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Rehab Bad Ankle Sprain + Prevent Future Ones

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Rehab Bad Ankle Sprain + Prevent Future Ones

Postby jthomas » Thu Aug 25, 2011 3:11 pm

Recently on a training hike, I managed to really trash my ankle. Torn ligaments, highest grade sprain, etc. I was in a boot for month, and am now doing rehab, which is icing plus the familiar rubber band exercises. The doc said it will be a couple of months before it is fully recovered.

The cause of all this was catching my foot on a tree root, causing me to stumble, then roll the ankle.

I am now paranoid and want to do anything possible to prevent this in the future. It was bad enough on this hike, which entailed me having to hobble in pain 3+ hours back to the car, but what if this had been on an expedition?

Some questions:

1. I was in low cut hikers when it happened. Would high top boots have made much of a difference?
2. I am doing the PT exercises with the rubber band now. Is there some weight training I can do to specifically strengthen the ankle?
3. Has anyone ever used these?
http://www.swedeo.com/TarsalLok.htm

Any input from folks with knowledge of PT or similar issues would be greatly appreciated.

Jim
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Re: Rehab Bad Ankle Sprain + Prevent Future Ones

Postby MoapaPk » Thu Aug 25, 2011 3:23 pm

Boots have to be REALLY stiff to prevent a sprain -- like winter mountaineering boots.

WHEN YOU ARE BETTER, try a wobble board each night (while watching TV or some other mindless activity), do toe raises, etc. The PT will help you do transitional exercises to make sure that you break up adhesions and scar tissue (I hope).

I had a scare recently, initially interpreted as a new fracture. It was actually a 2-year-old fracture that had healed. But I need a lot of daily foot exercise to keep the scar tissue down. Podiatrists will tell you not to walk around bare-footed.
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Re: Rehab Bad Ankle Sprain + Prevent Future Ones

Postby CBakwin » Thu Aug 25, 2011 4:50 pm

It's a pain but you can wrap it before hikes. Get ankle support wraps from a athletic store, pharmacy or even walmart! Not foolproof, but it helps. I have weak/bad ankles as well, I think high top boots help, but again, not at all foolproof (like rigid boots would be but way overkill and hot).
There are tons of exercises to develop the small, stabilizing muscles in your lower legs and ankles, but none of them are pleasant.....Your Physical Therapist can help with that. Good Luck.
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Re: Rehab Bad Ankle Sprain + Prevent Future Ones

Postby builttospill » Sun Aug 28, 2011 10:01 am

Lying or sitting down, lift your leg so your leg is kept relatively straight but your foot is off the floor. Draw each letter of the alphabet with your toes in the air. I used to do this for a different reason, but it seemed to help work out my ankle in new ways too. Once you're healed from the sprain, of course.
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Re: Rehab Bad Ankle Sprain + Prevent Future Ones

Postby aglane » Tue Aug 30, 2011 1:26 am

Try a leg-press machine with the seat set the furthest back it will go and thus legs as near straight as possible, so the feet can be placed at the bottom of the plate and presses done by ankle motion only. Getting that up to substantial weight, over time, may be a benefit.

Pretty much the same principle as using the band, but you can get heavy weight moved, and the whole system is well stabilized so that everything can be focused on the ankles.
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Re: Rehab Bad Ankle Sprain + Prevent Future Ones

Postby foweyman » Tue Aug 30, 2011 11:14 am

jthomas wrote:I am now paranoid and want to do anything possible to prevent this in the future. It was bad enough on this hike, which entailed me having to hobble in pain 3+ hours back to the car, but what if this had been on an expedition?


I'm not familiar with the Swede-O brand but here is a listing of available products.

http://www.nextag.com/ankle-braces-for- ... ducts-html

As a volleyball player and coach (and backpacker/hiker) I've worn and am familiar with several of these. The lace-up ones tend to be slightly more comfortable when first put on, but tend to restrict normal ankle flexion and extension more than the rigid hinged ones. The rigid hinged ones can me slightly less comfortable initially but tend to provide stronger lateral support.

Agree that a high-top shoe would have to be very stiff to provide good support and would restrict normal flexion and extension.
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Re: Rehab Bad Ankle Sprain + Prevent Future Ones

Postby BrunoM » Wed Aug 31, 2011 10:01 am

I suffered a bad sprain when I was 15 and due to an incompetent docter it never really healed properly (should have had a cast, doc said it wasn't necessary). Suffered from sprained ankles since.

