Ankle Sprain: How to Present the Injury to a Health Care Provider

I just got back from a 6 day trip to see my son and daughter in law and grandson William in San Diego. My wife and I had a marvelous time, but it is time to get to work tomorrow. Perhaps I care share one little photo of William for my readers. 

William is 6 months old and of course I am much older

     This post is about having an ankle sprain and trying to write down all the important things to tell the health care provider when you go in for the visit. However, it could apply to any injury, and it is both for the health provider and you. After the initial pain, and maybe you are still lying there on the ground, you have to start asking why? Why me? Why now? What lead up to this injury? The answers to these and other questions can help prevent other injuries in the future.

#1  What exactly happen? Fall down stairs, land on someone's foot, etc

#2  Has this happened before? Are you prone to sprain your ankles? 

#3  Did you feel that your ankle was weak before your sprain occurred?

#4  Were you doing too much prior to the injury?

#5  Do you have good stable shoes for your ankle?

#6  Do you wear ankle braces during the activity you sprained your ankle?

#7  In what direction did your ankle move during the sprain?

#8  In what direction did your body move during the sprain?

#9  Did the sprain cause you to fall?

#10 Was a pure accident like a slip on slippery surface?

I hope these questions will help you focus on the injury to get at the cause and mechanics of the injury. Rich 

Ankle Sprain with Significant Ankle Problems: Email Advice

Hello Dr. Blake,

You had helped me immensely through a long sesamoid recovery 7 years ago. In the end, I made it through to fully healed with no pain! For anyone with bad sesamoid injury, you can and will make it through the nightmare!  It can be done. 

Unfortunately I return with a new issue. 2 weeks ago I twisted my ankle stepping off a curb. I had some pain, though the majority of that pain went away in a few days. Then a few days later i was pushing my kids in the stroller up a steep hill (I’m new to the Bay Area) which put my ankles into intense dorsiflexion. I started getting pain the day after and was not able to dorsiflex, but Especially plantar flex without pain in my ankle (in the back). I was able to walk on it for the next week,  but had to limit dorsiflexion to avoid pain. After seeing a podiatrist, I was recommended to wear a boot (talk about PTSD from my sesmoid injury). The majority of my pain is on the lateral side, right behind and under the boney bump of the ankle (fibula). 

Nothing showed on x-ray, which I’m starting to realizing doesn’t mean all that much.  Today I got MRI results back and was hoping you could help to interpret and provide your thoughts? Photos attached.  I clearly have a talar dome issue (cartilage), though my Dr. seems to think that’s been there for a long time. For a long time I’ve always had some minor stiffness and pain in this ankle, but it always went away after a few minutes of getting ready in the morning. I’m assuming that what that is. But since that issue is more on the medial side (whereas my pain is lateral), is it possible that’s not the driver of most of my current pain? Or could a lot of this be due to that and I will need surgery?

My Dr believes the majority of the pain is from the sprains (ligaments) that need to heal. Though I see some remarks in my MRI about “stress reaction” which makes me think that there is possibly a stress fracture, but for some reason that didn’t make it into the MRI’s concluding remarks. What are your thoughts?

The Drs plan is to stay in the boot and revaluate after 4 weeks? I also know better and will do contrast bath.  

Does all these seem reasonable?  I “feel” like there is enough pain to possibly be a fracture, but can’t tell if it’s ligaments and soft tissue issue we’re dealing with here. How long of a healing process do you think I’m really facing?  I just want to set the expectation for myself, my work, and my family correctly. 

Thank you,

Dr. Blake’s comment: thanks for the update on your sesamoid. You have a fragile ankle, and someday you may have to have it cleaned out, possibly bone graphed or replaced. Someday! I see people all the time that sprain their ankles and wake up a sleeping giant, which you could have done. You have to treat the worse possible scenario to protect you, so you place it in a boot for awhile, gradually wean out into a brace, gradually increase all activities and follow how the ankle behaves. With the goal of walking around with 0-2 pain as our guide, you go one month at a time. Have you achieved 0-2 in the boot? Do not let anyone put cortisone into your joint as it can weaken it further. If you get a bone scan, and it lights up, you can call this a stress fracture and qualify for the bone stimulator. That may just strengthen the bone enough to have you dodge the surgical bullet. Separate from your injury, I would get surgical consult from several orthopedist or podiatrists on what they would do if this does not improve. Hope this helps. Rich

