Wednesday morning, I decided to adjust the volume on the television in the adjacent gym space. The batteries for the remote have bitten the dust so I grabbed the flat bench to reach the manual buttons on the TV. Success! I could listen to my TSN sports highlights!
Without thinking I stepped off the bench only to find that my heel was placed on the caster to the bench and as my weight came down my ankle flipped inwards..
The snap was quite audible, like a branch breaking in a silent forest. My initial thoughts were concerned with how I was going to treat my patients today, and whether or not the ankle was broken. I walked around the gym several times to see if it would get better with the movement. Luckily I could weight-bear, this being a good indication that it is likely not fractured.
I tossed ice on it immediately, though the outside aspect of my ankle was already beginning to swell and change colour. Below you can see the ankle at about 30 minutes after the injury.
My current working diagnosis on day 3 is a grade 2 inversion sprain with disruption of the ATF and CF ligaments as well as partial tearing of the lateral capsule. Although this does not sound that great, it is much better than a fracture or a grade 3 tear. The next image is my ankle at the end of day 2 (a little more colour and swelling, as I was standing most of the day).
Seeing as I have this blog up and running already, why not comment every so often about the recovery of my ankle sprain through physical therapy administered by myself.
Currently my treatment includes daily ultrasound over the swollen area and acupuncture. I am trying to ice the ankle 3x/day and will practice range of motion of the ankle constantly through drawing out the alphabet with my foot. Here you can see my ankle on day 3 with some of the needles in.
Today (day 3) I have added in strengthening of my ankle eversion muscles, as well as some wobble board exercises.
You mentioned using ultrasound to affect either symptom control or early repair. Is this something you offer your clients as well? How does it work? At what time point along the recovery path is it most valuable? Thanks. Glassfish
ReplyDeleteHi Glassfish,
ReplyDeleteUltrasound may be a modality that is chosen by your physiotherapist to achieve a therapeutic goal.
Ultrasound machines use an applicator head that transmits ultrasonic waves into the body's tissue. Those waves can be absorbed by different tissues at different levels (e.g.: blood and fat absorb the least amount of energy, whereas tendon, cartilage and bone absorb the most). Absorbed waves can collect as heat, thus making the ultrasound a deep heating agent.
The rise in temperature improves cellular metabolic rate (better healing) and increases the visco-elastic properties of collagen (the tissue becomes more pliable for stretching - possibly improving your range of motion).
The heat will also help expand local blood vessels, allowing inflammatory cells to be removed and picked-up quicker.
In my practice, ultrasound can be applied to an acute injury where swelling is predominant. This can reduce the amount of overall swelling, and allow for early mobilization of the area. A great example of this is for an acute ankle sprain.
I will also use ultrasound in those with chronic scar tissue buildup. An example could be an individual with chronic jumper's knee. I would heat up the scarred tissue with the ultrasound, then apply a transverse friction force over the scar to then break it down to regain mobility and extensibility.
One condition that ultrasound has been shown not to help with (at least with current studies) is pain located in the spine. If your therapist is using ultrasound on your neck or low back and you are not getting results, I would ask them if they could try a different treatment.
Thanks for the great questions!