Download Sprains - Bragg Creek Physiotherapy

WHY IT’S NOT JUST A SPRAIN
Most of us, at some point in our lives have experienced that painful and
sometimes embarrassing moment when we’ve stepped off a curb, only to find
that we have landed on the side of our foot instead of the sole. Usually that
sharp pain will subside in a few minutes and we are no worse for the wear. But
not everyone is that lucky. Just ask any basketball or volleyball player – they are
the ones who can come up with good stories as to how many times they’ve
sprained each ankle. The bruising, the swelling, the need for crutches – the
stories may sound progressively more exaggerated, but the truth is the injuries
worsen each time.
So what happened when we stepped off the curb and felt the sharp pain? The
ligament, the strong fibrous tissue that connects bone to bone and stabilizes a
joint, was stretched beyond its normal limitations. Ligaments are designed to
withstand a certain amount of stress, however, they are not like elastic muscle
tissue; ligaments have “crimp,” meaning the fibres are bunched up like an
accordion. Once the load on a ligament exceeds a certain point, the crimp is
stretched out and the fibres break. When you “roll your ankle,” you are
experiencing a quick stretch to those fibres, just enough to warn you that any
more load on the ligament will cause damage to the tissue.
In the case of a basketball player (keep in mind that ligament sprains can happen
in any activity – even walking). They typically say they jumped up, and came
down on their toes and on the side of the foot. Pain will be immediate and the
swelling not far behind. A few hours later, bruising will start to show. Depending
on the amount of stress the ligaments have sustained, three scenarios can
happen: First is a mild sprain – similar to rolling your ankle, but the swelling tells
us the fibres were stretched significantly. A moderate sprain results in some
fibres actually being torn, and when tested, the ligament does not have the same
resistance to stress. The worst case scenario is a severe sprain, where all the
fibres have been completely torn and the ligament no longer supports the joint.
Treatment at this time is RICE – rest, ice, compression, and elevation.
Sometimes crutches are called for, although only for a day or two, and often an
ankle brace is recommended. Physiotherapy can help reduce pain and swelling
and maintain range of motion in this initial stage, but it plays a much larger role in
assisting with healing and recovery. Ligaments do not heal by replacing the
same tissue that was damaged. They heal by laying down scar tissue. Scar
tissue is often formed in a mass, and is much weaker than the original tissue.
Physiotherapy assists in the healing process by coaxing the scar tissue to form in
a similar way to ligament fibres. This is important to make the joint as strong as
possible and to prevent re-injury.
Ligaments function to connect bone to bone, maintain joint stability and assist in
balance and proprioception – that is, where the joint is in space relative to the
rest of your body. Small receptors in the ligaments tell your brain what is
happening at the joint – an injury can affect these receptors. For example, in an
ankle injury, most people will exhibit a significant decrease in their ability to
balance. It is a combination of poorly organized scar tissue, weak muscles, and
poor propioception, which often leads to recurrent ankle sprains. Physiotherapy
can help return balance and stability by strengthening the muscles around it and
encouraging receptors in the tendons to take over this function from the defunct
ligament.
With trauma to any joint not only are ligaments damaged, but often muscles
critical to function become inhibited and will not perform normally unless they are
specifically retrained. This is particularly evident in the ankle, the knee, the low
back and the neck. Your physiotherapist can identify the muscle dysfunction and
teach you how to get those muscles going again, which will minimize the risk of
re-injury.
Sprains can happen at any joint – commonly we see them in ankles, knees and
fingers. But the shoulder can also suffer sprains, as can the ligaments of the
neck and back. It is important to get sprains addressed at the time of injury to
ensure guided healing occurs. Failure to get adequate treatment to a sprained
ligament increases your chance of re-injury. And with each re-injury, there will be
more severe damage to the whole joint complex – including other soft tissues
such as tendons and muscles, and even cartilage.