Nerve Irritation Post Ankle Sprain: Email Advice

Hi Dr. Blake,

I haven't seen you in many years (I think my last visit was around 2004/5 re: my plantar problems while qualifying for the Boston Marathon), and now find your immense blog! Since then, I got married, had 2 kids, and am quasi-coming up for air. Would you please advise me...I hurt my ankle again =(

Late last night, I rolled my left ankle outward while trying to get on a dome-shaped balancing ball at the gym. I heard a popping sound on my way falling down to the floor. I was able to get some ice on my ankle at home. But since then, I've been limping around the house (hardwood floors) and trying to avoid chasing my kids (ages 3 1/2 and 2). My biggest concern is a tingling feeling around the ankle bone that radiates down to my heel and up to my arch area.

I've wrecked this ankle before in a stupid snowboarding accident and have sprained it several other times in my life. But I don't remember the tingling. I'm worried about that because isn't that an indication of nerve damage?

Thanks so much for your advice! I'll call your office to make an appointment if the tingling is still going on. I went to the gym today and worked out my upper body. People thought I was nuts hobbling from machine to machine...

Best regards,

Dr Blake's Response:

Hey Allie (name changed), sorry for the delay. Yes, you must of jerked the nerve real good. It can take a while to calm down. If you have an ankle brace that ties up, that may rest it well. You can also adjust the lacing so that it does not push hard into any sore areas. Continue icing for 96 hours, then begin contrast bathing once daily. See my blog post on how to start contrast bathing. Be good to it and hopefully it will settle down quickly. Rich

http://www.drblakeshealingsole.com/search/label/Contrast%20Bathing

Nerves love non painful massage. And they usually love heat, in general, over ice. Try gentle massage to the swollen areas, and gently move the ankle. I typically teach patients to use their big toe as a paint brush in the warm water of contrast bathing and attempt to paint the alphabet. Also, order a bottle of Neuro-Eze online. It is a good nerve topical medication. You massage a small drop into the area 3 times daily. I sure hope this helps. Rich

Ankle Sprain: Injury Advice

Hello,

     About 5 weeks ago, I fell and the foot began to swell and turn to a purplish shade within about 5 minutes. I ended up in the E.R, being diagnosed with a bad sprain, and it was put in a splint for a week. Although I stayed off of it completely for that time, the swelling, pain, or coloring had not improved at all.

     In a visit to another orthopedist, he diagnosed it as a chip fracture, caused by tearing a ligament with the bone. He put it in a cam walker originally for 3 weeks. After those weeks, he looked at it again, but the swelling had not gone down very much, and the pain seemed to have increased, if possible.

Dr Blake's comment: With a 3rd degree sprain with chip fracture, swelling is going to take 4 to 5 months to go down. It never goes down when you are immobilized, as the velcro straps above the ankle will prevent the swelling from going back towards your heart. You can help this with compression within the walker, elevation, massage, PT, acupuncture, contrast baths, and various salves. You will see the first real reduction in swelling when you can walk normal with the cam walker for 2 straight weeks. The second reduction in swelling occurs when you have been able to wean successfully out of the walker and are in the Aircast brace full time. 

   He said to leave it in the boot for 3 more weeks, later transferring it to an air cast, before beginning therapy. But now, a week before the follow up, the foot hurts more every time I put pressure on it. The pain is not in the ankle, but in the inside of the foot and the heel. The swelling has gone down a bit, but the bruising has returned, and the pain is becoming more unbearable. Is it possible more than one ligament has been torn and this may require surgery?

