Ankle Ligaments

[Gem]

Hello all,

I'm wondering if you can assist me. Three weeks ago I was out running and as I stepped off the kerb my ankle turned over and "popped/cracked". It immediately started to swell and the hospital said it was my ankle ligaments!

I can just about hobble around the house on it but the swelling has not subsided. Thinking ahead to when I can eventually get back running can you recommend an ankle support to me as I obviously do not want this to occur again.

Thankyou in advance for any help you can give me.

Gemma x x

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[karen.hankey]

Hi Gemma,

I would reccommend that you spend your time strengthening up the ankle and improving your balance before buying a brace. You don't want to become reliant on a brace for the rest of your life.

Have you been trying anything to reduce the swelling?

To be honest swollen and struggling to walk after 3 weeks I would consider a second opinion from the hospital. For most ligament strains of the ankle you are looking at 6-8 weeks for recovery back to activity. At 3 weeks I would expect no swelling and little pain unless twisting or turning.

[Gem]

Thank you for your reply.

I've been taking Ibuprofen and in the initial stages was packing it with ice. I've also been using heat as I heard that could be beneficial. I'm going back the doctors later on tonight. My job can be very physical at times and was just worried about going back and doing the ankle again!! which is partly where the idea about some sort of support for such occasions.

Gem x x

[karen.hankey]

How did the doctors go?

Heat as well as ice can be good for swelling. I use the program of:

- First 2 days - ice 20 mins
- Second 2 days - ice 4mins, heat 1min for total of 20mins
- Next 2 days - ice 3mins, heat 2mins for total of 20mins
- Next 2 days - ice 2mins, heat 3mins for a total of 20mins
- Next 2 days - ice 1min, heat 4mins for a total of 20mins

[Gem]

Thankyou for the tips.

The doctors was a bit of a non event really. He just looked at it said "hmmmm that's not good", signed me off for another two weeks and sent me on my merry way!

Gem x x

[Adriaan]

How did the doctors go?

Heat as well as ice can be good for swelling. I use the program of:

- First 2 days - ice 20 mins
- Second 2 days - ice 4mins, heat 1min for total of 20mins
- Next 2 days - ice 3mins, heat 2mins for total of 20mins
- Next 2 days - ice 2mins, heat 3mins for a total of 20mins
- Next 2 days - ice 1min, heat 4mins for a total of 20mins

I do't think ice or heat er good to reduce swelling. I think compression is a very important factor to reduce swelling.

It seems that you want to improve circulation with the ice-heat applications. Am I right? Could you explaine me why you think ice or heat can change swelling?

[karen.hankey]

I do't think ice or heat er good to reduce swelling. I think compression is a very important factor to reduce swelling.

It seems that you want to improve circulation with the ice-heat applications. Am I right? Could you explaine me why you think ice or heat can change swelling?

I agree that compression in very effective with regard to swelling, but more to prevent it from occurring rather than get rid of it. If the ankle had been strapped up when it initially occurred then there wouldn't be any need for this thread.

The ice and heat is to boost the circulation. The fluid of the swelling is got rid of through the lymph vessels. Normally this can occur through movement due to the muscles compressing the vessels in a pumping action. The hot and cold will dilate and constrict the vessels to mimic this action.

I have always found the programme posted previously to help with swelling, especially with ankles

[kmdebique]

I've found that using supportive bracing, which also works as compression can help, e.g. aircast or similar products. Compression as suggested previously has seemed to work better for my patients than the icing/heat unless the patient has pitting swelling, Then icing has worked to reduce that and inprove circulation.
I'm less concerned about the swelling though, once it is getting less and occurs more after moving around, because that is expected (dependent swelling, reorganisaton and remodelling of tissue). I am concerned about reinjury of whatever structures have been injured, and so the P in PRICE system - Protection (splinting, casting, weight bearing status), and the C of compression, seems to be the most important at this point.
Strengthening is a really good idea, but with guidance at this point, to prevent further injury and protected, probably in water, varying resistance with speed and even temperature( so the two could be coupled).
Icing could then be used as suggested to control the swelling that may be caused by microdamage to scars as the tissue reorganises.
Have you been referred to /seen a Physiotherapist, Gemma?

