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traumatology

Remedies for Ankle Sprain

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Ankle sprain is a trauma that affects the joint between the leg and the foot.

It is one of the most frequent injuries in sports (volleyball, basketball, football, rugby, athletics etc.), but also in everyday life.

The ankle sprain is a lesion that mainly affects the ligaments, but sometimes it does not spare the muscles and tendons.

It occurs when the ankle joint excursion exceeds the physiological limit, especially in an uncontrolled and passive manner.

Usually, this injury is the result of a single episode (the so-called "retort") and is called "acute distortion". However, cases of chronic distortion are not rare, that is the articular compromise due to the repetition of several less intense stimuli.

The damage occurs mainly with the movements of internal rotation (more frequent) or external of the foot.

What to do

  • Joint injury can be very difficult to heal, even more than a bone fracture. This means that the most important factor is prevention (see below).
  • In the event of an accident, it is necessary to understand immediately if it is a sprained ankle or minor trauma. Doubt must arise in the presence of symptoms such as:
    • Ache.
    • Limitation of mobility.
    • Swelling.
    • Edema.
  • The severity of an ankle sprain is variable. If the swelling includes all the joint and the pain is very strong (even more if traces of hematoma are visible) it is necessary to deepen the diagnosis by taking an X-ray. This should allow the distortion to be classified into one of the 4 severity levels established for this injury.
  • WARNING! If the "hypothetical distortion" occurs in a place from which it is difficult to reach an emergency room, the footwear must not be removed. Pain and swelling may not allow you to put it back.
  • It is possible to use topical and, if necessary, systemic or injectable drugs (see below)
  • In the acute phase, cold packs can be very useful to reduce swelling (see below). If the lesion is chronic, after the acute phase, some suggest heat therapy (indicated for ligament injuries in the absence of edema).
  • Rehabilitation therapy is different based on the degree of distortion, as is the prognosis. However, in principle it is advisable to respect the following indications:
    • 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 pain.
        • Recover the particularity.
        • Eliminate muscle spasm and edema.
        • Start recovering strength.
    • During re-education:
      • Recover proprioceptivity.
      • Recover strength.
      • Prevent recurrences.
  • Generally, it is advisable to keep the ankle at rest and activate it only during therapy. The functional recovery will be programmed by the specialist.
  • After the rehabilitation 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).

What NOT to do

  • Grease or stay overweight.
  • Perform potentially risky "cold" activities without warming up progressively and accurately.
  • Exceed with the muscle-joint commitment in the very early stages of approach to sport or in sporadic sessions. This is especially true for adults.
  • Use of unsuitable or improper footwear.
  • Do not perform stretching and joint mobility sessions.
  • After an injury, avoid using the functional bandage.
  • Neglecting the symptoms and clinical signs that could suggest a distortion. Insisting with the load on the compromised ankle could happen:
    • Aggravation of the lesion.
    • Chronicization of distortion.
  • Do not investigate with diagnostic X-rays, especially when the injury is very painful and characterized by hematomas.
  • Remove the shoe after the accident if the medical center is far or difficult to reach.
  • Neglecting therapies. In particular, it is very harmful to skip rehabilitation.
  • Overloading the injured ankle early and / or excessively.

What to eat

There is no diet designed to heal better or more quickly from a sprain. However, some precautions can be useful:

  • In the case of obesity, it is advisable to reduce the weight. This especially affects people who tend to have recurrences 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: are eicosapentaenoic acid (EPA), docosahexaenoic (DHA) and alpha linolenic acid (ALA). They play an anti-inflammatory role. The first two are biologically very active and are contained above all in: Sardinian, mackerel, bonito, alaccia, herring, alletterato, ventresca of tuna, needlefish, algae, krill etc. The third one is less active but is 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:
      • Vitaminics: 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 shellfish and milk.

        Vitamin C is typical of acidulous fruit and some vegetables (lemons, oranges, tangerines, grapefruit, kiwi, peppers, parsley, chicory, lettuce, tomatoes, cabbage, etc.).

        Vitamin E is available in the lipid portion of many seeds and related oils (wheat germ, maize 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 contained above all in: meat, fishery products, egg yolk, milk and dairy products, fortified foods (potatoes, etc.).
      • Polyphenols: simple phenols, flavonoids, tannins. They are very rich: vegetables (onion, garlic, citrus fruits, cherries, etc.), fruit and related seeds (pomegranate, grapes, berries, etc.), wine, oilseeds, coffee, tea, cocoa, legumes and whole grains, etc.

What NOT to Eat

  • To prevent or cure obesity, it is advisable to eliminate all junk foods and beverages, in particular fast foods 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, meat and fatty fish, preserved meats and fish, sweets, etc.
  • The only group of foods (or rather beverages) not advisable in the event of ankle distortion is alcohol. Ethyl alcohol has a diuretic action and interferes with the metabolism, reducing the effectiveness of the active ingredients.
  • Furthermore, we remind that an excess of omega 6 fatty acids "could" have an effect diametrically opposed 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 the introduction of foods rich in linoleic, gamma-linolenic, diomo-gamma-linolenic and arachidonic acid such as: seed oil (especially peanuts), most of the dried fruit, certain legumes, etc.

Natural Cures and Remedies

Natural remedies for ankle sprain are mainly pain relieving and rehabilitative.

