Remedies for Sprained Ankle

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Ankle sprain is a trauma that affects the joint between the leg and foot.
It is one of the most frequent injuries in sports (volleyball, basketball, football, rugby, athletics, etc.), but also in everyday life.
Ankle sprain is an injury that mainly affects the ligaments, but sometimes does not spare the surrounding muscles and tendons.
Ankle sprain is a phenomenon that occurs when the articular excursion of the ankle goes beyond the physiological limit, especially in an uncontrolled and passive way.
Usually, this injury is the result of a single episode (the so-called "sprain") and is called "acute sprain". However, cases of chronic distortion are not uncommon, i.e. joint compromise due to the repetition of several less intense stimuli.
The damage occurs mainly with internal (more frequent) or external rotational movements of the foot.

The published material is intended to allow quick access to general advice, suggestions and remedies that doctors and textbooks usually dispense for the treatment of Ankle Sprain; such indications must in no way substitute the opinion of the attending physician or other health specialists in the sector who are treating the patient. . This means that the most important factor is prevention (see below).

In the event of an injury, it is necessary to immediately understand whether it is a sprained ankle or a minor trauma. Doubt must arise in the presence of symptoms such as:

• Ache.
• Mobility limitation.
• Swelling.
• Edema.

The severity of an ankle sprain varies. If the swelling includes the whole joint and the pain is very strong (even more so if traces of hematoma are visible) it is necessary to deepen the diagnosis by carrying out an X-ray. This should allow to classify the sprain in one of the 4 levels of severity established for this. wound.

ATTENTION! If the "hypothetical distortion" occurs in a place from which it is difficult to reach an emergency room, the footwear must not be removed. The pain and swelling may not allow you to get it back.

It is possible to use topical drugs and, if necessary, of the systemic or injectable type (see below)

In the acute phase, cold compresses can be very useful to reduce swelling (see below). If the lesion is chronic, after the acute phase has passed, some suggest heat therapy (indicated for ligament lesions in the absence of edema).

Rehabilitation therapy differs based on the degree of sprain, as does the prognosis. However, in principle it is advisable to respect the following guidelines:

• In the acute phase:
• Immobilize the ankle.
• Reduce the factors of inflammation and edema / hematoma.
• Eliminate mechanical stress on damaged ligaments.
• In the sub-acute phase:
• Mechanically stress the joint to correctly orient the collagen fibers during repair. The objectives are:
• Reduce the pain.
• Recover the particularity.
• Eliminate muscle spasm and edema.
• Begin strength recovery.
• In re-education phase:
• Recover the proprioceptivity.
• Regain strength.
• Preventing relapses.

In general, it is advisable to keep the ankle at rest and to activate it only during therapy. The functional recovery will be planned by the specialist.

After the re-education phase it is advisable to apply a functional bandage to prevent the onset of relapses in the resumption of motor activity.

If recommended, use kinesio taping (see below).

If recommended, use other methods to speed healing (see below).

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Carrying out potentially risky "cold" activities without gradually and thoroughly warming up.

Excess with muscle-joint effort in the very early stages of approach to sport or in sporadic sessions. This is especially true for adults.

Use of unsuitable or inappropriate footwear.

Do not perform stretching and joint mobility sessions.

After an injury, avoid using the functional bandage.

Neglecting symptoms and clinical signs that might suggest a sprain. Insisting with the load on the compromised ankle could happen:

• Aggravation of the lesion.
• Chronicity of the sprain.

Do not go into depth with X-ray diagnostic investigations, especially when the injury is very painful and characterized by hematomas.

Remove the footwear after the accident if the medical center is far away or difficult to reach.

Neglecting therapies. In particular, it is very harmful to skip rehabilitation.

Premature and / or excessive overloading of the injured ankle.

. This especially affects people who tend to have relapses on the same joint. To lose weight it is sufficient to reduce the caloric intake by about 30%, leaving the (balanced) distribution unchanged.

