Ankle sprain and neuromobs

[bernard]

Hi SomaSimplers,
This one is for our neuronuts!

Ankle sprain and neuromobs. How do you start/follow these orthopaedic cases?

I have and tried some but want your advices.

[nari]

Bernard, I haven't treated an ankle sprain for about fifteen years, but if I had treated one recently I would definitely use neurodynamics, on the basis of the brain needs direct information, which it may not get uniformly with electrotherapy and exercises. Oh, and lots of proprioception work in PWB/FWB too....
I presume we are talking about acute as well as chronic.

Nari

PS I am glad I didn't treat them - uniformly boring.

[Diane]

Hmmnn, I quite enjoy treating ankle sprains, whether they are fresh or old.
I treat the neural tunnels all the way back to the back of the knee, even around the hip sometimes. I make sure there's enough motion at the top tib/fib joint. The tib and fib should feel on palpation as though they can glide vertically against each other (tib down and fib up on front, fib down and tib up at the back). Then the swelling will drain out better. When I work at the lower end of the tib/fib I try to get the same sort of movement there. Plus I "wring" the foot/heel for sustained periods of time, foot plantarflexed/ inverted, or dorsiflexed/ everted, slowly and gently, heel taken opposite way, more firmly. I use a couple strips of kinesio tape after, just to remind the skin to report position sense. Seems sufficient to reduce swelling/restore function. They're still sprained, of course, but they don't perceive themselves to be in as much pain and have much more normal gait after.

On a personal note, every time I treat an ankle sprain I feel like I'm making up for the one I personally had age five, a bad one that was never treated properly and left me with a leg that can get quite cranky if I don't stay on top of the issues in my tissues/pain in my brain.

[emad]

Hi Bernard & Nari & Diane :

Very strange , we can NOT go without discussions , on , on , on ....we will spend our life discussing , i hope there will be discussing topic after death , and that will nice if there is internet to discuss more using the spirit , very strange that human being , unique ! very unique ........ the point will explode from my hand and will go on ,,, let me back to sprain /strain injuries , because , the injury usually is complex , not only ligament , but inculdes all soft tissues , from nerve to muscle to joint to to to .

Usually , i apply mobilisation , which Diane mentioned earlier. From my experience to address this type of injury , i noticed the most limited motion is ever/inver range of motion.As well as , the accessory motions of the tarsal bones , needs to be mobilised .

Another important point is the limping , how do you address that problem ???


Also , in your own view , what is the most appropiraie time to deal with sprain /strain injury ???


Regards
Emad

[bernard]

Emad,

Discussion are a way to merge knowledge coming from our professions and different countries.

I put this thread because it is certainly a way to have some reference's topics showing all aspects of such trivial/common problems.

It is a way to spread neuromobilisation over the French forum, too (for Cedric).
France is poor country for neuronuts.

[Diane]

Emad, you are quite right. Ankle sprains involve injury to every sort of tissue besides "ligament" (therefore brain) same as any other sort of "orthopaedic" injury. I should have pointed out that I rarely ever resort to "mobilization".. the hands-on is usually just at the skin level, amd the effects are gained through slowness and sustained positioning.

I'd say the most appropriate time to deal with ankle sprain is anytime you can, from the first second until years later, sooner the better.

[bernard]

Emad,

I begin to mobilize ankle at D+1 for 3/4 sessions on a fortnight duration.

[emad]

Bernard :

Just i was kidding /laughing


Emad

[emad]

Oh friends ;

This is just acute patient , do not we need rest ? to restore that injuried blood vessels .

I believe in rest for one week ?i can not go with that idea begining in the same day to move .

Diane ,

Just skin what ? touch ?good point to put in the position and still for moments.

Emad

[cedric]

Originally Posted by bernard

It is a way to spread neuromobilisation over the French forum, too (for Cedric).
France is poor country for neuronuts.

thanks if you can bring a "new", "fresh" point of view...
you are right but one thing, france is a great country full of nuts... (sorry if it is not clear, i'm a novice with english jokes...)

@diane : how do you treat the neural tunnel?
@emad: in france, there is no rest usually... but i don't know why...

[nari]

emad..

Rest for a week? I wouldn't go past 24 hours. Mobility aids healing (unless we are talking a fracture); immobility removes that natural opportunity to heal.
Slow ROM actions, weightbearing as tolerated, stick can be helpful, but functional movements as soon as possible.
That's just my neurobased 2 cents.

Nari

[Diane]

Cedric,
The treatment is to relieve the nerves, always..
All tissue that is not actual nerve is by definition neural tunnel. I do lots of work on skin, where the nervous system is anchored, by stretching it, and on deeper connective tissue, softening it through positional means (e.g., lifting the arm up and back with patient prone, to relieve tension through traps and other posterior parts..)

