The Bristol Step Saver: Functional Treatment is Gold Standard

18/02/14 8:37 AM

The Bristol Step Saver

Keith Sobkowiak DPT,

Keith Sobkowiak DPT, L/ATC

Functional Treatment is Gold Standard — As the winter sports heat up the most common musculoskeletal injury that occurs in ankle injuries. An astonishing 20% of all sports injuries are sprained ankles. Early functional treatment leads to the fastest recovery and the least rate of re injury. Supervised rehabilitation at PTC reduces residual symptoms and re-injury rates as well.

The most common injury to the ankle occurs with “rolling” it inwards, or an inversion ankle sprain. Although sprains are most common there can also be fractures in the ankle. Questioning should identify the exact mechanism of injury, previous injuries or operative intervention, as well as congenital or acquired instability of the ankle joint. An x-ray of your injured ankle is recommended if you cannot bear weight both immediately and in the ER for at least 4 steps. After a fracture has been ruled out, a careful physical examination should be carried out starting with observation of swelling, deformity and ecchymosis (bruising), as they are indicative of acute injury.

The two approaches to conservative treatment are:  1) immobilization, usually using a cast, and 2) functional treatment, with a short period of protection using tape, a bandage, or a brace, followed by early weight-bearing, including exercises and neuromuscular training of the ankle. Functional treatments produce better outcomes with regards to return to sport/ work, less time to return to sport/work, instability, swelling, and patient satisfaction.  Recommendation: immobilization should no longer be the conservative treatment of choice for patients with acutely sprained ankles.  Further disadvantages of immobilization are the need for prophylaxis of thrombosis (clots), increased atrophy of musculature, and increased costs.

So, what treatment is most beneficial? Functional treatment which offers a short period of protection with tape, bandage, or an ankle brace, and allows early weight-bearing. Exercises for range of motion, and neuromuscular training of the ankle, should begin as early as possible.  Initial management involves control of pain, swelling, and maintenance of range of motion.  This is where PRICE (protection, rest, ice, compression, and elevation) is appropriate in the acute stage to achieve these goals. It is important that this stage is followed by early supervised range of motion exercises and proprioceptive treatment. Supervised treatment has been proven to yield better results with both return to sport/work time and prevention of re-injury.

What brace or taping is the best? A semi rigid ankle brace versus an elastic bandage offers more support in an acute phase and also helps reduce time before return to sport/work and less subjective instability. A lace up style brace will also offer more reduction of swelling versus a semi-rigid brace, such as an aircast. An elastic bandage and aircast combination could also be very effective in reducing swelling

What if I have chronic ankle problems? Proprioception or balance training coupled with strength training can be very effective in reducing further ankle injury as well as reduce residual symptoms. A functional brace may also be appropriate to help improve your ability to perform.

What about ultrasound? Laser therapy, ultrasound, electrotherapy and homeopathic therapy, along with many others; have not been proven to enhance recovery from acute ankle injuries. The gold standard for acute ankle injuries is functional treatment.

The Physical Therapy Center of Bristol will provide you with the gold standard of treatment for your acute ankle injuries and get you back to your sports/work as soon as possible. If you are student athlete, weekend warrior, coach, parent or professional athlete we can take care of your needs. Rehab Like a Pro, from 8-88!

For more information please contact, Keith Sobkowiak DPT, Physical Therapist/Clinical Director at 860-585-5800 or, to help with all of your rehabilitation needs.

The Physical Therapy Center of Bristol, LLC has an A+ rating with the BBB with offices in both Bristol and Southingon, 860-585-5800 (Bristol) or 203-272-8490 (Southington) for your convenience. Same day appointments available. 

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