequent but more difficult to treat, so it is important to look out for them as well.

How can it occur?

A lateral ankle sprain often results from landing awkwardly after a jump. A fall, a sudden twist, or a blow that forces the ankle joint out of its normal position may also lead to an ankle sprain. Muscle dysfunction can seriously affect active ankle stabilization and is an important contributing factor to ankle injuries. The psoas muscle is probably the most important muscle involved with dance injuries. Psoas dysfunction leads to tightness of the rectus femoris muscle (a part of the quadriceps) and deactivation of the piriformis (one of the smaller pelvic muscles inserting on the sacrum). This causes pelvic torsion and functional leg length discrepancy. The increased amount of stabilization work needed to compensate for leg length discrepancy will overcharge different groups of muscles. The peroneals – a group of two active foot stabilizers on the lower leg – are often affected. Active ankle stabilization thus can be seriously affected and the risk of an ankle injury will rise.

What are the typical symptoms of a lateral ankle sprain?

Typical symptoms of a lateral ankle sprain include mild aching to sudden pain on the outside of an ankle, a swelling that can be severe and sometimes a hematoma. A hematoma is a bleeding under the skin surface often caused by a ruptured ligament. Typically a hematoma will move towards the sole of the foot during the first days after the injury. You may experience a limited range of motion and not be able to fully weight-bare your foot.

How can a lateral ankle sprain be diagnosed?

Your doctor will examine your foot and ankle and may find tenderness and swelling on the outside of the ankle. He will check for stability of the joint as far as possible and assess the grade of the sprain. To fully evaluate the condition, he may order x-rays to determine if a fracture has occurred in your foot or ankle. Eventually an MRI scan is needed to detect cartilage defects inside the ankle joint or an injury to the syndesmosis − a tough band connecting the tibia and the fibula. An injury of the syndesmosis is referred to as high ankle sprain and will demand a different kind of treatment. Given that an ankle sprain can be related to overuse issues, a thorough functional clinical examination, including specific tests to identify joint and muscle dysfunction is recommended in the course of the rehabilitation process. Finding out the contributing factors to an injury is often challenging and your doctor may ask a specialist in manual medicine for his opinion.

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This MRI scan of the back foot shows a severely sprained ankle. All liquid appears white in this picture. Inflamed soft tissue contains a high amount of liquid. You can see joint effusion in the ankle joint as well as inflamed soft tissue in the front and back of the foot. The anterior lateral collateral ligament is torn.

What treatment options are there?

If you had an ankle injury, you should take a break from your ballet training immediately. Ignoring the pain can have serious consequences, as the situation will become increasingly complicated the longer you train with pain.
The RICE concept (rest, ice, compression and elevation) is an easy guideline that can be used to initially treat acute ankle injuries. Please read my “First Aid” post to obtain some background information that you will need to adapt this concept successfully and learn about the use of painkillers. In some cases a brace will be necessary to immobilize and protect your ankle. Depending on the severity of the sprain there are different types of braces that can be used. If you have been prescribed a stabilizing ankle brace, it is extremely important to wear it all of the time: that means 24 hours a day! You will have to make sure that your brace fits properly during the whole time that you are told to wear it. Sometimes due to muscle loss and decreasing soft-tissue swelling, braces become loose and cannot fulfill their function properly. Because most ankle braces do not apply a desired circular compression to the soft tissues, you should wear a compression sock under the brace. You will find these in any sports shop if not given to you by your doctor. Rehabilitation after an ankle sprain is mandatory and should start as soon as possible after the accident. While reducing pain and swelling will be the aim of the therapy in the first phase, restoring the full function and stability of the joint is the overall goal of the therapy. You will be shown exercises to build up active stabilization again and should constantly continue doing these at home until you have fully recovered. Electric muscle stimulation (EMS) is an excellent tool to reactivate dysfunctional muscles of the ankle and build up active stabilization quickly.
In order to handle a given overuse situation in the course of rehabilitation, its underlying causes – namely muscle dysfunction and muscle dysbalance – have to be addressed specifically. Muscle dysfunction can appear as muscle tightness (contraction) or weakness (inhibition) and the muscles affected have to be treated accordingly in the rehabilitation process. Some muscles will have to be stretched whereas others will rather have to be strengthened. A well-suited training program including corrective exercises as well as a general strengthening and endurance routine is the most effective way to deal with most overuse situations. Manual medicine and especially deep myofascial release treatment is recommended to address present joint and myofascial dysfunction. Restriction of the fascia plays a key role in all overuse issues and can be addressed effectively with manual medicine.
Ensure that you follow your specific training routine after the rehabilitation is finished. Myofascial rollers (Blackroll, Triggerpoint Roll, etc.) as well as Lacrosse balls and resistance bands are easy to use in the studio and will help you remain balanced in the long run.

Next steps

Do you think that you might have a hip overuse problem and want to have it sorted out? These are the next steps:

  • See a doctor

Dancers seek help from various different kinds of therapists, many of whom may employ treatments that are outside of mainstream medicine. Before considering the use of such alternative medicine, you should see a doctor for an evaluation and diagnosis.
Finding a doctor who is familiar with the specific medical issues faced by dancers is often challenging and you may need to see several different specialists in order to get a full picture of your diagnosis. A good place to start is to ask your friends and fellow dancers for the names of their favorite doctors.

  • Find a specialist in manual medicine

Doctors who specialize in manual medicine practice a whole-body approach. They will try to identify and specifically treat the underlying causes of your problem, rather than just the localized symptoms. This approach is important in addressing all aspects of the often very complex overuse problems that dancers experience. A specialist in manual medicine will perform a functional examination on every part of your body and will treat you according to these thorough findings.
To find a physician who specializes in this field, search for “Manual Medicine”, “Osteopathic Manipulative Medicine” or “Osteopathic Physician” on the internet.

  • Start working on your problem

There is a lot that you can do to work on your problem after a proper diagnosis has been set. Ultimately, it often comes down to addressing the same fundamental issues. Here are some useful exercises that I recommend to my patients:

Flexibility training: Foot release, Professional calf and foot release, Piriformis release, Compex “DECONTRACTURE” program (peroneal muscles)

Strength training: Compex “DISUSE ATROPHY” program (peroneal muscles), “The clamshell” – Piriformis training, “The monster walk” – Piriformis training

Please refer to your doctor to confirm that the exercises you choose to do are suited to your individual problem, and obtain supervision from a professional trainer to ensure that you are performing them correctly.

  • Talk to your ballet master or dance teacher

Technical issues and faulty dance technique are important predisposing factors of overuse and injury in dancers. Amending dance techniques often plays a crucial role in the treatment and prevention of overuse and injury and you should not hesitate to address any issues, if necessary.


 

 


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