Ankle Sprains and Chronic Ankle Instability

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(CAI) Part I

Ankle sprains are among the most common of all traumatic injuries. It is estimated that 1 out of every 10,000 people in the US sprain an ankle daily or 23,000 ankle sprains per day. Of those, only around 50% are estimated to seek treatment from a healthcare professional. However, up to 70% of patients will suffer from repetitive ankle sprains and chronic pain after injury. (CAI) With all injuries, ankle sprains included, it is important to figure out injury severity, determine if imaging is necessary, and how is the injury BEST treated?

One question is; when do you need treatment, and what type of treatment is needed? Initially, it must be decided if your sprained ankle is only a ligament injury (most common) or whether you need an x-ray to rule out a fracture. There is good research behind a Canadian developed clinical prediction rule called the Ottawa Ankle Rules. Essentially, if you can’t walk a few steps immediately after the injury, or in the ER, and there is tenderness to palpation on the inside or outside of the ankle on the malleoli, then you need a x-ray. Other- wise there is a low likelihood that a fracture is present.

Most inversion ankle sprains involve the lateral (outside) ligaments of the ankle. It has been theorized that due to the position of the fibular head getting positioned too far anteriorly (forward) that chronic ankle pain and instability are more likely. One study looked at this theory in regards to self reported chronic ankle instability (CAI). Of the two test groups,the position of the fibular head in the CAI group showed on average a 2.4 cm position anterior in comparison to the uninvolved ankle by way of fluoroscopy (real time moving x-ray). Essentially, in patients with CAI and pain, that even after the injured ligaments have healed, if the fibular position isn’t addressed, then the likelihood of CAI and pain are more likely.

In regards to treatment, there are hands on manual therapy techniques that address the fibular head position. At Holland Physical Therapy we treat one patient at a time using evidence based, hands on, manual therapy techniques. Exercise is an integral part of treatment for ankle sprains, but the ankle joint mobility and fibular head position have to be addressed to give complete resolution of symptoms. Part II will look at more research behind treatment for ankle sprains. Call us at 616-355-4284 or visit us at www.Holland-PT.com to get evaluated.

Ford Reinink PT, DPT

Director of Clinical Operations for Holland Physical Therapy

https://holland-pt.com

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