Dr Blake's comment: 30 years ago, in the infancy of sports medicine as a discipline, doctors and physical therapists were encouraging mobilization for ankle sprains, not immobilization. I definitely feel this needs to be tailored to each individual, but immobilization can lead to all your symptoms. When you sprain an ankle, you may have an obvious injury, and several less obvious injuries (minor or severe). Since you are having more pain, the obvious thing to do this next month is to get some other test your doc feels appropriate (MRI, bone scan, other xrays, etc) and to re-create a pain free environment (different boot, out of the boot, crutches more, or some obvious change in your activity). Typically with your injury I would have you in PT within the first week. The PT can successfully work on the swelling, find sources of pain, re-create a pain free environment, and give great feedback to the doc treating. Surgeries for torn ligaments, even with chip fractures, are done 9 to 12 months after the injury when the PTs can not find a way to get you functionally stable (where you feel a small crack in the road will cause a sprain). I sure hope this helps you some. Rich

Ankle Brace Advice: Email Correspondance

This patient is my patient on her honeymoon backpacking in some remote place and sprained her ankle. We already had one correspondence. 

Hey Dr Blake,

Thanks so much for the advice.  By the time I received your email, the X-ray facility was closed for the weekend so we moved on.  We got back on the bikes and I was able to pedal big miles and hike small miles, but your advice of X-ray did haunt me a bit.  The stable motion of biking caused me almost no pain at all, but my ankle did worsen after one 5 mile hike...it really exposed the pain and weakness of my limited range of motion.  I haven't been improving much since that setback.  I can walk on even surfaces with zero pain, but it is painful if I bear weight at a slightly different angle (stairs, kneeling, dirt roads, etc).  It has been just over 4 weeks since injury.  

Last question, I promise...should I see a doctor?  Do you think it unwise to continue my very slow self-healing program of limited activity, occasional ice, and gentle ankle stretches?  

Thank you as always! 

Sally (name changed)

Dr Blake's response:

Sally,

     I probably would definitely get an ankle brace if you can to stabilize the ankle for walks on uneven ground and keep soaking in the Ocean 10 minutes at least at a time to control the inflammation. Not sure if you need to see a doctor to get a brace, or some other supplier. You should get one where the sock part of the brace is loose, and there is some form of tightening you can do with velcro or laces that you are in control of the tension--which will vary throughout the day. The fact that you can walk without any pain on even surfaces is a good indicator that their is no major break needing surgery. You may have irritated some cartilage or ligaments which will take some time. Small hairline fractures after an ankle sprain can take a year to completely get comfortable. A brace to protect, cold water soaking for anti-inflammatory, and maintaining a pain free environment as best as possible should do the trick. Rich

Ankle Sprain Advice From Afar: To Xray or not Xray That is the Question??

Hello Dr Blake!

We're enjoying a wonderful honeymoon in Tasmania, but despite the small population we haven't met your second cousin yet!  

Unfortunately I injured my ankle last week and wonder if you will check your email today for some quick advice.  8 days ago, we were hiking and I rolled my right ankle severely outwards.  With my loose joints, this happens all the time and I usually recover in 1 or 2 minutes, but this time it was bad.  I think I felt a "pop".  After hiking about 2 miles back to our friends' vehicle, the ankle was very swollen.  We wrapped it for compression, but were unable to get any ice on it for at least 6 more hours.  For the next 24 hrs, I iced and elevated, limited walking around our camp site to the bathroom and picnic table, etc.  The following 3 days, I didn't have ice available at next site, but took max dose of ibuprofen daily, limited walking.  Only have pain when ankle rotates outward on uneven ground.

On days 5, 6, and 7 we did minimal cycling (10 - 15 miles) on fairly flat, easy roads.  I noticed that I was OK for the first hour, then some pain in different parts of the ankle and foot towards the end of the ride.  We finally rolled into a bigger town and decided to see a doctor at an urgent care clinic.  She barely looked at my foot, but said it was probably a sprain or torn ligament, prescribed a strong anti-inflammatory.  

I also have a referral for an X-ray and ultrasound, and currently deciding what to do next.  I would like to try some minimal, easy cycling for the next 9 days of vacation and see how it goes, though a little voice is worried that this may be unwise.  I have the option to get an x-ray here in this small town today, and/or travel to the bigger town (1 - 2 hrs by bus) for an ultrasound.  Do you think either of these is necessary?  I still have some swelling after 8 days, some level 3 (out of 10) pain while walking.Thank you and happy new year!

