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Chiropractors and Sprained Ankles
Ankle injuries are not only common, but also costly for many people. According to a study published in 2013, in the United States, an estimated 2 million acute ankle sprains occur each year, averaging $318 to $914 per sprain. Ankle sprains are significant because if not treated properly, the patient will lose mobility and arthritis will be accelerated down the road.
Another major concern with ankle sprains is the likelihood of recurrence. It is well-known that the most common predisposition to suffering a sprain is the history of having suffered a previous ankle sprain.
The best place to start is with a review of the anatomy. “Understanding biomechanics of the normal and arthritic ankle joint can aid in analysis of an underlying clinical problem and provide a strategic basis for a more optimal management.”3 A closer study of the anatomy gives you the confidence to know when and how to treat this area.
Ramifications of Typical Ankle Sprain Treatment
I want you to think about the people in your life. They could be your family, friends strangers. Now I want you to think of how many of those people have sprained their ankles at some point. Off the top of your head, you can probably think of a few, perhaps yourself included. Ankle sprains are so common and most people have suffered at least one in their life.
What is so interesting is that once a person sprains their ankle, they usually consult their allopathic doctor (MD). The doctor might take some X-rays and examine it. Most of the ankle sprain cases do not result in any type of fracture, but will stretch and sometimes tear the ligaments described above.
Typical treatment involves waiting for 2-4 weeks for the pain and swelling to go down. Sometimes, crutches or a boot come into the picture to immobilize and take pressure off the ankle joint. Pain-killers, anti-inflammatories and the usual players come out in an effort to make the symptoms go away. Eventually, some motion is introduced by the patient or a physical therapist for therapy and rehab.
What the average person does not realize is that the talus, calcaneus, cuboid, navicular and the rest of the foot bones generally shift out of their healthy alignment during an ankle sprain. Alignment of these bones is hardly ever considered in typical medical treatments. This is where you come in as the chiropractor. Chiropractors are the best kind of doctor to help these patients because of our knowledge of biomechanics and joint health.
Chiropractic Care Strategies
Most patients have no idea that chiropractic treats anything but the spine, but we have the knowledge to treat many other areas of the body, like the extremities (the arms and legs and the parts that attach to them, not the torso where all your organs are). Utilizing foot / ankle ROM, orthopedic testing (to rule out serious ligament tears, fractures, etc.) and palpation skills, a chiropractor will find that most sprains of the ankle are well within areas readily treated with chiropractic knowledge and treatment abilities.
Physiotherapy modalities: I have gravitated toward using my class IV laser more and more over the past four years. Ultrasound, muscle stim, and ice / heat are also viable treatment tools. Depending on how acute, swollen and painful the ankle sprain is will determine which therapy to use.
Adjustments: I will adjust all 26 bones of the foot. How do I know which way the bones have misaligned? Invert your right foot as you are sitting or standing and feel the stress on those bones. You can feel how they would misalign. Your body is your cheat sheet. I use my hands to motion palpate the bones and confirm my findings.
Rehabilitation and home care: Common care modalities include ice / heat and passive / active ranges of motion (PROM / AROM), progressing to ankle strengthening and stabilization. I find that having the patient trace upper- and lowercase letters of the alphabet with their big toe works on ROM and strengthening at the same time. In some cases, a wobble board is excellent for ankle strength and balance as well.
Foot support and orthotics: In my experience, one of the prime reasons patients sprain their ankles is due to fallen, collapsed arches, attributable to overpronation of the feet. As a result, I see patients who present after a traumatic sprain in which they landed with their foot turning in.
An important point to remember here is that dropped arches from excessively pronated feet make the person more susceptible to an ankle sprain. The ankle is already weakened and strained on the medial side due to the fallen arches. This lack of medial ankle support makes it easier for the foot to turn inward and damage the ligaments and soft tissue of the medial ankle region.
Remember that patients are dealing with the myth that “no pain means you are fine.” I have seen patients with past or chronic ankle sprains who have not been treated properly. They have biomechanical problems, hypomobility of the foot / ankle joints and some level of chronic pain that comes and goes.
The absence of pain does not mean they are fine; in fact, it can mean quite the opposite.
As my patients will tell you, every patient is treated in a unique manner, with therapy changing each visit as they demonstrate improvements or may display new problems while previous problems disappear.
As far as I am concerned, if your therapy is the same every visit, why are you still there? If you haven’t improved, then the therapy is bad; if you have improved, why the therapies and the areas worked on the same?
Is your doctor incompetent? If he can’t make you better, then you need to move on!
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