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
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
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.
Should you have any further questions
regarding this article, please direct your questions or comments to "Ask
the Doctor" section.
Copyright © 2004 - 2012Taras V.
Kochno, M.D. All Rights Reserved
Board Certified in
Physical Medicine and Rehabilitation