Dr Blake's comment:

Hey Stephanie,

      Sorry to hear about your ankle, and hope you run into my relatives soon. Maybe they own an xray machine. 
Definitely I would get the xray to rule out a fracture. I say rule out because that is what we want to do---eliminate it from the discussion. It is the best information you can give me. If you have a negative xray, the injury is probably all soft tissue, and pushing through some of the pain is probably okay. If the xray shows a fracture, more beach time for you girl!!! Keep me in the loop. Rich

Chronic Swelling Post Ankle Sprain: Email Advice

Hi, Dr. Blake,

I’ve written you in the past about my sesamoiditis, which hasn’t been giving me any trouble since working to help it heal based on your suggestions, and wearing the right footwear since then.  THANK YOU!

Now, I am having an issue with a spot on my right ankle.  I sprained it badly last September, when I was out of town for a conference, and couldn’t take care of it very well.  It healed OK, as far as I could tell but since the sprain it's always had a larger profile.  Now, without any precipitating event that I can tell, I have had swelling in the same spot for about three weeks—at first, hard to tell the difference between left and right silhouettes, but now pronounced.  It subsides during sleep, but then by the end of the work day (I am wearing compression socks, the kind nurses wear, all day, on both legs) it is getting swollen.  It’s right over the ankle bone, above and along the edge of my shoe on the outside of my foot towards the back and the area of swelling is about 4” long by 1” wide. 

There has been no pain, except a few twinges, and no range of motion has been affected … which is why I waited so long to write.  I kept thinking it was something minor, but now that it is not resolving I am wondering if I reinjured myself?  I just read your post to Roberta from 2/5/2012 with alarm—I am WAY past 14 days with this.  Most of what I read is about immediately post sprain-- what to do much later?

Do you have any suggestions for me?  I have made an MD appointment, but as great as my MD is, she is not the expert that you are.  Thank you, again, for your help!

Ann from Seattle

Hey Ann,

     Thank you so very much for your email and I am glad that the sesamoiditis has resolved. When I did a study in the 1980s on ankle sprains, I found nearly 20% of all ankle sprain victims still had some symptoms after one year. Only 1-2% of those patients had a significant injury like a missed fracture. The other 98% of these patients had problems, but did not know if they had any significance, and thus were just living with them. The reasons were varied, like still feeling weak or unstable, and approximately 20% of them complained swelling like you. If I do my math correctly, that means 4% of all ankle sprains patients are still having swelling issues after one year post injury. 


     So, why is this a big deal? The ankle joint is the tightest major weight bearing joint in the body. The tibia (leg bone) and the talus (foot bone) normally fit like a hand and glove. Swelling causes instability by separating the joint surfaces. Add some amount of ligament damage with your typical sprain and more potential instability or wobble can occur. Add the typical sub par re-strengthening program of most ankle sprains, and the potential of significant re-injury occurs. Add the heels that most women want to wear, or the cobble stones streets in Europe, or the months of deconditioning/weakness produced by a new job, move, illness, etc, and more potential for injury occurs. 


     Question #1: Does the swelling without pain mean something really bad is lurking? Probably not.
     Question #2: Should you work aggressively on the swelling with more PT, contrast bathing, elevation, acupuncture, etc? Probably not, although some daily icing with a pack 20 minutes to the front and outside of the ankle is helpful. At least, you can slip inside your sock and walk around the house with an ice pack. Do for the next 2 months, near the end of each day, Also, if your soaks or support hose when you take off produce a visible depression in the skin, this alone may be preventing the fluid from getting back to your heart. 
     Question #3: What should be your primary focus over the next 2 months? Place yourself on a great ankle restrengthening program with the balance and theraband exercises listed in this blog. Do these for 5 minutes every night within 2 hours of going to sleep to gradually strengthen the ankle and then go to 3 days per week. Over the next year, make sure the time or difficulty increases each month, so you become super strong. Then let me know how you feel. If you do the various exercises, and you can isolate one that hurts you, now we have probably labeled some form of tendinitis and the treatment can be more exacting. 


Sure hope this helps you Ann, Rich. 

Ankle Sprains: Make sure Ankle Strength Even On Both Sides!!

More soccer sprains when one ankle is stronger: study Chicago Tribune (Reuters) - Pro soccer players are much more likely to suffer ankle sprains when one foot is stronger than the other, according to a Greek study. Ankle sprains ... See all stories on this topic »

This is a good study of a fact that the sports medicine world has known, but little has been documented. So in order to reduce the amount of sprains in the first place, or prevent further sprains after the initial incident, get those ankles strong. The blog post on Single Leg Balancing Exercise is a great way to start. 

