Case #1 Inversion Ankle Sprain Injury

In an attempt to become more of an educator and less of an informative know-it-all, let me first start off this blog by talking about motion. Every joint in the human body has some sort of motion, whether it's pretending you can fly with your arms or tucking them under your pillow when you sleep. Many health care practitioners, including chiropractors, will, when a joint is injured or as a daily objective test will put a joint through it's entire range of motion. When the patient does this by themselves, it is known as active ranges of motion or AROM. Another test for ranges of motion include the patient relaxing the joint and letting the practitioner take the joint through it's motion, this is called passive ranges of motion or PROM (or as I tell my patients, I'm going to take you to your prom now!). If pain is provoked during PROM, this indicates ligamentous injury. (Ligaments attach bone to bone). The final range of motion testing is called resisted ranges of motion or RROM, where the practitioner will resist the patient as they actively put the joint in question through it's range of motion. If pain is provoked on RROM, the pain is due to muscular injury, as you are utilizing your muscles to resist the motion.

Onto the more interesting item at hand: Did you know that over 25,000 inversion ankle sprains are reported every day? Let me first define inversion ankle sprain. An inversion ankle sprain is when someone rolls their ankle in such a way that the bottom of their foot is facing the opposite foot or inward, compared to an eversion ankle sprain where the bottom of the foot is facing outward, away from the other foot. I currently have a young adult, male patient who came in with an extremely bruised and inflammed (swollen) left ankle. Mechanism of injury: he was playing lacrosse when he rolled his ankle via inversion and while rolling his ankle, he was pushed forward. After doing a thorough ankle regional examination, his PROM provoked pain which added a mark in my intial thought column of ligamentous injury (don't give me too much credit, it's how most inversion sprain injuries come out), orthopedic testing confirmed as well. If you will notice in the picture to the left of a normal ankle, there are three ligaments on the outside or lateral side of the ankle that attach the fibula (one of the lower leg long bones) to the ankle. The most common ligament to be injured is the anterior talofibular ligament (ATFL) which attaches the fibula to the talus, a tarsal bone that helps compose the ankle and ankle joint, as you can see there is a posterior one as well. Anterior and posterior refer to their location on the body, anterior basically means in front and posterior means in back. The second most common ligament to injure is the calcaneofibular ligament (CFL), which attaches the fibula to another tarsal bone in the foot, the calcaneus. The calcaneus is also the tarsal bone that makes up the heel of your foot. When inversion occurs in the ankle, the ligaments stretch out, this is clinically called a sprain. After taking my patient to the diagnostic ultrasound suite, my diagnoses had been confirmed. He had a grade 2 ATFL sprain and a grade 1 CFL sprain. Treatment for sprains include resting, icing, elevating, and compressing (RICE) the injuried area, usually via an ace bandage. We have been doing some cold laser therapy to the area which helps increase blood flow to the area which promotes a faster healing time, I'll post separately later about cold laser and it's clinical applications and research. We will eventually move to a more rehabilitative model to get his ankle back in shape, but as he has done this before, he will need to wear a brace or have his ankle taped every time he decides to participate in any sporting activity. Once ligaments are stretched out, it can take years (if ever) for them to return to normal size and shape.