Ankle Sprain - Chiro or Physio - Fight it out

[RA.]

I went to physio a week after I sprained my ankle. She told me to keep icing it while it was swollen and elevate it. Once the swelling went down (for the most part) she told me icing wouldn't help, except to ice after I run or do vigorous activities. She's using ultrasound and a bit of manipulation. It doesn't hurt when I see her.

I went to the chiro today for my ongoing back issue. He offered to look at my ankle. It still has "pitting edema" and he basically said that it's a crock to say icing only helps for the first 72 hours. He says ice it often as the warming and cooling of the soft tissue will help to get rid of the swelling. He did ART. It really hurt, and hurts now, a half hour later.

Which one is right, and which is wrong? Or, are they both somewhat right? Which one will help a sprain more?

Just curious.

[Irongirl]

pain is good. (post ART pain)

I'm pro-ChiroART and icing.

I vote for your chiro......mostly because physio hardly ever works for me!

[scrumhalfgirl]

Sprained ankles are one thing I've had really good physio experience with. I've found them especially good for rehab to regain flexibility and strength to avoid further sprains. I can't remember how long ago you injured your ankle, so I'm not sure if you're at that point yet.

Personally, I do agree with your chiro about ice - I lean towards more ice rather than less!

[Avis]

[quote="RA"] He says ice it often as the warming and cooling of the soft tissue will help to get rid of the swelling.

A homeopathic practioner once advised to alternate hot and cold soaks to relieve swelling. I had some problems with pain and tenderness in my achilles tendons a while ago. I tried soaking them in really hot water for 2-3 minutes, then ice water for 2-3 minutes, alternating for 30 minutes total. The theory is that the alternating hot and cold quickly opens and closes the blood vessels, causing them to help "pump out" the fluids retained in the injured tissues. I did this treatment before and after running, and on days off, and it really worked. Of course, I am not an MD, but it fits in with what your chiro told you.

[farmgirlinthecity]

Good Physio or Good Chiro beats bad ones of either anytime!

I'm biased but go physio. DH sees lots of patients that have been wrecked by bad chiros and physios so the important thing is to find a good one!

[RA.]

I like my chiropractor, and my physiotherapist. It's just such different methods - one painful, one not. I never know which to go to, and to be honest, the pain this morning, and swelling that followed, kind of made me wonder. Again, wondering if it was helping more, or not.

[ultraslacker]

My RMT told me to do the hot/cold water thing too, so there must be something to it!

[Spirit Unleashed]

I think no ultimate will work the best.

[Jwolf]

It really all depends on how good the individual is. Some of the methods used by many physiotherapists are very similar to what some chiropractors use.

I've been to some crappy physios and one really good one. I have a really good chiro, but he can't do everything (and I once went to different one that messed me up).

Sometimes the body does need to do the healing on it's own for some time before any method will work, and therapies just aggravate the healing tissue.

[RA.]

I think no ultimate will work the best.

I'm not playing until June. I should be good and healed by then. I'm not ready to give it up just because of one sprain. People sprain ankles running. I do, however, need to work on strengthening.

If I sprain again, I will likely give it up.

[b_squared]

RA - I sprained my ankle on July 31 and it's not 100% yet, more like 80% with some persistent swelling. I saw a sports med doctor this week because I had expected it to be settled down by now but he said I am still within the normal healing time for a severe sprain; my ankle x-ray is normal. He recommended 3 weeks of 2x per week physio and if it hasn't settled by then he would request more investigative imaging like MRI. I've not had great luck with physio in the past but this is the most conservative option at the moment and I'll be going to a new clinic so we'll see. Like me, if you still have swelling in your ankle the inflammatory response is still active and working to protect the joint; depending on the severity of your sprain you may just need more time.

I'd be concerned about the pain caused by ART. You are familiar enough with pain associated with training and massage. These have a certain quality to them and people often say it is a 'good pain'. In my experience, deep tissue massage can be painful but the pain doesn't persist. On the other hand, a treatment which produces a severe uncomfortable pain, that persists after the treatment, seems to be a bad sign to me. If your ankle is still damaged from the sprain then inducing more damage with ART may not be what is needed right now. Just my thoughts.

[RA.]

Today it doesn't hurt, but it does when I move it. However, I also seem to have more range of motion now.

[RA.]

Today it doesn't hurt, but it does when I move it. However, I also seem to have more range of motion now.

I take that back. It does hurt a bit, and it's really swollen again. But, I was told that it could swell at the drop of a hat.

[Robbie-T]

RA - I sprained my ankle on July 31 and it's not 100% yet, more like 80% with some persistent swelling. I saw a sports med doctor this week because I had expected it to be settled down by now but he said I am still within the normal healing time for a severe sprain; my ankle x-ray is normal.

That's good to hear I'm in the same boat, hurt my ankle on Aug 21 and still is painful at times now. I'm able to run pretty had on it, but not pain free, and I still baby it around hard corners and move to planting on my toes at times for comfort on uneven ground.

[RA.]

