Ankle Sprains
Immediate Care The immediate care of this injury
encompasses the first 24 hours post–injury. The goals of this first
stage are to limit the amount and severity of any swelling, limit any
pain, and, by immobilizing the joint and having the athlete use
crutches, prevent any further injury. Immediately after the
evaluation of the injury, treatment consists of ice (cold),
compression, and elevation (I.C.E.). This consists of repetitive bouts of
cold for 15 to 20 minutes, with 30 or so minutes without ice between applications. Compression should be applied and the leg elevated. When the
player is sent home for the day or night, he should continue this
routine. At this time, it is also important that the joint be
immobilized and the player is weight bearing to tolerance on crutches.
Immobilization can be accomplished with a bandage, brace posterior
splint, or tape. Open–gibney ankle taping in particular provides
compression and allows the damaged tissue to begin healing in an
approximated or shortened position. The tape can then be removed during
icing to better facilitate the transfer of cold to the injured area,
but after the ankle has been iced, it should be rewrapped or taped.
Post Immediate Care This stage of treatment usually
includes the time period of 24 to 96 hours post injury. During this
stage, there is still bleeding and swelling occurring within the joint,
and the chance of re–injury is still high. The goals for this phase are
to decrease any pain the athlete is having, decrease or hold steady the
severity of swelling, and begin to restore range of motion. All of
these can be accomplished simultaneously. It is important to continue
the repetitive bouts of I.C.E. for 15–20 minute periods. Gentle active
R.O.M. in combination with the cold treatment may also be used along
with the start of gentle calf stretching. Positive galvanic stimulation
(bouts of 10–30 minutes at a tolerable setting), interferential current
(20–60 minutes high pulses/second {pps}), and microcurrent (30–60 minutes
high pps) have been shown to be successful in limiting pain and
swelling post–injury. In addition a portable TENS unit can be used to
help with the athlete's discomfort while away from the treatment room.
A splint and crutches should be continued for ambulating with continued
weight bearing to tolerance.
Early Care The early care phase usually runs from 96
hours post–injury to roughly 7–10 days. During this phase, the goals
continue to be to control and reduce swelling, regain ROM, and
facilitate healing, with the added goal of beginning to strengthen the
area. Because the active bleeding in the joint has decreased, you can
now introduce heat into your treatment regime. This can be in the form
of a “contrast bath” or “contrast treatment," where the athlete will
alternate between heat and cold exposures. The contrast will act to
pump the swelling out of the joint. Alternating bouts of hot and cold
in a 1:3 or 2:5 manner, sandwiched between 10 minutes of cold, are the
most common (that is, start with 10 minutes cold, then 1 to 2 minutes
warm followed by 3 to 5 minutes cold. This cycle should be repeated 6–8
times, finishing with 10 minutes cold. The athlete should perform
passive stretching and active ROM while treating to help pump the
swelling from the joint. Use of negative galvanic stimulation,
microcurrent and interferential, can also be used to facilitate
swelling reduction, pain control and tissue healing. Since there is
still a chance of injury outside the treatment setting, it is important
that the athlete continue using the splint and crutches with weight
bearing as tolerated.
Reprinted with permission from Training and Conditioning Magazine,
April, 2001. By Rick Guter, ATC, PT, Head Trainer with
the MLS's D.C. United.
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