Ankle Sprain

NMT IN ANKLE SPRAIN REHABILITATION

David Blow
NeuroMuscular Taping Institute
Rome, Italy
31/10/2009

An injured, unstable ankle creates susceptibility to recurrent sprains. The importance of effective reeducation following a sprain is therefore easily appreciated. Once the trauma has been treated, between 10% and 30% of patients complain of chronic symptoms characterised by:

  • Synovitis
  • Tendinopathy
  • Stiffness
  • Increase in dimensions due to edema
  • Pain
  • Muscle failure.

These symptoms may or may not be associated with instability of the instep, difficulty in walking on uneven ground and recurrent sprains. All of these may occur irrespective of the kind of treatment given to the acute event.

An Overview of Ankle Sprains

  • 20% from sport injuries
  • 30% of cases represent chronic dysfunction
  • Frequent recurrence
  • High social costs

Recovery therapy for ankle sprain involves complex treatment of the ligament, nerve, muscle/tendon and fascia tissue of the entire tibiotarsal astragalus joint. Whatever treatment is provided for the patient – whether surgical or conservative – the time required for complete functional recovery can vary between 3 and 5 weeks. The time needed before a return to work can vary between 4 and 7 weeks. 10 weeks are required before it is possible to return to competitive sports. Usually, recovery times are shorter among professional athletes because much more time is spent on rehabilitation than is the case for amateurs.

Sprains may be acute in nature (following impacts, tackles, collisions or sudden changes in direction) or chronic (following sizeable, prolonged loads). The traumatic event can lead to pathology of the joint, which may be subdivided under two clinical schemas:

  1. Joint looseness, with capsular lesions, enlargement and laceration of the lateral and medial ligamental compartment of the tibio-tarsal and subtalar joint, causing excursion of the joint beyond its normal physiological limits.
  2. Joint instability, which is perceived by the athlete as a sign of yielding of the joint while executing a movement in sport, and which can be pathologically identified as a more or less complete rupture of the ligaments.

Classification of Sprains

Grade 0 – tilt of astragalus of less than 8°, no ligament rupture Grade 1 – tilt of astragalus of 10°- 20°, rupture of the anterior peroneal astragalus ligament Grade 2 – tilt of astragalus of 20°- 30°, rupture of the anterior peroneal astragalus and peroneal calcaneal ligament Grade 3 – tilt of astragalus of more than 30°, rupture of the three ligaments

Symptoms of Ankle Sprains

Symptoms of acute sprains are: sharp pain, localized at the level of the anterior peroneal malleolus area, provoked by palpation; moderate or conspicuous periarticular and articular swelling, sign of rupture of the small arteriole passing above the anterior peroneal astragalus ligament (Robert-Jaspert sign). Other symptoms are functional limitation caused by pain the patient feels during articulation movements and instability of the tibiotarsal joint.

Conservative Treatment

Treatment for tibiotarsal sprain follows an approach of three phases of rehabilitation:

  • Acute
  • Sub-acute
  • Functional Reeducation
  1. Acute Phase
    The most widely proven protocol for acute lesions is P.R.I.C.E. (Protection Rest Ice Compression Elevation). In the acute phase, the objectives are:

    1. Immobilization
    2. Pain reduction and facilitation of drainage of the edema or of the tissue stasis.
    3. Prevention of further mechanical stress on the injured structure.

    During the acute-phase rehabilitation, supplementary treatment with NeuroMuscular taping has the following objectives:

    • Reduction of inflammation
    • Drainage of edematous congestion
    • Drainage of hematic congestion
    • Pain reduction
    • Mechanical support for the joint axis

    The application of NeuoMuscular taping focuses on improving lateral drainage of the ankle. The double fan may be applied in conjunction with an ankle brace to provide support and coherence to the ligments.

    Figure 1
    Lateral fan and lateral double fan
  2. Sub-acute Phase
    During the sub-acute phase, the purpose of treatment is to provide the injured tissue a series of mechanical stimuli in order to promote the physiological orientation of the collagen fibres.

    1. The objectives of this phase are:
    2. Eliminatoin of pain
    3. Recovery of articulation
    4. Elimination of muscle spasm
    5. Elimination of edema
    6. Recovery of muscular strength.
    Figure 2
    Adding lateral stability in the final application

    Supplementary therapy with NMT during the sub-acute phase has the following objectives:

    • Reduction of inflammation
    • Drainage of edematous and hematic congestion
    • Pain reduction
    • Assistance with weight-bearing
  3. Functional Reeducation Phase
    The functional reeducation phase aims at:

    1. Recovery of proprioception
    2. Recovery of strength
    3. Prevention of recurrence
    4. Prevention of relapse or recurrence on resumption of motor activity
    5. Reduction of damage from a prolonged period of immobility or of functional inactivity
    6. Reduction of recovery times
    Figure 3
    Application dorsal functional correction – lateral stability – stability of Achilees tendon and of the gastrocnemius

    Supplementary therapy with NMT during the functional reeducation phase has the following objectives:

    • Recovery of proprioception
    • Recovery of strength
    • Prevention of recurrence
    • Lateral stability
    Figure 4
    Recovery of proprioception
    Figure 5
    Recovery of strength and of lateral stability

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