by David Merson, PT, DPT, ATC
You often hear people say, “I rolled my ankle again”, but what does this really mean? Chronic ankle instability is a common orthopedic condition in which the ankle lacks stability and subsequently goes through an inflammatory process time and time again. The common treatment approach is “Rest, Ice, Compression, and Elevation” (RICE). Most people are able to continue their usual daily activities, including playing sports, while implementing the RICE treatment. However, while this helps alleviate the immediate symptoms, the RICE technique does not correct the actual biomechanical problem within the ankle.
To avoid further injury, more formal treatment is recommended. After reading through some recent evidence-based PT journals, I have outlined some of the best treatment strategies that can be performed by a qualified sports medicine professional in addition to the standard RICE protocol.
More Than Ice: In addition to applying ice (an inflammation reducer), treatments like ultrasound, cold laser or electrical stimulation can be applied to help control pain, improve blood circulation to the injured region and subsequently allow the injured area to heal. These treatment strategies may not be 100% effective in each case, but in my professional experience, mixing modality-based treatment with exercise and other manual therapies is often helpful in creating a more comprehensive and effective treatment approach.
Ankle Stability Evaluation and Exercise: Sports medicine offers a number of different ways to evaluate a person’s balance ability as well as many different options for treatment exercises. The exercise plan should include some type of balance work that challenges a person’s upright balance ability and prepares him or her for the many varying surfaces we encounter during the course of the day.
Soft-Tissue Mobilization: Massage, huh? Many of my patients cannot pass this up because it is soothing and relaxing, but because of the effects of massage, it should be considered as part of a larger treatment plan and only in the right amount. Much of the time muscles, ligaments, and tendons can become adhered together. This in turn can create a blockage in blood flow and a decrease in the mechanical efficiency of muscles and tendons. Reducing tissue adhesions through massage, instrument-assisted massage, and trigger point release can allow the body to function as it was designed to.
Joint Mobilization: This technique is often utilized in chronic ankle instability and must be performed by a sports medicine professional. In many instances, the joint does not function to its fullest capacity due to joint restrictions, and cannot move through its full range of motion. If the ankle is not allowed to move at its maximal capacity, its muscles are not functioning at their optimal length nor use the optimal amount of force. Joint mobilization corrects joint restrictions and allows range of motion to improve. Just as with massage, allowing the body to function at its optimal level will, in turn, reduce the risk of injury.
Bracing and Taping: Support via taping or bracing will allow the ankle to be supported and protected. Every patient is different, so approaches may vary.
In summary, please consult your physical therapist, athletic trainer, or chiropractor for a proper evaluation and comprehensive treatment approach. This blog is meant as food for thought as treatment approaches can certainly vary between healthcare professionals and a variety of approaches can be effective in the treatment of this condition.
Dr. Merson is a Physical Therapist at Boston Sports Medicine