ANKLE REHABILITATION

ANKLE REHABILITATION

DEFINITION
The lateral inversion sprain is one of the most common injuries and one of the most neglected. A sprain is the partial or complete disruption of a ligament or ligaments when the ankle joint exceeds its normal range of motion.
The lateral side of the ankle is composed of the three major ligament structures and their associated capsule: 1. Anterior Talofibular: 2. Calcaneofibular: and 3. Posterior Talofibular ligament. The individual ligaments provide lateral stability depending upon the position of the foot. Thus the position of the foot and amount of intrinsic or extrinsic force applied determine which of the ligaments will be injured.

RECURRENT ANKLE SPRAINS
People who chronically sprain their ankles may have some inherent factors that predispose them to re-injury. Some obvious reasons may include weakness or muscle imbalance, residual ligamentous instability, lack of an effective proprioceptive feedback system, etc.


REHABILITATION PHILOSOPHY
In the rehabilitation of an acutely sprained ankle we have to be aware and concerned that we are not just dealing with a musculoskeletal problem, but a neuro-physiological problem as well. The rehabilitation process should begin immediately after injury for many reasons.


METHOD THAT CAN BE USE FOR ANKLE REHABILITATION
MODALITIES
Appropriate modalities such as ice, cold or contrast baths, electrical stimulation, massage and compression units etc. are used during the early rehabilitation process of ankle sprains primarily for controlling and reducing swelling.
TAPING
How much compression is needed is dependent upon:
1. How much return of swelling the patient has on a daily basis.
2. How much weight bearing he/she is able to perform.
These two criteria will determine whether a reinforced in between these two extremes is needed. Therefore a combination of taping that will allow some give for swelling without compromising the stability is utilized.
MANUAL MOBILIZATION
Mobilization techniques are utilized to facilitate mobility of the soft tissues as well as the normal rolling and gliding of the ankle and foot articulations.
WEIGHT BEARING
Some degree of weight bearing is encouraged with or without crutches depending on the signs and symptoms present. Patients who are unable to walk with a fluid gait are encouraged to use crutches and bear what weight is necessary on the hands, to facilitate a normalized smooth full gait pattern.




STRETCHING TECHNIQUES
1. Non-weight bearing: Sit with legs outstretched. Place (towel stretch) loop of towel around the ball of the foot. Hold free ends on your hands. Pull towel towards you stretching foot and ankle. Do 20 holding each 10 full counts.
2. Partial-weight bearing: Sit in chair with the involved leg (chair stretch) bent 90 degrees and foot flat on the ground. Slowly move forward out of the seat keeping the heel flat on the ground. Move forward until good stretch is noted. Do 20 each 10 full counts.
3. Full-weight bearing: Stand two or three feet away form a (traditional heel wall. The feet should be flat and cord stretch) shoulder width apart. Knees should be straight. Lean slowly forward with the arms supporting the body weight against the wall. Slowly fall forward until good stretch is noted. Do 20 holding each 10 full counts.
WHIRLPOOL EXERCISES
Active exercises performed while in the whirlpool help to facilitate motion, lymphatic drainage and neuromuscular re-education.
1. Flexion-extension: Point ankle toes upward and downward.
2. Supination: Point ankle and toes down and in.
3. Pronation: Point ankle and toes up and out.
4. Circumduction: Circular movements.
5. Alphabet: Print in capital letters the entire alphabet with the foot.
6. Toe Spreading: Spread the toes widely apart.
7. Pick-up exercises: Pick up marbles etc. from the bottom of the tank with the toes.
8. Partial weight bearing toe raises off the bottom of the extremity tank.

TOWEL EXERCISES
1. Toe flexion-ankle plantarflexion: Sitting on a chair, with the foot near the bottom of the towel, pull the towel under foot with the toes. Gather the length of the towel toward you several times. Graduate by placing a weight on the other end of the towel.
2. Supination: Sitting on a chair with knee bent 90 degrees and the outside of the foot near the edge of the towel. With the heel as a pivot, slowly move the towel inward using a scooping action with the floor. Graduate by placing a weight in the end of the towel.
3. Pronation: Same as above except place the inside of the foot near the edge of the towel. With the heel as a pivot, slowly move the towel outward using a pushing action with the foot. Graduate with a weight.

OTHER METHOD THAT FUNCTIONAL THE REHABILITATION
 Treadmill
 Nordic Track
 Jump Rope
 Mini-Tramp
 Sports Cord
 Step-ups
 Profitter-Bongo Board



AZMIL MUSTAPHA