Twisting in the New Year

I hope that everyone’s New Year’s Holiday was happy and healthy.  Mine started out with a re-twisted ankle, but I’m well on my road to recovery.

The ankle is known as the ‘most forgiving joint’ in the body because if you damage ankle ligaments (which connect bone to bone), the joint usually doesn’t have excess motion, or laxity.  Ankle sprains are incredibly common; 7-10% of ER visits are ankle injuries.  In the US, there are about 23,000 ankle sprains a day.

As an avid swing dancer, most people assumed that I twisted my ankle dancing.  This was sort of true.  The first time, I misstepped in my dance flats while jogging to the classroom, and the second time, I tweaked it while hiking.

There are several factors that affect ankle sprain incidence.

  1.  Sport – About 25% of sporting injuries are ankle sprains; the most commonly effected sports are basketball and dance.
  2. Playing surface – a slick surface can increase your risk, and studies have shown that ankle sprains are more common on artificial turf than natural grass.
  3. Shoes – ankle sprains are more common in shoes that do not have ankle support like heels.
  4. Joint motion/stability – if your ankle joint already has excessive motion or you have had a previous ankle sprain, your risk increases.  Additionally, if your ankle joint is restricted in dorsiflexion (moving your toes towards your nose), you risk increases.
  5. Strength – if your peroneal muscles are weak, your risk increases.  These muscles are on the outside of your lower leg.
  6. Proprioception/kinesthesia – these are both great Scrabble words that describe ‘movement awareness’ in regards to your joints and muscles.

The most type of ankle sprain is known as an inversion sprain.  This is when the bottom of your foot moves towards your other leg.  The peroneal muscles help to stop this movement.  The main ligament involved in an ankle sprain is the anterior talofibular ligament (ATFL), which is the top ligament below.  This ligament is the weakest in the outer ankle.  In more severe ankle sprains, the calcaneofibular ligament (CFL) is involved, which is the lower ligament shown below.

ankle lig.jpg

A physical therapist can determine the grade of ankle sprain.  They range from Grade 1 to Grade 3.

Grade 1 is a mild sprain, where the ligaments are slightly stretched and microscopic tears might occur.  The ankle is mildly tender, and there is some swelling.

Grade 2 is a moderate sprain, where the ligaments are partially torn.  In this grade, usually both the ATFL and CFL are involved.  The ankle has moderate tenderness and swelling.  During special ankle movement tests, a physical therapist would notice abnormal looseness in the ankle joint.  Bruising is usually present.

Grade 3 is a severe sprain, where ligaments are completely torn.  The ankle is significantly swollen and tender.  During special ankle movement tests, a physical therapist would notice substantial instability.

My next post will discuss the differences in healing depending on the grade of sprain as well as what I’ve been doing to keep on my feet.  Feel free to post any questions below!

References

A review: The difference in lower extremity injury rates when played on natural grass compared to third-generation artificial turf

Ankle Stability and Movement Coordination Impairments: Ankle Ligament Sprains

Sprained Ankle

I am so thankful to Greg Todd & Smart Success PT for all that I have learned about physical therapy and businessPre-register for  Smart Success that re-launches in January. Be the first to know how to Change you Career!!

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