Here, Will Kenton, Head of Physiotherapy here at Teladoc Health UK, discusses his recent treatment of an ankle injury.
In a recent case, I had the great satisfaction in supporting an active patient who had recently injured their ankle playing football.
Ankle sprains are one of the most common musculoskeletal injuries, with a high incidence among physically active individuals. Unfortunately, without comprehensive rehabilitation these injuries do have a high recurrence rate. A rehabilitative course of physiotherapy is the first point of call for the vast majority of patients with such injuries.
The patient had ‘rolled’ their ankle with progressive swelling over the next few hours and into the next day. The patient was able to weight bear but had pain, a feeling of weakness and real lack of confidence in their ankle.
The first objective was to take a full history from the patient. Firstly, it is key to rule out a more sinister injury such as a fracture that would require imaging.
The patients swelling was significant and the primary goal was initially to reduce this swelling and in turn reduce the pain. This was achieved by a short period of activity modification, good supportive footwear and a regular icing regime for the first few days.
Once the pain and swelling had started to improve, we were able to begin some work on improving ankle mobility. Starting this early is key in getting ahead with a successful rehabilitation.
When the patient was able to move the ankle in all directions freely and comfortably, I introduced some light resistance. We used resistance bands which provide a simple method of applying more load to the structures.
Improving muscle strength is a large component of successful rehabilitation and a return to sport and activity.
Heel raise exercises were also added, not only are these great at building strength, but they also play a role in helping redistribute swelling after an ankle sprain. It’s a win-win!
With improving pain and mobility we turned our attention to working on balance. Following the ankle sprain the patient had experienced less control with single leg activities and balance. Restoring this in the context of returning to their activities was key to prevent reinjury and ensuring they would be able to return to sport.
We started with some simple exercises including sing leg standing – aiming for 10 seconds and building up to 30 seconds. I increased the challenge further for the patient by asking them to close their eyes and working again towards 30 seconds. We also utilized different surfaces in this stage of the rehab. Simple household cushions, pillows or a folded yoga mat are often great for challenging balance in ankle rehabilitation.
The patient’s goal was to return to football, so we worked out a plan for the latter stages of their rehab. This included a gradual return to running. I approached this using short walk-run intervals whilst monitor comfort levels and any swelling. It’s important to start this at the appropriate time to build strength, stamina and so the patient can gain confidence in their ankle again.
I combined this with some further movements to work on the patient’s explosive power. We worked on movements that involved hopping and bounding alongside movements at speed and directional changes. You have to be confident in the patient’s ability to be able to conduct of all of the potential movements they will experience in the context of their sport.
The most satisfying part of the process is seeing the patient get back to their activity, sport or just living their life without the challenges of an injury.
In this case it was a great outcome and demonstrates how a tailored plan for a common injury can have such a significant impact for the patient. It’s great to see in this case the patient return to football but also have a preventative plan going forward, to help minimize potential future injuries.