  • The most used painkiller system (different from drug therapy) exploits 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 constricting vessel to reduce joint swelling. The ice should be 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 packs: 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 chronic pain of ligament and tendon injuries.
  • The traditional rehabilitation therapy for ankle sprain includes a work program divided into 3 phases:
    1. Proprioceptive re-education: exercises aimed at stimulating and re-educating the sensitivity that allows us to know the position of the body in space:
      • They must first be unloaded.
      • Subsequently, in an upright position we will allow a load distribution.
      • Bipodalic exercises are then adopted on unstable surfaces (circular planes, tablets, etc.).
      • It continues by isolating the joint, or by soliciting it in a monopodal and bilateral manner.
      • Finally, “proprioceptive journeys” are followed to adapt the pace and stimulate the receptors during walking on inhomogeneous terrain.
    2. Muscular reinforcement: a good tropism of the muscles reduces the risk of recurrent lesions and allows to resume activities:
      • Initially it is advisable to practice many series with few repetitions.
      • Avoid overloads that can damage the already suffering compartment.
      • Use the elastic or sponge ball.
      • Later it is possible to perform full-load exercises; these are of two types:
        • Development of the musculature of the posterior loggia of the leg.
        • Strengthening of the thigh muscles.
    3. Recovery of the gesture: restoration of the step and specific athletic movements.
  • There is also the possibility of rehabilitation in the water . This involves performing exercises with the body immersed in water, taking advantage of the principle of Archimedes and the viscous reaction. It is also divided into 3 phases:
    1. Proprioceptive re-education: the most used exercise is walking while keeping a floating tablet under the foot.
    2. Muscular reinforcement: exercises with the step in flexion-extension 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 when standing.
    3. Gesture recovery: walking forward, backward, lateral, running, jumping, jumping and other situations similar to the specific activity.
  • Some choose to use footwear improved by the installation of specific orthotics: these are designed to correct the biomechanics of the foot and ankle. Some are preformed, others are custom built.

Pharmacological care

  • Non-steroidal anti-inflammatory drugs (NSAIDs):
    • For topical use: they are mainly ointments or gels containing Ibuprofen lysine salt 10% or Ketoprofen 2.5% (for example Dolorfast®, Lasonil®, Fastum gel® etc.). They have the advantage of acting locally without tiring the stomach and liver.
    • For oral use: for example Ibuprofen (Brufen®, Moment®, Spidifen® etc.). They are more powerful though generic than ointments and gels. They may require the use of a gastroprotector. Those who suffer from 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.

Prevention

  • Guaranteeing correct weight: mild overweight is not a considerable risk factor, but obesity is directly implicated with the incidence of distortions.
  • Heating: not only has the function of heating and "stretching" the joint, it also serves the nervous system to adapt to the condition of the ground and to the athletic gesture.
  • In the initial stages of a new activity, increase the intensity gradually: distortions are very frequent in novices and in "Sunday sportsmen". The classic "soccer game with friends" often ends with an injury. This is due to an excessive muscular-articular effort and to 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 heeled shoe of women, as well as the shoes with the studs of footballers, rugby players etc. (badly combined with the type of terrain turn out to be very dangerous). Furthermore, it is not uncommon for novice hikers to experience injuries related to the use of flat shoes that do not wrap around the ankle.
  • Stretching and joint mobility: they are controversial. If carried out far from the activity they have a primary importance in the increase of the elasticity and the ability of movement; nevertheless, recent studies have not found a correlation with the reduction of joint injuries.
  • In the case of a pre-existing injury, the use of the functional bandage has proved very useful in increasing the stability of the newly rehabilitated ankle.

Medical Treatments

  • Arthroscopic surgery: it is an extreme treatment and used only in the most severe cases. It can be very useful when the pain does not cease with other therapies and it is possible that the ankle hides an unexpected injury. It consists of inserting a small camera in the joint to visualize the situation; if necessary, other small incisions will be applied to insert the tools needed to repair or remove the damaged parts.
  • Tecar therapy: it is a healing system that uses the principle of the electric condenser to treat ankle sprain and other muscle joint injuries. The mechanism of tecarterapia is based on the restoration of the electric charge in the injured cells, to make them regenerate more quickly. It can be very effective. It can be used in hypothermia (cold) or in hyperthermia (hot).
  • Transcutaneous Electrical Nerve Stimulation: TENS is an antalgic electrotherapy that acts mainly against pain. Send electrical impulses to the skin through electroconductive plates. These block the nerve signals of pain and stimulate the production of endorphins.
  • Magnetotherapy: exploits the effects of the magnetic field on the body. It is applied using two solenoids directly on the ankle. It exerts a force on magnetic, paramagnetic and diamagnetic molecules. The high and low frequency produces benefits if the treatment is long 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 up to 50% but the effectiveness changes depending on the damage.
  • Ultrasound: uses high frequency acoustic waves. It is very useful as an anti-inflammatory, stimulating edematous reabsorption and to dissolve the adhesions that are formed 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 laser electron beam acts on the cell membrane and mitochondria, increasing metabolic activity, reducing pain and inflammation, creating vasodilation and increasing lymphatic drainage.
  • Electrostimulation: it is used to strengthen the muscles that orient the ankle. It is used above all after an injury to prevent recurrences. The muscles involved are mainly the lateral peroneal muscles.
  • A very recent treatment against pain is kinesio taping: this system exploits 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 shape and crossed between them. They should have a draining, slightly pain-relieving-anti-inflammatory and guardian function.

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