[Gem]

Thanks. I have JUST been referred to see one. I have to ring later to receive my appointment! x

[xplando]

It seems that you want to improve circulation with the ice-heat applications. Am I right? Could you explaine me why you think ice or heat can change swelling?

The application of ice to an injury,in the acute phase can substantially decrease the extent of the damage. It achieves this in a number of different ways:

1. Decreases the amount of bleeding by vasocontriction into the injury site and so lessens swelling
2. Reduces pain
3. Reduces muscle spasm
4. Reduces the risk of cell death by decreasing the rate of metabolism

[Adriaan]

The application of ice to an injury,in the acute phase can substantially decrease the extent of the damage. It achieves this in a number of different ways:

1. Decreases the amount of bleeding by vasocontriction into the injury site and so lessens swelling
2. Reduces pain
3. Reduces muscle spasm
4. Reduces the risk of cell death by decreasing the rate of metabolism

Thanks for this explanation for the effect of ice-application. Do not forget that after a while the nerves conduction speed decreases as response of the ice-application (= pain reduction) and after a while you get a vasodilatation (because the vasoconstrictic muscles need nerve activity to contract).

The question was more about the effect of changing between ICE and HEAT. Any good explanation why we should do this (beside: 'I have good results with this method in practice')

Thanks Adriaan

[karen.hankey]

Thanks for this explanation for the effect of ice-application. Do not forget that after a while the nerves conduction speed decreases as response of the ice-application (= pain reduction) and after a while you get a vasodilatation (because the vasoconstrictic muscles need nerve activity to contract).

The question was more about the effect of changing between ICE and HEAT. Any good explanation why we should do this (beside: 'I have good results with this method in practice')

Thanks Adriaan

Swelling is removed through the lymph system. To pump the swelling centrally to allow it to enter the venous system and there be removed relies on the muscle-pump system. This mean that muscles action squeezing on the lymph vessel pushes the fluid centrally. However, in acute injuries patients tend not to want to move around due to too much pain so this is not an option in these cases.

Due to the close proximity of blood vessels to the lymph ones you can achieve this muscle pump action by vasoconstricting and vasodilating the blood vessels which in turn allows the pressure to the lymph vessels as detailed above.

Hope I made that clearer.

[fire_ice]

hello all,
it was really intresting to go through all these details as i stand no where in ortho, can u help me further ,after acute injury when should the assessment be carried out immediately even when its swollen and painful or just wait for a couple of days till the thing goes down ? and how less should the pain go down any specific point on the pain scale before starting the assessment.
regards

[frances]

Hi all
Have any of you heard of Deep Oscillation Therapy. This therapy penetratrates through all the tissue layers and even has effects in the connective tissue. It can be applied immediately after an injury and starts to reduce the swelling as soon as it is applied. It also helps reduce pain. Where abouts are you Gem in the UK. I am in Nottingham and know that this will reduce youe swelling straight away.

Deep Oscillation Personal - PhysioPod UK Ltd

[Adriaan]

Hope I made that clearer.

Thanks for your explanation.

On first sight it seems very logic, and I agree with you that the lymphatic system must be stimulated. In normal circumstances, the muscle-pump system is indeed ONE of the systems to do this. But when you have an ankle distortion, there is a(n) (small) inflammation. So adding heat to an already warm/hot articulation wouldn't be my first thought. (But maybe if you change it with cold, it can have a good effect)

Next to this, lymphatic drainage is also effective against swelling. This is a technique where you give a (small) pressure (40 mmHg) with a special technique. So I still think compression, even when the swelling is already there, is effective.

Greetings, Adriaan