Ankle sprain: treatment and rehabilitation at home * Crossfit

Ankle sprain is a rather unpleasant sports injury, which, however, can be treated at home. But only after the obligatory consultation with a specialist doctor. If you got such an injury during training, be prepared that rehabilitation may take several months.

Ankle anatomy

The ankle joint is an extremely flexible joint with a high degree of freedom of movement. At the same time, in contrast to the equally movable shoulder joint, the lower leg carries a constant load equal to the weight of our body, and when doing physical exercises, it often exceeds it. This, in turn, in case of non-observance of the technique of performing exercises in training or banal negligence in everyday life, can lead to a sprain of the ankle ligaments.

The ankle joint provides mutual mobility of the leg and foot. The talus is a kind of "transmitting link" here.

Ankle bone skeleton

The bones that form the shin - the tibia and the fibula, joining motionlessly with the help of the interosseous membrane, at the level of the ankle form a kind of "fork", which includes the talus. That, in turn, is connected to the heel bone - the largest of the components of the skeleton of the foot.

Together, these structures hold the ligaments together. Here it is important to draw a line between ligaments and tendons: the former are used for the mutual attachment of bones, the latter for connecting muscles to bones. You can injure both ligaments and tendons, but the symptoms and consequences will be different, but more on that below.

Ligaments

And so, the ankle ligaments are divided into three large groups, in accordance with the relative position relative to the joint.

Ligaments located inside the joint, directly supporting the bone structures of the lower leg: interosseous ligament; posterior inferior ligament; anterior inferior peroneal ligament; transverse ligament.
Ligaments that strengthen the outer, or lateral, surface of the joint: anterior talofibular ligament; posterior talofibular ligament; calcaneofibular.
Ligaments that strengthen the inner surface of the joint: tibial-scaphoid; tibial-ram; anterior tibial-talus; posterior tibial-ram.

Tendons and muscles

Somewhat above, we mentioned such important structures as the tendons attached to the ankle joint. It would be wrong to speak of them as separate elements, since the latter are an integral morphofunctional unit of the muscles serving the foot.

The largest, most important and often injured tendon of the ankle is the Achilles tendon, which connects the foot to the triceps calf muscle.

The tendons of the following muscles are also not so visible, but nevertheless important structures:

the long peroneal muscle, which is attached to 1-2 metatarsal bones, lowers the medial edge of the foot;
short peroneal muscle, attached to the 5th metatarsal bone, raises the lateral edge of the foot;
posterior tibial muscle, attached to the sphenoid and scaphoid bones of the foot and is responsible for turning the lower leg outward.

Of course, this list is not limited to the muscles that provide the entire range of motion in the ankle, however, it is the tendons of these muscles that tend to be most frequently damaged.

Causes of injury

Having considered the anatomical features of the ankle joint, let's move on to the mechanism of injury.

The ligamentous apparatus of the foot is adapted to quite serious loads. That is why it is possible to injure him only by making significant efforts. When the load is redistributed from several ligaments to one, this ligament is injured.

In terms of injury risk for the ankle, CrossFit is in one of the first places due to the wide variety of exercises. There are enough reasons for a sprained ankle.

An increased load on the ligaments of the ankle lays down in situations when:

the outer edge of the foot is tucked in, with almost all of the body weight being distributed here. In this case, the lateral group of ligaments is injured, since it is they that prevent excessive supination of the lower leg;
the foot is fixed, the body weight is transferred to its anterior section, while the lower leg is bent. In this case, the Achilles tendon is injured;
the foot is fixed, the lower leg is unbent as much as possible - the anterior talofibular and interfibular ligaments are injured;
the foot is fixed, rotation occurs in the joint, external or internal. Depending on the direction of the applied load, the external or internal ligaments, the Achilles tendon, the tendons of the short and long peroneal muscles suffer, with excessive internal rotation, the tendon of the posterior tibial muscle may be damaged.

Types and degrees of sprains

In traumatology, there are several of the most common types of ankle injuries and three degrees of so-called sprains. Let's talk about them in more detail.

Types of ankle injuries

There are such types of ankle injuries as:

turning the foot inward (inversion);
© Aksana - stock.adobe.com
turning the foot outward (eversion);
© Aksana - stock.adobe.com
stretching the upper ankle.
© Aksana - stock.adobe.com

Stretching ratios

As for the degree of stretching, the word "stretching" can only be used here conditionally. In other words, it is impossible to stretch the tendons or ligaments. In any case, the collagen fibers that make up these structures break apart. But the extent of this gap is different. Depending on the extent of damage to the ankle ligaments, sprains in this area are divided into three degrees:

For the first degree, fiber tear is characteristic, while more than half of all fibers remain intact.
The second degree is rupture of half of the collagen fibers, in which there is severe swelling of the joint area with displacement of the articular elements.
The third degree is a complete rupture of the ligaments, abnormal mobility in the joint, very pronounced swelling and pain in the injured area.

Signs of ankle injury

In addition to the symptoms described above, a crunch can be heard at the time of injury (in the event of a complete rupture, possibly when the ligament is torn in half).

Another option is to feel like something is tearing inside the joint. In any case, you won't be able to lean on your leg - it will be very painful. Try to move your ankle leg - mark the movements that cause the most discomfort. Those ligaments that interfere with the redundancy of this movement are most likely damaged.

