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Saturday, July 11, 2020

How PTs in College Treated My Sprained Ankle

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I played organized basketball for 12 years. In those twelve years, I’ve managed to participate in two European Championships, one Mini-World Cup (only 16 countries) and several conference playoff games in college.

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Throughout my career, I’ve had to sit out dozens of games. The reason was always the same – a sprained ankle. Thankfully, I was always fortunate to be under the care of great physical therapists (PTs), who made sure I was able to get back in the game as soon as possible. In this post, I will go over how the PTs treated my ankle, as most forms of treatment I received are easily replicable at home.

Quick (But Important) Side Note

Most times I sprained my ankles, it happened when I would step/land on someone else’s foot. Unfortunately, it started happening to me when I was young – maybe 14, and then it continued to happen as my ankles grew weaker with every injury. In all fairness, all I did to prevent future sprains was to either tape my foot or wear an ankle brace. That is not enough!

The thing is, when you get an ankle sprain, your ligaments either tear or stretch, both of which makes them weaker. Therefore, you must regularly do ankle-strengthening exercises for the first 2 months after the injury, in order to prevent future sprains from occurring.

That’s especially important because your ankles grow weaker with each subsequent sprain. I’m saying this because I don’t want you to repeat my mistakes. We will talk more on preventing ankle sprains towards the bottom of this post. Anyway, here’s what I was instructed to do for my ankle sprains:

1. First 3 days immediately after the injury

1.1 Ice & Elevation

In the immediate aftermath of an ankle sprain, the best treatment procedure is similar to the treatment of most other injuries. I was to apply ice for 20 minute-long intervals, with four-hour brakes. In addition, I was also supposed to keep my foot higher than my heart, at all times (including while icing). I was not allowed to walk any further than the distance between my bed and my bathroom.

The way I iced my ankle at home was by wrapping enough ice to cover all sides of my foot with a plastic wrap. I always made sure my entire foot is being iced, as the ligaments in your foot run quite long.

1.2 NSAIDs

Just like the ice and elevation, the NSAIDs (anti-inflammatory drugs like Advil and Aleve) are not a groundbreaking remedy for any injury. Even though I didn’t like taking them, they did help. Also, I didn’t have to take them any longer than the first 7 days after the injury, so I wasn’t concerned about developing kidney, stomach, or heart problems, which are all associated with the regular use of NSAIDs.

Anyway, in the first 3 days of my sprain, I was instructed to take NSAIDs every 4-6 hours.
Check out what some people with way more expertise than me say about ice, elevation, NSAIDs, and the first 72 hours after an ankle sprain:

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2. After the initial 72 hours (Sessions with the PTs)

2.1 Heating pads (and electrical stimulation)

After the first three days, I would start going to my PTs for therapy sessions. Firstly, I would wear a heating ankle wrap, which was plugged into two wires and it provided warmth and electrical stimulation. I would keep it on for 10 minutes. I tried finding one of those ankle wraps online and share it with you, but I couldn’t come across one.

However, you could buy a regular heating pad and a TENS unit separately to achieve the same effect.

Anyway, the athletic trainers would turn the electric stimuli on, and set it on a setting that wouldn’t feel painful, but it definitely felt slightly uncomfortable.

I should say that based on the existing clinical trials on electrical stimulation, there isn’t sufficient evidence to prove its short-term effectiveness in treating ankle sprains. All studies conclude by stating that further, and more in-depth, analysis is required. Still, based on reading online, it seems that many PTs seem to be including it in their rehabilitation treatments. UConn Health, Orthopedics & Sports Medicine, lists electrical stimulation as one of the components of the process of sprain rehabilitation here.
Want an expert opinion on the matter?

2.2 Stretches & Exercises

After applying the heating pad for 10 minutes, we would move on to stretches and exercises. All the exercises I was told to do were done right to the point of pain and not a step further. If a certain exercise were particularly painful, they would tell me to skip it.•

Stretches

The stretches I was told to do were pretty similar to the ones in the picture above (figures 1 through 4). For every stretch, I’d start with a very small movement. I’d increase the radius of movement gradually, but not beyond the point of pain. If one of those stretches were impossible to do without experiencing pain, I would completely skip it. The same principle applied to the exercises we did.

Rubber Band Exercises

The PTs gave me four rubber band exercises to do. You can see them all in the picture above (figure 5, 6, 7 and 8). While doing those exercises, it’s important that you focus on slow and controlled movements. For the exercises in figure 7 and 8, the motion should come from rotating your ankle and not your entire foot. In other words, your knee should remain pointing towards the ceiling at all times while doing any of those two exercises.

For a better idea and more thorough explanation, check out a video like this one:

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It’s important to note that the lady in the video, Doctor Jo, showed another way of doing the exercises from figure 7 and 8. In case you didn’t watch it, she doesn’t’ wrap the band around a leg of a table, rather she wraps it around her healthy foot. That seems harder, so I’d stick to the way shown in the figure. Still, the lady in the video seems to have the ankle movement correct, so it’s your call really.

Drawing the alphabet with your toes

It’s exactly as it sounds. If you really want to see it on a video, there it is:
I wouldn’t do the whole alphabet, rather maybe from A to J each set.

Leg Raises

In the first day or two of the exercises, I did leg raises with both feet simultaneously. After that, they instructed me to do them on one leg – obviously, the one that was sprained.

I actually did a few more exercises and stretches than what I’ve included in this post. If I haven’t included an exercise I used to do, it’s because I either can’t really remember what it was or couldn’t find an illustration or video of it online.

The problem was, as I already mentioned in the beginning, is that I didn’t continue to do those exercises and stretches after my physical therapy sessions ended. I would only go to physical therapy until I was ready to play, which was never any longer than two weeks after the sprain, which is not enough.

Preventing Future Ankle Sprains

As we already mentioned towards the beginning of this post, your ankles grow weaker with each subsequent sprain. So, if you don’t strengthen your ankle after your first sprain, and you’re unfortunate enough to sprain your ankle again, you’ve dug yourself into an even deeper whole. If you don’t believe me when I tell you that exercising your ankles will help you prevent future sprains – check out this PMC article

The article recommends balancing exercises (with a balancing board), to strengthen your ligaments after stretching or tearing them. The article even provides you with a link to a PDF, which contains a set of balancing, ankle-strengthening exercises.

Realistically, most of you won’t read the peer-reviewed article, so I might as well give you the link here – (link to balancing exercises)

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Closing

‪ Obviously, in the first few days of an ankle sprain, I was advised to rest, ideally in a horizontal position, with my leg elevated at all times. But, when the swelling had gone down, I was allowed to walk small distances. If I wanted to walk, however, I was required to wear an ankle splint. It acts as a brace, with two long pieces of plastic going on each side of your foot and Velcro straps holding them relatively tight. The splint looked kind of like this:‬‬

Thankfully, I haven’t had to deal with ankle injuries after college. Of course, that’s mainly because I have stayed away from exercising like I’m allergic to it. In any case, if it happens again, I will try to stick to the same treatment I received when I was playing basketball. I’m going to go out on a limb and say that if I sprained my ankle today, I would not be back in the game as quickly as I was back then.

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Disclaimer: This article is purely informative & educational in nature and should not be construed as medical advice. Please use the content only in consultation with an appropriate certified medical or healthcare professional.

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