With regard to the ankle, the neural tunnels are a lot more superficial.
Hope that answers your question.
Diane

[emad]

Hi Nari :

All of you on the forum confirmed the necessity of begining mvt in the first day of injury ,well , is there an evidence ??

Diane :

Can you clarify in more detail that skin approach you apply , i would aplly it , however all sprain ankle cases i meet after 3 weeks from injury .


All friends :

Why we speak /discuss in the limited corner of ankle , let us speak in general , Do you apply /encourge movement from the first day for any soft tiusse injury (including neral injury )?

For example , the hopsital where i am working , our director 55 years has fallen since 2 weeks ,he got a shoulder injury ,Orthopedists and radilogoists run to approach our dierctor , they performed X-ray , coformied no bone fracture , the head of orthopedic departement (53 years old ) applied straps around the whole shoulder and chest , leading to our bad director to home and rest ,he came back 2 weeks to the hospital to attack us all in the hospital , because of his pain , he asked about me to come to his bad office , asked what could i do for my sholuder ??

I began to discuss with him the whole issue , what did you do for the strap ? he said i removed it after 2 days , it was so bad , i could not breath , my stomach was hurted .............During our discussion , he told he is taking drugs to sleep at night , i said why drugs ? no benefit ! just complications !he said yes , but i can not give up ?

Actually , i do NOT like that man at all , because of personal issues , but i am foreced to manage his pain ?

So that , Do you see this case was better treated from the first day by movement ? by the way , he is NOT convinced at all bu exercise , he asked my about heat therapy , i think i will do for him what he wants .

Regards
Emad

[nari]

emad,

You are in a difficult position with the director, so I can understand the problem. Strapping shoulder AND chest was not a good idea at all - perhaps a strip of tape across the shoulder for a day or two for some neuromodulation, and rest for a day. If your director wants heat, tell him to put a heat pack on at intervals...I am kidding, I know you are not in a position to do that..
There is so much evidence around for early movement a day after a mild to moderate injury that I can't even start to tell you about them. It applies to acute low back pain, ankles, any part of the body where there is not a fracture or dislocation.
A neural injury depends on the sort of injury - if it is just a compression or similar - yes; but if there is real damage, rest for longer may be indicated.

Have a look at references on the Net for 'early movement' or similar. I am not at work at present, so cannot access many sites.
Perhaps someone else can give you some sites.

With someone like your director, I would have advised: Rest for a day, then start to move, test out neural status, advise against sustained movement and avoid very heavy working of the shoulder. Tape the first day, just one or two strips across/over/around the acromion - doesn't matter much, see what feels good - for neuromodulation. Some would choose pendular exercises, but I don't like them much - non functional. Trouble with shoulders is - they are unstable at the best of times, and there can be hidden injury that doesn't show up well on imaging until down the track.

Nari

[bernard]

Hi all,

I tried neuromobilisations with a "fresh ankle sprain".
The man is a "heavy" basket player: 1.97 m and 104 kg.

I saw him before for a recurrent LBP and I was surprised to see him, again at the office with crutches and an immobilized ankle.
The incident intervened during the first game of the season. His back was fine but he said that he didn't went to trainings (a bit lazy). Another player felt on him and bent his ankle. he listened a big "crack".

Well,
the ankle was splinted and impressive by its size.The fourth one in five years on the same side (and three on the other side).
He said that normally it needs around 3 months to "find" again a functional joint.
I said that he needed to remove the splint and we did only neuromobs, twice a week, 3 weeks. He was surprised that pain was so low and movement (walking) was possible and he was able to work.
The crutches were removed at 10 days and he begun to run at 25 and jump at 30.

He returned to play basketball six weeks after the injury. The first trial was a bit worry and he felt a little fear and a slight tighness. The second was clearly good and he told me it was the first time, in six years, he enjoyed to play.
He wasn't the only impressed.

[nari]

Treating nerves can be sooo rewarding.

I would hope that, with attention to the neural system, he won't have repetitive problems with the ankle.
Splinting is never a good idea for nonfractures, but it is still faithfully done in the belief that it protects and heals. Unfortunately, it is slow that way. And the nerves are not talked to during all that period of splinting.

Nari

[emad]

Bernard ;

Thanks for giving life to this thread of ankle sprains.

I have a friend doctor , yesterday experienced ankle sprain injury it is the third time Left side .

Any way there is edema around the ankle . he moves much ,walks works.......

Do you suggest encourging activity and mobilization.

Regards
Emad

[bernard]

Emad,

I suggest no immobilization but normal activity while there is a repairing, is really governed by pain. I adviced to move without fear but without overloading. Light activity and with respect of signals coming from the site of injury.