Common Wrestling Injuries: Sprained Ankle with SPLX Team Physio Iestyn Rees

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A sprained ankle is one of the most common injuries caused by participation in wrestling. It refers to soft tissue damage (mainly ligaments) around the ankle, usually caused by an inversion injury (where the ankle is twisted inwards)

physio1Because of the position of the bones around the ankle, the inversion injury is far more common. This injury causes damage to the lateral ligaments on the outside of the ankle.

The most commonly injured ligament is the Anterior Talo Fibular (ATF) ligament which, as the name suggests, joins the fibular and talus bones together. If the force to the ankle is more severe, the Calcaneo Fibular ligament (between the Calcaneus and Fibula) is also damaged. The Posterior Talo Fibular (PTF) ligament is very rarely damaged in comparison to the other two ligaments.

As well as damage to the ligaments, the capsule which surrounds the ankle joint is also damaged. The damage causes bleeding within the tissues and the ankle begins to swell up and can be extremely painful.

Ankle sprains can be classified as follows:

  • First degree, where only a few ligament fibres are damaged
  • Second degree sprain refers to more extensive damage to the ligament with associated swelling
  • Third degree sprain refers to a complete rupture of the ligament with swelling and a possible joint dislocation

In the more severe injuries there may be associated bone injury and it is wise to get an x-ray to determine whether there is a fracture.

Sprained Ankle Injury Signs & Symptoms

With a first degree sprain there is pain when turning the foot in or out and also pain when the damaged area is touched. With a second degree sprain the pain is more severe, there is swelling all around the area and it is painful to walk. With a third degree sprain the pain is excruciating and walking is impossible. There is gross swelling and there may be deformity if the ankle is dislocated.

Once a patient is able walk on the ankle, more active rehabilitation can be started.

Rehab – Stage 1: Acute Stage (days 1 to 3)
This ankle rehabilitation programme is an example of the progression followed by a professional wrestler with a sprained ankle under the treatment/management of a physiotherapist. The progression of the exercises should be based on pain free completion of the previous exercise. All rehabilitation exercises should be preceded by a warm up.

Follow the PRICE protocol:

  • Protection – The injured tissues should be protected from further damage. Avoid any movements or activity that could potentially re-injury the tissues.
  • Rest – Rest from sports is essential, but even walking on the ankle, if it is painful, may cause further damage and should be avoided. No weight should be put through the injured ankle and crutches should be used.
  • Ice – Ice Packs are applied for periods of twenty minutes every couple of hours. The Ice Packs relieve pain and are thought to reduce bleeding in the damaged tissue.
  • Compression – A swollen ankle is a sign of a significant ankle sprain. The swelling is caused by bleeding in the tissue and a leaking of cellular fluid secondary to tissue damage. If this swelling is allowed to consolidate it can produce excessive scar tissue which seriously lengthens the rehab period. Compression during the early stages helps to resolve swelling and is essential for a good outcome.
  • Elevation – If the ankle is not elevated the effect of gravity causes the tissue fluid to accumulate at the ankle. This can cause increased tissue pressure which is extremely painful. To relieve pain and prevent excessive swelling, the ankle is elevated above waist height.

If the pain allows, the ankle should be  gently pumped forward and back 20 times each hour. This is done by sitting down with the leg elevated and pushing the toes forward and back. This facilitates the dispersal of swelling from the ankle. Electrotherapy treatments such as ultrasound and pulsed short wave diathermy are effective in speeding the healing process.
Stage 2: Sub-Acute Stage (Day 3 to Week 4)
Encourage a normal walking pattern should be encouraged and there should be no limping, Ice therapy can be continued so long as there is pain.

Ankle pumping exercises can be continued and progressed to being done in water. Exercises in water are effective because they involve only partial weight-bearing and because the hydrostatic pressure provided by the water has the effect of encouraging the swelling to disperse.  Exercises in water involve only partial weight-bearing and are effective in helping to disperse swelling.

General fitness is maintained by using a static exercise bike and resistance weight machines in a gym.

After two weeks most of the rehabilitation is achieved through active exercise.

Examples of these include the following:

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Elastic resistance band around the foot and pointing the toes to strengthen the ankle.

 

 

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Elastic resistance band to strengthen the muscles on the outside of the ankle.

 

 

Apart from mobilising and strengthening exercises, the rehabilitation for a sprained ankle can be greatly enhanced by practicing what are called proprioception exercises. These enhance neuromuscular control around a joint and are very important to the professional wrestler. These exercises should be started as soon as pain allows and include the following:

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Patient’s aim to stand for up to 30 seconds without losing their balance, this strengthens the small control/stabilising muscles at the ankle.

 

 

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Single leg tip toes build strength and control. Both of these exercises can be performed stood on a cushion/wobble board to increase the difficulty and increase strength and control further.

 

Progressive strengthening of the muscles around the ankle should be continued, as should the proprioception exercises. To prepare for a return to functional activities the intensity of exercise should be increased. This may include completing plyometric exercises including hopping on one leg and hopping in various directions.

Jogging should also commence, and should be progressive as follows:

Stage 3: Weeks 5+

Wrestling specific drills can be restarted as long as the patient is pain free when completing all the exercises in the rehab program to date.

Once the patient is pain free when completing all wrestling specific drills and they are confident they can return to their full in ring capabilities they should return to full action.