Ankle Sprain Advice

Hi, Dr. Blake -

It's been almost a year since I last was in contact with you.  I sprained my ankle today, and wanted to check in with you.  Last year it was the right ankle, today it was the left.  I looked at your blog, but I wanted to clarify a few things with you directly.

I am elevating and icing and took some ibuprofen.  I still have a few compression socks and horseshoe padding from last time.  Should I start that right away?  Should I not use the padding while icing?

I remember how to do the contrast baths, but I seem to recall that I'm supposed to wait a day or two before starting those.

I have attached a couple pictures of my ankle.  It swelled up right away.  It also feels somewhat different than last year's injury.  With that one, I was able to walk without limping.  This one causes me to limp.  I was not in motion when my ankle rolled, but I was standing on an elevated surface, and rolled down from that (if that makes sense :)

Please let me know if I should come in to see you.  I'm pretty sure it's just a sprain.

Thanks, 

Roberta

Roberta, 

     Thanks for the email and I am so sorry about the sprain. Until the swelling is gone for 2 straight weeks, you should use compression 24/7. Those compression socks will help you, along with the horseshoe padding. I am going to use your email for my blog tomorrow, but will remove your identity (probably call you Roberta). Ice for 96 hours, then begin the contrasts at 1 min hot, 1 min cold for 20 minutes. When you ice you can remove the compression. Schedule with me for Wednesday on, but cancel if it is getting better and better. I will try to be even more thorough in my blog. Rich

     When you sprain your ankle, you need to immediately control the swelling. The more PRICE you do over the first 4 days, the assault and battery days, and the less swelling you have by the end of those 4 days, the faster your ankle will recover. Now, Roberta's (identity removed) ankle looks more like a high ankle sprain (the ligaments above the ankle called the tib-fib ligaments), and it could be a distal fibular bone fracture. So the next few days will tell us if we should xrays. Ankle sprains get better and better, ankle fractures go much slower. So, if Roberta is not feeling a significant improvement with the ability to weight bear on the 5th day post injury, we should definitely be xraying her. I always recommend weight bearing xrays on the foot and ankle since sometimes how the bones line up to the ground and each other can make a difference in diagnosis and/or treatment. To summarize PRICE for you, it is:

Protection: crutches, bracing, removable boots,etc

Rest: Restricting motion of the ankle just enough to not stimulate the pain response

Ice: All the wonderful Anti-Inflammatory measures we have available including avoiding certain foods.

Compression: Remember Compression should be tighter below the injury and looser above the injury

Elevation: Even 1 inch off the floor makes a difference, but get it up as much as you can for the first 4 to 14 days.Control that swelling.

I will leave a Rx for ankle xrays on my asst Kathy's desk. If you feel you should get an xray, call her, schedule an appt, and go to xray 1 hour before. Rich

Talus Injury and Initial MRI Followup Post Ankle Sprain

Ankle Sprains: Taping Technique

I hope this video gives you an idea on how to self tape your ankles. You need prewrap, 1 inch and 1 and 1/2 inch white athletic tape. There are so many modifications that if you get the main idea of what you want to get accomplished, you do not have to do it exactly as the video.

RICE therapy following Ankle Sprains

     Following an Ankle Sprain, it is important to create a painfree environment. The keys components have been taught in High School and College Health Classes forever.

R----Rest
I-----Ice
C----Compression
E----Elevation

Rest is a four lettered word to most athletes, but crucial in minimizing the re-aggravation of the ankle. Rest is created by whatever it takes to make the ankle painfree. This may be crutches, removable cast, ankle brace, limited activity, and/or completely getting off the foot involved. The first 4 days after a sprain is the most crucial time to chill out. Yet, since no one can really be sure 100% of the time what is wrong, the first 2 to 3 weeks following a sprain should be relatively painfree.