Increase the intake of anti-inflammatory molecules:

• Omega 3: they are the eicosapentaenoic acid (EPA), docosahexaenoic (DHA) and alpha linolenic (ALA). They have an anti-inflammatory role. The first two are biologically very active and are mainly contained in: sardines, mackerel, bonito, sardinella, herring , alletterato, belly of tuna, garfish, seaweed, krill etc. The third, on the other hand, is less active but constitutes a precursor of EPA; it is mainly contained in the fat fraction of certain foods of vegetable origin or in the oils of: soy, linseed, kiwi seeds, grape seeds etc.
• Antioxidants:
• Vitamins: the antioxidant vitamins are carotenoids (provitamin A), vitamin C and vitamin E.
  Carotenoids are contained in vegetables and red or orange fruits (apricots, peppers, melons, peaches, carrots, squash, tomatoes, etc.); they are also present in crustaceans and milk.
  Vitamin C is typical of sour fruit and some vegetables (lemons, oranges, mandarins, grapefruits, kiwis, peppers, parsley, chicory, lettuce, tomatoes, cabbage, etc.).
  Vitamin E can be found in the lipid portion of many seeds and related oils (wheat germ, corn germ, sesame, etc.).
• Minerals: zinc and selenium. The first is mainly contained in: liver, meat, milk and derivatives, some bivalve molluscs (especially oysters). The second is mainly contained in: meat, fish products, egg yolk, milk and derivatives, enriched foods (potatoes, etc.).
• Polyphenols: simple phenols, flavonoids, tannins. They are very rich: vegetables (onion, garlic, citrus fruits, cherries, etc.), fruit and relative seeds (pomegranate, grapes, berries, etc.), wine, oil seeds, coffee, tea, cocoa, legumes and whole grains, etc.

, especially fast food and sweet or savory snacks. It is also necessary to reduce the frequency of consumption and the portions of: pasta, bread, pizza, potatoes, derivatives, fatty cheeses, fatty meats and fish, preserved meats and fish, sweets, etc.

The only group of foods (or better drinks) not recommended in case of ankle sprain is alcoholic beverages. Ethyl alcohol has a diuretic action and interferes with metabolism by reducing the effectiveness of the active ingredients.

Furthermore, remember that an excess of omega 6 fatty acids “could” have a diametrically opposite effect to the intake of omega 3 (resulting pro-inflammatory).
If not compensated by a diet rich in omega-3, it would therefore be a good idea to avoid exceeding with the introduction of foods rich in linoleic, gamma-linolenic, diomo-gamma-linolenic and arachidonic acids such as: seed oil (especially peanuts) , most nuts, certain legumes, etc.

and rehabilitation.

• The most widely used pain reliever system (other than drug therapy) uses the physical mechanism of temperature:
• Cryotherapy: it is widely used for the treatment of the acute phase (up to 48 hours); it is used 3-4 times a day for about 2 minutes. It acts as a vasoconstrictor to reduce swelling of the joint. The ice is immersed in water and placed in a special bag. The application is direct, but the skin must be protected with a woolen cloth to avoid cold burns.
• Hot compresses: they are exactly the opposite. They should not be used in the acute phase, especially when the ankle is still swollen or with hematoma. On the contrary, they are useful against the chronic pain of ligament and tendon injuries.
• Traditional rehabilitation therapy for ankle sprain involves a work program divided into 3 phases:
  1. Proprioceptive re-education: exercises aimed at stimulating and re-educating the sensitivity that allows to know the position of the body in space:
     • Initially, some unloading exercises are planned.
     • Subsequently, exercises are planned in standing position, in order to allow a distribution of the load.
     • Then you need bipodalic exercises on unstable surfaces (circular planes, tablets, etc.).
     • We continue, therefore, by isolating the joint, or by soliciting it in a monopodalic and bilateral way.
     • Finally, "proprioceptive journeys" are performed to adapt the pace and stimulate the receptors while walking on uneven ground.
  2. Muscle strengthening: a good trophism of the muscles reduces the risk of recurring injuries and allows you to resume activities:
     • Initially it is recommended to practice many sets with a few repetitions.
     • Avoid overloads that can damage the already suffering compartment.
     • Use the rubber band or the sponge ball.
     • At a later time it is possible to carry out exercises with a full load; these are of two types:
       • Development of the posterior leg musculature.
       • Strengthening of the thigh muscles.
  3. Gesture recovery: restoration of specific gait and athletic movements.
• There is also the possibility of rehabilitation in the water. This involves performing exercises with the body immersed in water, using the Archimedes' principle and the viscous reaction. It too is divided into 3 phases:
  1. Proprioceptive re-education: the most used exercise is walking while keeping a floating board under the foot.
  2. Muscle strengthening: exercises with the flexion-extension step of the legs with the support of a float, crawl swimming with fins, walking with tools that increase resistance, adduction, abduction and flexion-extension movements of the leg in standing position.
  3. Recovery of the gesture: walking forward, backward, sideways, running, leaps, hops and other situations similar to the specific activity.
• Some choose to use footwear enhanced by the installation of specific insoles: these are designed to correct the biomechanics of the foot and ankle. Some are pre-formed, others are custom built.