I've had great results with this, a stability cushion. Cost me 50 euros.

http://www.sportime.be/nl/skimmy-trial-c1-8069.htm

Just stand on it 30 minutes a day while you're watching tv or a dvd.
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Re: Rehab Bad Ankle Sprain + Prevent Future Ones

Postby Sierra Ledge Rat » Thu Sep 01, 2011 3:16 am

Physical therapy is critical to strengthening the joint's supporting structures. But physical therapy is also critical to help retrain the damaged nerves that provide proprioception (subconscious sensation of joint position). Without proper proprioception your brain doesn't know your ankle's position in space and you will sprain again.

The wobble board is the standard device for ankle rehab, for both strength and proprioception. Not sure whther or not you can buy one. Looks to me like Bruno's stability cushion is a proprioception trainer.

I am a firm believer in high-top footwear to minimize risk of ankle sprains. I really think that there is a significant difference between low and high-top footwear, enough to make a difference. I used to run trail ultramarathons in Colorado and New Mexico, and I did so in high-top footwear. I never sprained my ankle during an ultra. (Did stuff like the Manitou Incline, Leadville Mosquito marathon (29 miles, absorbed into the Leadvile 100), Hermosa Creek trail (32 miles) near Durango, Road Apple Loop in Farmington (30 miles), etc.)

Once I sprained my ankle so badly that it took me two years to be able to run again. I was running on a road at night when an on-coming car blinded me. I stepped into a pothole and blew out my ankle. After rehab I bought something similar to the Tarsal Lok and wore it intermittently for 2 years during high-stress events. Mine was a heavy canvas lace-up that had metal strips for support. Most of the time I removed the metal strips and just used the canvas lace-up. I think that the Tarsal Lok would be great initially, but later in your rehab it would be too bulky and too supportive. Hard to tell without getting one in my hands.

Image

There's a fine line between helping and hurting yourself with an ankle brace. If you wear a brace too much then your ankle will not get strong again. If you don't wear a brace when needed then you risk injuring your ankle again.

After numerous ankle sprains and ankle fractures, I have two rules for the trail:

(1) Keep your head down and ALWAYS watch where you are stepping
(2) If you want to look anywhere besides where you are placing your feet - STOP walking and then look around

The more remote the area, the more important it is to strictly abide by the rules. If I am 2 days from the nearest trailhead, then I follow my rules without exception.
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Re: Rehab Bad Ankle Sprain + Prevent Future Ones

Postby foweyman » Thu Sep 01, 2011 11:15 am

Sierra Ledge Rat wrote:
I am a firm believer in high-top footwear to minimize risk of ankle sprains. I really think that there is a significant difference between low and high-top footwear, enough to make a difference. I used to run trail ultramarathons in Colorado and New Mexico, and I did so in high-top footwear. I never sprained my ankle during an ultra. (Did stuff like the Manitou Incline, Leadville Mosquito marathon (29 miles, absorbed into the Leadvile 100), Hermosa Creek trail (32 miles) near Durango, Road Apple Loop in Farmington (30 miles), etc.)


There may be more recent studies available but back when I took an athletic training class I did a small research project on sprained ankles and came across a study in a leading training journal that determined that high-top shoes did nothing to prevent or reduce the severity of ankle sprains. A stiff ankle taping (which is much stiffer than any high top shoe) reduced frequency and severity for a limited time (15 min?) before activity made them too loose to be functional.

Sierra Ledge Rat wrote:There's a fine line between helping and hurting yourself with an ankle brace. If you wear a brace too much then your ankle will not get strong again. If you don't wear a brace when needed then you risk injuring your ankle again.


This isn't the case with the rigid, hinged supports sold today. (see link in previous post) They don't provide lateral ankle support during normal activity, but do a good job of providing support during an event that would otherwise produce a typical ankle inversion sprain or fracture.
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Re: Rehab Bad Ankle Sprain + Prevent Future Ones

Postby jthomas » Thu Sep 01, 2011 7:17 pm

Sierra Ledge Rat wrote:Physical therapy is critical to strengthening the joint's supporting structures. But physical therapy is also critical to help retrain the damaged nerves that provide proprioception (subconscious sensation of joint position). Without proper proprioception your brain doesn't know your ankle's position in space and you will sprain again.

The wobble board is the standard device for ankle rehab, for both strength and proprioception. Not sure whther or not you can buy one. Looks to me like Bruno's stability cushion is a proprioception trainer.

I am a firm believer in high-top footwear to minimize risk of ankle sprains. I really think that there is a significant difference between low and high-top footwear, enough to make a difference. I used to run trail ultramarathons in Colorado and New Mexico, and I did so in high-top footwear. I never sprained my ankle during an ultra. (Did stuff like the Manitou Incline, Leadville Mosquito marathon (29 miles, absorbed into the Leadvile 100), Hermosa Creek trail (32 miles) near Durango, Road Apple Loop in Farmington (30 miles), etc.)

