ANKLE SPRAINS ARE COMMON especially among athletes and especially among athletes who have a long second toe known as Morton’s Toe. It has nothing to do with the length of the second toe. If you bend the toes under with your hand, you will note that the knuckle of the second toe is forward of the big toe knuckle. This means that instead of landing on the heel and falling forward to the inside and outside of the foot which forms a solid tripod, the long second toe person falls forward from the heel to the second metatarsal creating a knife edge and a foot and lower leg tasked with adjusting themselves throughout a life time and making it prone to ankle sprains.
A sprain is a stretching or tearing of tendons and/or ligaments. The ligaments are tough bands that go from bone to bone. The tendons, which have more give, go from muscle to bone. When a sprain occurs they are damaged and the body is programed to begin to protect itself from further damage and start the process of repair. The damaged tissue leaks blood, the resulting swelling limits range of motion and the pressure from the swelling causes pain. HOWEVER, the body sends further protection in the form of spasm to the surrounding muscle groups which makes it difficult for the debris to be absorbed.
What to Do?
RICE: Rest, Ice, Compression, Elevate
For years, physical therapists and trainers have been using this method to treat ankle sprains and the sooner the better; this is known as the “golden hour” in the sports arena. Thus treated I’ve known sprains to go on forever and become old sprains resulting in “iffy” ankles.
Recent articles say that RICE reduces blood flow needed for healing and they have introduced METH as the new RICE.
METH: Movement, Elevate, Traction, Heat
The movement they suggest is flexion and extension of the ankle to toleration. Since it is the action of the muscle that pumps the debris out this makes sense. But if movement is painful one is not inclined to do much of it.
They say Elevate if you want to.
Traction is supposed to encourage healing but the warning in the article is that it should not be done “in earnest without training.”
Heat, like ice, has always been around and the caution is don’t apply for too long or too hot.
Which brings us to POLICE.
POLICE: Protection, Optimal Loading, Ice, Compression, Elevation
The article by Medscape doesn’t go into much detail. It does say that most sprains should be moved soon after injury but that doctors often prescribe walking boots. It also says that in the United States some 28,000 ankle sprains occur daily and that only 35% – 85% of sprained ankles heal in 3 years.
Last but not least, MICE.
MICE: Myotherapy, Ice, Corrective Exercise
Myotherapy relaxes the muscles that have been thrown into spasm as protection when the sprain first occurred. It is the first step in opening up the pathway for the debris to be removed. In the case of an ankle, the trigger points would be addressed starting in the gluteals and upper leg, especially in the adductors and groin where there are lots of helpful lymph nodes. And then in the lower leg and lastly the foot and ankle.
Ice, we say is nice if you want it but should be used as Flouri Methane Spray is applied, along the line of the offending muscles.
Corrective Exercise will start to pump the debris out now that the spasm has been released and an open pathway created. As the action of the muscles begin their work, swelling and pain will be reduced and range of motion will increase.
We Call it Immediate Mobilization
The first time I saw it work was back in the 80s when a tennis player appeared at Bonnie Prudden’s Institute for Physical Fitness and Myotherapy in Stockbridge, MA. He came hopping in with the aid of two ski poles and wanted to know if we had a cane. He had been playing tennis with a doctor friend and sprained his ankle. The famous Red Lion Inn across the street from the tennis courts supplied him with ice and he went home. And here he was, at our door, still not able to bear weight three weeks after the injury.
We applied MICE, which took about 15 minutes, led him through the corrective exercises and he left walking normally and carrying his ski poles.
More recently, I had a call from a BODYFLOW instructor who had just sprained her knee at a water park and was taken to her car in a wheelchair. She was on her way to the doctor to have it checked out. Good move. Then she would come to me. She arrived hopping on the good leg with the help of her skeptical husband. The damaged leg sported a knee brace.
I began by telling her she could take the knee brace off. Following an hour of Bonnie Prudden Myotherapy, trigger point work, and passive exercise, I led her through a series of corrective exercises to music. The swelling was gone, there was no pain and range of movement had been restored. She left carrying her knee brace, happy, pain free, and with her skeptical husband who really couldn’t believe his eyes. She never required a second treatment.
If you have questions or need help, email me at firstname.lastname@example.org.
For more information about Bonnie Prudden®, Bonnie Prudden Myotherapy®, workshops, books, self-help tools, DVDs, educational videos, and blogs, visit www.bonnieprudden.com. Or call 520-529-3979 if you have questions or need help. Enid Whittaker, Managing Director, Bonnie Prudden Myotherapy®