(NSAIDs):

• For topical use: they are mainly ointments or gels containing 10% Ibuprofen lysine salt or 2.5% Ketoprofen (for example Dolorfast®, Lasonil®, Fastum gel® etc.). They have the advantage of acting locally without straining the stomach and liver.
• For oral use: for example Ibuprofen (Brufen®, Moment®, Spidifen® etc.). They are more potent even if generic than ointments and gels. They may require the use of a gastroprotector. People with liver or kidney disorders are not always able to take them.

Cortisone:

• Injectable: these are infiltrations to be used only in case of real need. They have a very strong anti-inflammatory action but in prolonged therapy they tend to compromise the affected tissues.

: it not only has the function of warming and "stretching" the joint, it also serves the nervous system to adapt to the condition of the ground and the athletic movement.

In the initial stages of a new activity, increase the intensity progressively: distortions are very frequent in novices and "Sunday sports". The classic "soccer match with friends" very often ends with an injury. This is due to excessive muscle-joint effort and the poor efficiency of the central nervous system in managing movements.

Footwear: An unsuitable shoe can be the main cause of ankle sprain. The most classic example is the women's high-heeled shoe, as well as the spiked shoes of football players, rugby players, etc. (badly combined with the type of terrain they prove to be very dangerous). accidents occur due to the use of flat shoes that do not wrap the ankle.

Stretching and joint mobility: they are controversial. If carried out away from the activity they have a primary importance in increasing the elasticity and the ability to move; nevertheless, recent studies have not found a correlation with the reduction of joint injuries.

In the event of a pre-existing injury, the use of the functional bandage proved to be very useful in increasing the stability of the newly rehabilitated ankle.

): it is an extreme treatment and used only in the most serious cases. It can be very useful when the pain does not stop with other therapies and it is possible that the ankle is hiding an unexpected injury. It consists in "inserting a small camera in the joint" to visualize the situation; if necessary, other small incisions will be applied to insert the tools necessary to repair or remove the injured parts.

Tecar therapy: it is a healing system that uses the principle of the electric condenser to treat ankle sprain and other muscle and joint injuries. The mechanism of tecar therapy is based on the restoration of the electrical charge in the injured cells, to ensure that they regenerate more quickly. It can be very effective. It can be used in hypothermia (cold) or hyperthermia (hot).

Transcutaneous Electrical Nerve Stimulation: TENS is an analgesic electrotherapy that acts above all against pain. It sends electrical impulses to the skin through electroconductive plates. These block nerve pain signals and trigger the production of endorphins.

Magnetotherapy: takes advantage of the effects of the magnetic field on the body. It is applied by means of two solenoids directly on the ankle. It exerts a force on magnetic, paramagnetic iron materials and on diamagnetic molecules. That at high and low frequency produces benefits if the treatment is prolonged enough; the effectiveness of the static one is not scientifically proven. Its effects on cells, inflammation, inflammation, etc. they are very numerous. It can reduce healing times by up to 50% but the effectiveness varies according to the damage.

Ultrasound: uses high frequency acoustic waves. It is very useful as an anti-inflammatory, stimulant of edematous reabsorption and to dissolve the adhesions that form during healing. It produces heat and increases the permeability of cell membranes.

Laser therapy: it is a treatment that uses electromagnetic rays directly on the affected area. The photon beam of the laser acts on the cell membrane and mitochondria, increasing metabolic activity, reducing pain and inflammation, creating vasodilation and increasing lymphatic drainage.

Electrostimulation: used to strengthen the muscles that orient the ankle. It is mainly used after an injury to prevent recurrence. The muscles involved are mainly the lateral peroneal muscles.

A very recent treatment against pain is kinesio taping: this system uses the traction of adhesive and elastic bandages sometimes containing small pharmacological concentrations. On the ankle are applied two strips about 25cm long arranged in a fan and crossed between them. They should have a draining, slightly pain-relieving-anti-inflammatory and bracing function.