Ice for 96 hours following a sprain is crucial. You can refer the previous link on application of ice below. Yet, ice is used for months and months in a typical sprain, it is just knowing when to use it.

http://www.drblakeshealingsole.com/2010/04/ice-or-cold-therapy-helps-in-injury.html

Compression is also crucial. The product seen in the video is Tubigrip, but a common substitute is an Ace Wrap. The secret to compression is to put more compression below and less compression above the ankle. This may require some tape of some type to hold on the wrap above the ankle. Make sure this tape is not wrapped all the way around.

Elevation even 1 inch off the floor is very beneficial. As long as it is comfortable, and as long as there is swelling, try to elevate the foot and ankle as much as possible. Super Elevation once a day for 30 minutes is very important. Super Elevation is where you lie on the floor and elevate your foot on the wall or couch 3 feet above your heart. Combine this with compression and gentle nonpainful range of motion of the ankle and the swelling will improve the most.

Horseshoes are not Just for Horses: Try it for Ankle Sprains

Following an Ankle Sprain, Compression is essential 24/7 to reduce swelling as quickly as possible. Swelling is your enemy slowing down the speed of healing by reducing good arterial blood flow to the injured areas, floating the joint surfaces adding to the instability, increasing the pain which leads to more swelling cycle, limiting the range of motion, and making it difficult to walk (no walk, no activities for rehab). A horse shoe has a hole over the bone (does not matter if it swells there) and material to compress the swelling in the areas of the ligaments and tendons. This is held in place by the compression sock which has been folded down so that you can see the horse shoe. I use 1/4 inch felt, but even a rolled up sock, face cloth, etc will do. Be creative for once it your life!! Just kidding. Add contrast bathes, see link below, and you should be able to reduce the swelling dramatically in a short time. By the way, horseshoe patterns are much better than donut patterns since the hole at the top (hole towards the heart rule) makes sure the swelling moves freely away from the injured area.

http://www.drblakeshealingsole.com/2010/03/secret-of-contrast-bathing.html

Ankle Sprain: Advice from Afar

Dr. Blake,

You were recommended to me by Dr, Pribut, In Washington DC. I live in Santa Barbara.

I recently injured my ankle. It is very serious, Lots of pain, swelling, etc. I did a classic roll of the ankle coming down from about 4 feet in height off of a rock climbing move. I heard a loud pop at the time of the trauma. The Orthopedic I saw at my local clinic diagnosed it as an anterior inferior tibio-fibular ligament tear. He also said, “probably other ligaments have torn too”. I am 50 and have had many ankle sprains in my life, the Orthopedic took x-rays and said my history of multiple injuries probably prevented it from breaking. He did not see any fractures.

He went quickly to a diagnosis and put on a removable cast, ordered physical therapy and told me he didn’t need to see me again, but to follow the instructions of the physical Therapist. He also said this injury could take 2-3 months to heal.
I have been experiencing ankle pain for some years and in the x-rays, there is a lot of indication of arthritis tissue. Having a proper healing is extremely important to me and I would gladly get myself in to see you if you were available for an appointment. Dr. Pribut recommended a second opinion and I’m worried the local clinician may have rushed through it. I can have the x-rays sent to your office if necessary. Can you offer some input?

Marty

Dear Marty,

     I am honored that Dr Stephen Pribut recommended me. For all of my readers, you should definitely check out Dr Pribut's informative website.
http://www.drpribut.com/sports/sportframe.html
Athletes come into the office all the time with their "worst" ankle sprain. When they tell me that they have had multiple sprains, I always ask where the most current one fits into the range of severity with the other ones. Is this your worse one on this side of your body? If they answer yes, red lights should be flashing. This may be more than an ankle sprain. After the first sprain, with the ligaments torn or stretched, the ankle joint has the ability now to go further, rattling the bones around under the skin, and possibly causing more damage. With any ankle sprain, there is the risk of chip fractures, cartilage injury, and tendon injury. This is along with the definition of a sprain: an overstretching (grade 1 sprain), a partial tearing (grade 2 sprain), or a complete tear of the ligament(s) (grade 3 sprain).