Once I sprained my ankle so badly that it took me two years to be able to run again. I was running on a road at night when an on-coming car blinded me. I stepped into a pothole and blew out my ankle. After rehab I bought something similar to the Tarsal Lok and wore it intermittently for 2 years during high-stress events. Mine was a heavy canvas lace-up that had metal strips for support. Most of the time I removed the metal strips and just used the canvas lace-up. I think that the Tarsal Lok would be great initially, but later in your rehab it would be too bulky and too supportive. Hard to tell without getting one in my hands.

Image

There's a fine line between helping and hurting yourself with an ankle brace. If you wear a brace too much then your ankle will not get strong again. If you don't wear a brace when needed then you risk injuring your ankle again.

After numerous ankle sprains and ankle fractures, I have two rules for the trail:

(1) Keep your head down and ALWAYS watch where you are stepping
(2) If you want to look anywhere besides where you are placing your feet - STOP walking and then look around

The more remote the area, the more important it is to strictly abide by the rules. If I am 2 days from the nearest trailhead, then I follow my rules without exception.


I am doing the PT with rubber band 3X a day, and it is definitely progressing. Totally agree with your advice. I hate to become dependent on the brace, but I hate the thought of another sprain as well.

Here is the brace the doc gave me. http://www.braceshop.com/productcart/pc ... s-p831.htm

It looks like yours might fit in a boot better. Can you send a link? Thanks.
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Re: Rehab Bad Ankle Sprain + Prevent Future Ones

Postby jordansahls » Thu Sep 01, 2011 7:54 pm

Wait a minute. Did you have surgery for your town ligaments? Or are you going with the more conservative approach? If you have torn or sprained ligaments, than the chances of a re-sprain are much higher. The good news is that the re-roles won’t be as bad as the first. Basically, once your dynamic support is compromised (in this case, ligaments), you become much more reliant on your dynamic stabilizers (muscles) for support and stability. And as others have said, restoring the muscle-brain coordination (proprioception) is critical. If you're seeing a PT just keep doing the exercises. Any PT is going to know a lot more than us internet docs. Good luck!
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Re: Rehab Bad Ankle Sprain + Prevent Future Ones

Postby jthomas » Thu Sep 01, 2011 9:35 pm

jordansahls wrote:Wait a minute. Did you have surgery for your town ligaments? Or are you going with the more conservative approach? If you have torn or sprained ligaments, than the chances of a re-sprain are much higher. The good news is that the re-roles won’t be as bad as the first. Basically, once your dynamic support is compromised (in this case, ligaments), you become much more reliant on your dynamic stabilizers (muscles) for support and stability. And as others have said, restoring the muscle-brain coordination (proprioception) is critical. If you're seeing a PT just keep doing the exercises. Any PT is going to know a lot more than us internet docs. Good luck!


No surgery for the ligaments, but they seem to have healed fine. Ankle is still a little sore and slightly swollen after roughly seven weeks, but it is getting better day by day. I had not considered the proprioception angle, but that makes sense, so I will look into some kind of wobble board, etc.

The big question I have is whether or not to plan on wearing the brace long term for hiking/climbing as a precaution.
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Re: Rehab Bad Ankle Sprain + Prevent Future Ones

Postby MoapaPk » Fri Sep 02, 2011 1:23 am

I actually used a versaDisc
http://www.power-systems.com/s-16-balance-training.aspx

with a wooden platform over it (they still sell these). I made my own bongo board.

My best recovery came from walking on curbs -- about 200 miles worth.
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Re: Rehab Bad Ankle Sprain + Prevent Future Ones

Postby jthomas » Fri Sep 02, 2011 2:35 pm

My best recovery came from walking on curbs -- about 200 miles worth.[/quote]

Could you elaborate? Not sure what you mean exactly. Thanks.
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Re: Rehab Bad Ankle Sprain + Prevent Future Ones

Postby jthomas » Fri Sep 02, 2011 9:09 pm

MoapaPk wrote:I actually used a versaDisc
http://www.power-systems.com/s-16-balance-training.aspx

with a wooden platform over it (they still sell these). I made my own bongo board.

My best recovery came from walking on curbs -- about 200 miles worth.


I am looking at getting a CorDisc or VersaDisc. If I had been using this all along I think it would have made a big difference. I have always had weak ankles and been subject to minor sprains, but nothing like this recent one.

When using one of these things, do you mainly stand on it, or do things like one legged squats, etc. Thanks.
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