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An Approach To Upper Ankle Sprains


Athletes involved in physical contact sports are susceptible toward upper ankle strains. Whereas the lower ankle sprains involve ligaments in the tibial, fibular, subtalar bony structures, the upper sprains are more muscular strains to the attachments to the mid or lower third of the tibia or fibula.

Upper ankle sprains occur usually when a person has planted their ankle and foot on the ground and another force pushes the mid leg downward with the foot planted causing a strain of the proximal insertion of attachment of muscles and tendons.

Swelling occurs in the distal third of the leg. The ankle ligaments are usually intact with an occasional minor sprain.

The most important aspect of upper ankle sprains is to identify specific structures involved and their actions in the lower extremity. Frequently, the extensors or evertors are more commonly affected, as they are more superficial than the invertors or flexors of the leg.

The higher ankle sprain usually shows minimal or no bruising as the avulsion of the tendon from the bone is slight or partial. This is in contrast to a more severe tear of the lower ankle sprain that can be evidenced by bruising in the ankle and foot.

Whereas in the lower ankle sprain retraction of the joint allows muscles to fatigue or relax during joint mobilization promoting recovery, the upper ankle sprain responds well to myofascial release techniques. Myofascial release techniques identify anatomically the muscle tendonitis that has occurred from the sprain; whereas, myofascial release techniques allow for restoration to full flexibility.

The most successful myofascial release techniques are Active Release Technique (ART) in combination with the Mattes Method of Active Isolated Stretch (AIS). These techniques focus on the anatomical structures utilizing the fascia of specific muscle and tendon with active movements relieving muscle tension thus promoting faster healing and return to prior athletic activity.

Unfortunately, higher ankle sprains are usually treated with modalities such as electrical stimulation, ice and excessive tape wrapping which cause further tightening of the shortened muscle. Ice is appropriate for the initial phase for reducing inflammation; however, the quicker one can mobilize the myofascial structure of muscle the faster the healing.

In my experience there have been no complications or adverse consequences to utilizing myofascial release techniques actively and actively assisted with return of muscular function within a couple of days of treatment. 


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