Next, notice the position of the foot in the passive position. If it is noticeably displaced from its usual position, it is obviously a complete rupture of the ligaments.

A significant deformation of the ankle area also allows one to suspect this type of injury. Pay attention to the relative position of the ankles - the bony protrusions to the right and left of the ankle joint. Deformation of one of them indicates a ligament injury from the corresponding side. The relative shortening of the distance between the foot and ankles indicates an injury to the talocalcaneal joint.

The rate of edema growth is not a serious diagnostic criterion: its formation depends on the caliber of the affected vessels.

Even with a complete rupture of the ligaments, edema can form only by the end of the first day after the injury.

Regarding tendon injury: if you feel that you cannot make any movement in the ankle joint purely physically, despite any volitional effort, you can suspect an injury to the tendon of the muscle that is responsible for the corresponding movement. In this case, we are talking about the complete separation of the tendon. Typically, the tendon is torn off the periosteum with a piece of bone, so you can think of a full-fledged fracture.

First aid for trauma

Regardless of what you find in your self-diagnosis, if you have an ankle injury and experience any of the above symptoms, you need to do the following:

If possible, get to the trauma center, or at least to the house, without stepping on the injured leg.
Fix the foot in the most motionless position. For this, you can use an elastic bandage or orthosis. As a last resort, a high boot with a rigid ankle fixation will do until you get an elastic bandage. You need to bandage the joint with a "figure eight". The first round of bandage is applied over the ankle area, the second around the foot, the third round the first, the fourth round the second, each time we alternate the place of transition of the previous round, either from the side of the medial ankle, then from the lateral side. The bandage should tightly tighten the joint, limiting its mobility and preventing swelling from forming when you walk.
Apply a cold compress to the damaged area. Ideally, an ice pack. This can be an ice heater, frozen berries, a frozen piece of meat, or even regular snow in winter. It is necessary to apply such a compress to the place of the greatest edema for 20-30 minutes, no more. Then you need to take a break (about 20 minutes) and repeat the procedure. Ethyl chloride can be used instead of ice. It creates a cooling effect by evaporating from where it was applied. In the arsenal of sports medicine there are also special packages with a refrigerant. They can also come in handy, but their "lifespan" is too short.
Place your leg on a dais so that the lower leg area is located above the hip joint area. This will provide improved venous outflow and slightly reduce arterial flow. Thus, the swelling will subside a little, which means that the pain sensation will also slightly decrease. Remember, to a greater extent it is the edema that provokes pain due to purely mechanical pressure on the tissues from the inside. The pressure impairs the outflow of venous blood and this, in turn, further increases the edema, closing the vicious circle.
Do not hesitate to visit a traumatologist for an X-ray examination. This is a very important point! It is important to rule out or confirm the presence of an ankle fracture. Depending on what the picture shows, the treatment tactics will entirely depend. Either you go home and follow the doctor's recommendations, or you go to a specialized hospital, with all the ensuing consequences. In this situation, there is no need to be afraid of the hospital: improperly fused ankle bones can create significant problems for you in the future: difficulty walking with the formation of chronic lameness; lymphocytes; vein thrombosis of the lower extremity; chronic pain syndrome and so on.

Treatment methods

All the measures described above are relevant for the first three days of ankle sprain treatment at home. After three days, the vessels, as a rule, heal, the tendency to form edema is significantly reduced. From this time on, dry heat is prescribed - these are physiotherapy procedures performed in the polyclinic at the place of residence.

During the healing phase of the ankle ligaments, it is necessary to significantly limit the vertical load on the joint. Walking and sitting with your legs down is highly discouraged. The limb is best placed in an elevated position.

If you need to walk, it is better to wear a brace. It is necessary to get one, since even after clinical recovery, some instability in the joint will persist for some time. Bandaging your leg every time is not very convenient, and it can be difficult to wear shoes.

Of the drugs, you can be prescribed painkillers and venotonics. You don't need to take any medications on your own, without a doctor's prescription!

Rehabilitation after injury

Rehabilitation is an important step in the treatment of ankle sprains. Unfortunately, it will be difficult to give universal recommendations for severe injury to this joint.

Walking

In case of mild stretching, restoration of ankle mobility should be started with normal walking, excluding jumping and running at the initial stage of rehabilitation.

The pace of walking should be moderate, you need to walk at least 5 km per day. But not right away - start with small walks 2-3 km.

After the walk, you should do a contrasting water procedure: pour your feet with a cold shower, hot, cold again. This will help restore blood microcirculation and accelerate venous outflow.

For a month, your "workout" should stretch at least 7-10 km. The pace should be slightly faster than moderate.

Rise on toes

The next step is to add the toe lift to the walks with a change in the position of the ankle: socks inward, socks apart, socks in a neutral position.

We perform each movement slowly, until there is a strong burning sensation in the area of the feet and calf muscles. This stage will take 2 weeks.

Running and jumping

You need to devote half of your walk time to running - but you don't need to start right away. Start with a 5-7 minute run, gradually adding time. Run should be at an average pace, without acceleration. When you can run 5 km, this stage of rehabilitation can be considered mastered.