Ankle Sprains: Science Based Treatment

Chiropractor, Dr. Alexander Jimenez examines the ankle sprain treatment options presented in this case.

The treatment plan I outline below has been utilized in professional sports for years but hasn't entered into mainstream injury management protocols. I suspect the reason is simple: it is very uncomfortable! Nonetheless, it works: I have seen athletes on crutches after sustaining diagnosed Grade 2 2+ ankle sprains who could walk without crutches with only a minimal limp following their first session of this treatment, and who had been back training after three to four days (obviously with a great deal of tape support).

Readers will probably be familiar with what occurs after an ankle sprain: internal bleeding, inflammatory processes, pain and swelling. The brain also gets involved, producing muscle inhibition and a decrease in proprioception, which usually compels the injured athlete to limp in an effort to reduce pain.

By numbing the toe and tricking the brain into allowing the ankle to move through a normal range of motion without pain, I believe we can minimize the detrimental effects of ankle sprains.

25-Minute Cryo-Kinetic Ice Bath

By icing the ankle in an ice tub, just following the protocol outlined below, I think you will be able to:

• Limit the bleeding by reducing the micro-circulation (Knobloch et al, 2006)
• Trick the brain and hence the muscles into thinking that the ankle isn’t that badly injured, so normal function can be restored more rapidly than you would otherwise expect.

Precaution!

1. You MUST check whether your client has any vascular conditions (such as Reynaud’s disease) or diabetes, which will be adversely affected by this cold treatment.
   If so, this obviously isn’t for them.
2. If your patient experiences severe unremitting pain during this process (rather than extreme discomfort that settles after 4-5 minutes), it is possible that they have suffered an ankle fracture, so cease icing immediately. If you suspect an ankle fracture, don’t prescribe this technique until after an x-ray has excluded any fractures.
3. Action! – The ice-bucket protocol
4. Use a bucket (rectangular is best) that can easily accommodate the client’s foot.
5. Fill with cold water and enough ice to make the water really cold (How cold? I’m not aware of any research that states an optimal temperature, but I suggest 12-15°C).
6. Check precautions and contraindications of ice applications with your client before you start treatment.
7. Sit the client on a chair with their foot and ankle (up to mid shin) in the iced water for 10 minutes. It is normal to feel pain from the cold but this should abate after five minutes, as the foot and ankle go numb.
8. After 10 minutes, the client stands, with their foot still in the bucket, and performs two minutes of mini squats, keeping the range within what pain permits (ie, don’t push into pain).
9. Client sits again for two minutes with their foot stationary in bucket.
10. Client stands and performs two minutes of small calf raises, again within pain limits (ie, the calf raises should not cause pain).
11. Client sits for two minutes.
12. Client stands and repeats the two minutes of mini-squats.
13. Client sits for two minutes.
14. Client stands and repeats the two minutes of calf raises.
15. Client sits for one minute, totaling 25 minutes of cryo-kinetic icing.

Perform this regime every two to three hours for the first two days following the injury. In professional sports, injured athletes may also set their alarms and ice a few days, late at night and early morning (eg, 12pm and 3am) to minimize swelling and optimize recovery speed. For your averagely active individual who also has a day job, I'd get them to perform this program as soon as possible following the accident and after that, for the initial two to three days, once a day towards the end of the day once they're back from work and have settled down to the evening. I have even had success using this technique on chronic swollen ankles that was sprained four to six weeks previously. After one to two sessions in the bucket, the swelling was minimal and the range of movement improved dramatically.

Caution!

There are a few basic principles which the patient should be informed of:

• Only exercise within pain limits, to avoid making tissue damage worse.
• Only take as much weight on the injured foot as you can tolerate within pain levels, but aim to progress the amount of weight-bearing during the ice sessions.
• This regime is supplemental to, not a replacement for the other RICE principles, so it is vital that you continue with compression and elevation between ice sessions.

Sourced From:

Mark Alexander was sports physiotherapist to the 2008 Olympic Australian triathlon team, is lecturer and coordinator of the Master of sports physiotherapy degree at Latrobe University (Melbourne) and managing director of BakBalls (www.bakballs.com).

Scott Smith is an Australian physiotherapist. He works at Albany Creek Sports Injury Clinic in Brisbane, specializing in running and golf injuries. He is currently working with Australian Rules football teams in Brisbane.

Sean Fyfe is the strength and conditioning coach and assistant tennis coach for the Tennis Australia National High Performance Academy based in Brisbane. He also operates his own sports physiotherapy clinic.

Mark Palmer is a New Zealand-trained physiotherapist who has been working in English football for the past five years. He has spent the past three seasons as head physiotherapist at Sheffield Wednesday FC.