Ankle Sprain Case Report
By Dr. Steven Bird
Patient details: Female, 32 yo. Physical activity rock climbing and strength training.
Injury: dropping from bouldering onto drop pad. Right ankle inverted during landing on drop pad. Patient hobbled/crawled back to her car.
Preliminary findings: visual bruising and swelling present at time of initial exam. Increased pain with palpation and motion of ankle into inversion. No loss of ROM in dorsiflexion and plantar-flexion. Surrounding soft tissue tender to the touch.
Assessment: Patient injured ankle while rock climbing, landed poorly and received a Grade 1 ankle sprain inversion ankle sprain. Prognosis was fair/good do to patients desire to get back to activity and no signs of depression. No sign or reason for advanced imaging at this time.
Plan: Phase 1: initial treatment included our Soft Tissue Support Pack Supplementation from OrthoMolecular Products with major ingredients of Vitamin C, B6, Magnesium, proteolytic enzymes and Bromelain. This is a 5 day serving, meant to be used at the onset or acute phase of soft tissue injury.
Manual therapy involved low level dry needling with e-stim at low level frequency. Used IASTM and manual joint mobilization to improve movement.
Joint mobilization added when tolerable for both dorsiflexion and long axis distraction.
Kinesiology tape for support of the ankle and decreasing major movements of the ankle for a short period of time.
Phase 2: When symptoms were close to 0-1/10 isometric strengthening of the ankle ligaments and muscles were introduced at 4 sets of 8 while in office per week. Each rep started with small forces to introduce load back to the joint tissue to increase stimulation of tissue. Phase 2 was 4 weeks of once per week.
Follow up. Patient was able to walk without fear of re-injury, work out in the gym to strengthen other body regions. Treatment using passive modalities had its place at the beginning of injury, helped to decrease symptoms and improve mild function. Active rehab included more exercises and foot strengthening in a variety of ways. The patients goal was to get back to rock climbing and back to normal every day function for her, which included exercising and being active.
Citations:
- Struijs PA, Kerkhoffs GM. Ankle sprain. BMJ Clin Evid. 2010 May 13;2010:1115. PMID: 21718566; PMCID: PMC2907605.
- Rathnavelu V, Alitheen NB, Sohila S, Kanagesan S, Ramesh R. Potential role of bromelain in clinical and therapeutic applications. Biomed Rep. 2016 Sep;5(3):283-288. doi: 10.3892/br.2016.720. Epub 2016 Jul 18. PMID: 27602208; PMCID: PMC4998156.