Physio Edge podcast with David Pope
148. How to assess ankle sprains & start rehab with Zoe Russell
Podcast summary created with Snipd AI
Quick takeaways
- Proper assessment is crucial for ankle sprains to prevent chronic instability and long-term issues like osteoarthritis.
- New evidence suggests more proactive treatments are necessary, especially for professional athletes, to address ankle injuries comprehensively.
- Controlling swelling within 72 hours, educating patients on managing inflammation, and setting achievable goals are vital for a successful ankle sprain recovery.
Deep dives
Ankle Sprains: Importance of Proper Assessment and Management
Identifying structures involved and performing necessary assessment tests is crucial when treating ankle sprains. Often underestimated due to commonality, ankle sprains can lead to serious issues if not managed properly. Lack of awareness about impairments and subsequent injuries can result in long-term problems like post-traumatic osteoarthritis. Recurrent ankle injuries and chronic instability can lead to increased risks, emphasizing the importance of thorough assessment and management.
Evolution in Ankle Sprain Treatment
Recent evidence highlights a shift towards more proactive and aggressive treatments for ankle injuries. An increase in discussions with specialists, reconstruction procedures for lateral ankle sprains, and research on post-traumatic osteoarthritis have influenced treatment approaches. Emphasizing the need for addressing ankle injuries comprehensively rather than simply relying on traditional practices like strapping and ice, healthcare professionals are exploring more interventionist strategies, especially in cases of professional athletes.
Assessing Ankle Injuries: Subjective and Objective Measures
Assessing ankle injuries involves obtaining detailed subjective information about the mechanism of injury, previous history, pain levels, and progression over time. Objective measures like figure-eight taping for swelling assessment, weight-bearing dorsiflexion, strength testing, and balance evaluations play key roles in determining treatment plans. Understanding the patient's pain response, activity level, and utilizing outcome measures enhance the diagnostic and treatment processes in ankle injury management.
Managing Swelling and Inflammatory Response for Ankle Injuries
Controlling swelling and the inflammatory process within the first 72 hours of an ankle injury is crucial as it can lead to less sensitivity and easier recovery. Educating patients on managing swelling with medications and gentle exercises like toe curls and foot drills early on can empower them to aid their recovery. Setting acceptable pain levels and educating patients on gradual movement can help with early mobilization and long-term recovery.
Rehabilitation Strategies and Approaches for Ankle Sprains
Addressing individual goals, such as returning to sports, formal events, or daily activities, is essential in ankle sprain rehabilitation. Setting achievable strength and range of motion goals rather than strict timelines can guide patients' progress effectively. Incorporating balance tests, dynamic movements, and sport-specific drills can enhance patients' recovery and ensure functional outcomes. Taping and bracing can be beneficial based on patient needs and circumstances, focusing on reconditioning and gradually reducing reliance on external support for long-term stability.
Untreated or poorly rehabilitated ankle sprains can develop into chronic ankle instability (CAI), osteoarthritis, or other lower limb injuries (Bestwick-Stevenson et al. 2021; Delco et al., 2017; Herzog et al., 2019; van Ochten et al., 2017).
In this podcast Zoe Russell discusses ankle sprain assessment and treatment, and how to return your patients to sport. You’ll discover how to help your ankle sprain patients fully recover as quickly as possible, and avoid long term ankle issues.
Zoe is a Specialist Sports Physiotherapist (FACP), APA Titled Musculoskeletal and Sports Physio, as well as a Clinical Edge Senior Educator and Presenter, and in this Physio Edge podcast hosted by David Pope, we discuss the latest evidence and practical treatment strategies for ankle sprains, including:
Assessment- Common issues therapists face when rehabilitating ankle sprain patients.
- Questions you need to ask your ankle sprain patients.
- How a previous history of ankle sprains impacts your assessment & treatment.
- Why patients with inversion injuries may have medial ankle pain.
- How to avoid stirring up patients pain during your assessment.
- Common mechanisms of injury, and how this guides your diagnosis.
- Structures that are likely to be injured with different ankle injuries.
- 10 key elements to include in your assessment & treatment.
- How to help reduce swelling quickly after an ankle sprain, and why this is important.
- Immediate sideline management for ankle sprains at sporting events.
- Whether manual therapy has a role in acute ankle injuries or persistent ankle pain and swelling.
- How to explain ankle sprains, recovery & rehab to your patient.
- What you’re looking to achieve with your early rehab.
- How to set rehab targets or goals with your patients.
- The role of taping in ankle rehab.
- Taping compared to bracing.
- Whether long term taping or bracing is a useful long term injury prevention strategy.
- The latest surgical procedures for patients with chronic ankle instability (CAI).
- Zoe Russell
- David Pope on Twitter
- Improve your musculoskeletal and sports injury assessment & treatment results with a free trial Clinical Edge membership
- Explain acute and persistent pain to your patients, without giving them the message “It’s all in your head” with the Making sense of pain training module
- Comprehensive low back pain assessment & treatment training module
- David Pope at Clinical Edge
Chapters:
- 03:47 - Untreated ankle sprains
- 05:27 - Latest evidence
- 07:04 - Subjective questions
- 09:45 - Common mechanisms of injury
- 11:47 - Plantarflexion/inversion injury with medial ankle pain
- 15:22 - Dorsiflexion eversion injuries
- 15:54 - Swelling
- 21:11 - Objective tests
- 26:32 - Irritability
- 26:47 - Figure of 8 taping technique
- 28:56 - Inferior and superior tib-fib joint assessment
- 32:14 - Treatment
- 42:41 - Change of direction
- 43:17 - Tape or brace?
- 50:06 - Mobilise or immobilise?
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