     By the sound of your description, you have more severe damage until proven otherwise. You need an MRI to identify what has been injured exactly, so that the exact treatment can be outlined if possible. You have a better chance of healing properly if we know what is wrong. It is so common to bruise the cartilage in your ankle with a sprain like this, and that can take 2 or 3 years to mend if at all. Of course, this is the worst case, but if this is you, please show this to your family doc and get an MRI of the ankle ordered. With a bad ankle sprain, just going to physical therapy, if you have cartilage damage could make you  worse. The physical therapist will treat the diagnosis of an ankle sprain, not a fracture or cartilage problem. The therapist can only go off of the perscription.

     Once we know what is wrong, appropriate treatment can be obtained. Self pay for ankle MRI at our hospital is $650 so this is an option. Please comment privately through my email, or by posting a comment on this post. I hope all this makes sense.  Rich Blake
PS If you start PT, avoid sharp pain. Read the post on Good Pain vs Bad Pain and follow it closely.

http://www.drblakeshealingsole.com/2010/04/good-pain-vs-bad-pain-athletes-dilemma.html

Ankle Strengthening: Video on Eversion with Exercise Bands

Thera-Band is to exercise bands what Xerox is to copiers. I grew up as a podiatrist on Thera-bands, although never honestly knew there was a hyphen. And there are so many other good sources of traditional exercise bands and sports cords that will all do basically the same. The video demonstrates the most important exercise for ankle sprains, balance, supinators, and general foot and ankle strength. The peroneal tendons are vital for big toe joint stability, arch stability, and lateral (outside) ankle stability. The peroneus longus should be strengthened separately from the peroneus brevis as demonstrated well in the video. Home strengthening exercises should done daily in the beginning stages to make sure the habit develops, but gradually over the 2nd and 3rd months done every other day. I love my patients do 2 sets of 10 repetitions (reps) at a resistance that they can do daily, gradually increasing the tension on the band. With these exercise bands, as the exercise gets easy, the level of resistance is increased. Our current office system of exercise bands has 6 levels, and the patients are normally started on the easiest level. You can go very gradual with initially 2 sets of 10, then 2 sets of 15, 2 sets of 20, and then 2 sets of 25, before moving to the next color. Doing the exercise slow as Liz demonstrated well is important. Doing the exercise more in the evening or late afternoon is preferable, since you are tiring the ankle. If you do the exercise before vigorous activity, you could risk strain from fatigue. I love with patients and unstable ankles to eventually get them doing 2 sets of 25 reps with a bike inter tube (off the charts in resistance!!).

Athletic Injury Rehabilitation: The Law of Parsimony

Deception Point

The Law of Parsimony: When multiple explanations exist, the simplest one is usually correct.

This is my first post being inspired by the Mediterranean Sea along the coast of the Italian Riviera (this time from Diano Marina, Italy).

As I watched the Mediterranean Sea and read Dan Brown's Deception Point thriller, on page 238 he mentions the Law of Parsimony. This is a common law utilized in medicine; a good starting point in the treatment of injuries. I will use the Law of Parsimony in this post to describe the common starting point of treatment based on the commonest cause for several injuries listed below. If you have one of the injuries mentioned below, make sure that your treatment is addressing this issue.

• 
  
  Achilles tendinitis--tight achilles tendons
• 
  
  Plantar Fasciitis--inadequate arch support
• 
  
  Recurrent Ankle Sprains--weak peroneal tendons
• 
  
  Chondromalacia Patellae or Patello-Femoral Dysfunction--weak vastus medialis
• 
  
  Ilio-Tibial Band Tendinitis--tight Ilio-Tibial Bands
• 
  
  Morton's Neuromas--tight front area of your shoe or boot
• 
  
  Posterior Tibial Tendinitis--excessive pronation
• 
  
  Bunion Pain--tight front area of shoes
• 
  
  Metatarsal Area Pain--development/increasing of hammertoes (see post on Budin Splint)
• 
  
  Peroneal Tendinitis--lateral instability in shoes
• 
  
  Generalized Arch Pain--weak intrinsic foot muscles

These are great starting points to treat these injuries. In many cases, it will take awhile to get weak areas strong, tight areas flexible, and correct biomechanical and shoe issues. Other treatments will be used to address anti-inflammatory concerns, and less common causes of the same injuries at the same time to hopefully sped healing along. See the post on Tips for Bunion Care as a good example. Thank you Dan Brown and the Mediterranean Sea for this inspiration. Now off to a great pasta or seafood dinner.