RA - I sprained my ankle on July 31 and it's not 100% yet, more like 80% with some persistent swelling. I saw a sports med doctor this week because I had expected it to be settled down by now but he said I am still within the normal healing time for a severe sprain; my ankle x-ray is normal.

That's good to hear I'm in the same boat, hurt my ankle on Aug 21 and still is painful at times now. I'm able to run pretty had on it, but not pain free, and I still baby it around hard corners and move to planting on my toes at times for comfort on uneven ground.

I remember seeing pics of both of your ankles and think you both sprained yours worse than mine. I don't like hearing that you're both not 100% yet. But it's good if it's not stopping you from running!

[ultraslacker]

I landed badly on my ankle two weeks ago... it wasn't even a sprain, didn't swell or anything, kept running. But it's STILL stiff if I turn it a certain way.

I guess ankles just take a long time. :(

[drghfx]

I've had many ankle sprains over my life and have always let them heal on their own. As soon as I could put any pressure on them I was walking on them. I'm not one to baby an ankle sprain. I think working it and getting blood flow to it is the best thing for it. In reality that is what a Chiro is doing. Ankles take a long time to heal completely. You will feel twinges and stiffness months after you first hurt it.

[Sir Crashalot]

I've had many ankle sprains over my life and have always let them heal on their own. As soon as I could put any pressure on them I was walking on them. I'm not one to baby an ankle sprain. I think working it and getting blood flow to it is the best thing for it. In reality that is what a Chiro is doing. Ankles take a long time to heal completely. You will feel twinges and stiffness months after you first hurt it.

Couldn't agree more!
I have "lost" 2 summers due to ankle sprains from ball hockey & have always let them heal on their own. Once they feel "ok", I immediately got myself back into action. During those time when running was not an option, I kept on biking just to keep things loose.

Whatever you choose, heal naturally, chiro, or physio, once you are good to go. Don't give up frisbee!

[RA.]

Went to physio today with my inflamed ankle. She looked at it and said "what happened?".... I told her I went to the chiropractor and he did some active release. She said it could have gone either way - responded well to it, or not. And it didn't. She didn't say that it hurt it, per se, but the inflammation was likely from the aggressive treatment. She got the inflammation down, and now I'm supposed to keep it elevated as much as possible over the weekend. I see her again Monday. But, other than the inflammation, it IS healing well.

[PinkLady]

Hmm.

Icing is said to only be effective for 48-72 hours to reduce swelling, because swelling is what causes most of the pain and lasting damage. But ice is still useful after that for pain management and to reduce swelling caused from activity after the original injury.

I vote for physio, but only if you find the right one. I really think the ultrasound/electrical zappy thing are fairly silly and useless. It's the hands on stuff that'll make the difference, but only if you have a good physio. That, and the strengthening exercises.

My physio guy spent 3-4 appts shifting my ankle and foot bones back into place, and then taping it into the right place so my strengthening exercises done at home would actually strengthen things into their right position. I TOTALLY felt the difference after the very first time he did it - all of a sudden my ankle felt stable and 'right' again. The physio guy I use is the manager at the physio place, and he's had years and years of hands on experience. So I really think experience matters and not all physiotherapists are the same.

I'm 6 weeks out from the original injury, and my ankle feels entirely better. I'm back to 25km this week. I do think I need to keep taping the foot for support for a few weeks more though. I don't get twinges or even aches at all while running, and not even afterwards unless I've overdone it (I ran 4 days in a row last week - BAD idea! ) I attribute all of that to the right physio guy, and doing my exercises religiously. The one exercise I think helped the most is ankle raises on the edge of stairs.....I let my heel drop over the edge, rise to the toe on one foot, and slowly lower over a count of 5. I've worked my way up to 5 sets of 10. I also do a lot of balance exercise - standing on one foot on a cushion with eyes closed, next to a wall, 2 min per foot(I try not to touch the wall unless I lose my balance. The eyes closed thing is really hard!)

[PinkLady]

I take that back. It does hurt a bit, and it's really swollen again. But, I was told that it could swell at the drop of a hat.

Really? I'm no expert, but.....I dunno, I wouldn't be comfortable with that. I had pretty much no swelling after the initial swelling.

Oh, and my physio guy recommended as much icing as I wanted, for pain management if nothing else. And when I started running again, pretty much exactly at the 4 week mark, it was my foot that fatigued quickest and ached after, but my ankle was fine. I didn't get any swelling after running either. I don't remember how many weeks it has been for you though.

[b_squared]

.....because swelling is what causes most of the pain and lasting damage.

Why do you think that?

[PinkLady]

Why do you think that?

Mentioned in a few medical articles/sports doc sites. Here's one example from http://www.nismat.org/ptcor/ankle_sprain (emphasis mine):

Ankle Sprains
by admin — last modified 2007-03-08 10:46

The most common type of ankle injury is a sprain. A sprain results from the stretching and tearing of small ligaments (fibrous bands connecting adjacent bones in a joint). There are many ligaments surrounding the ankle that can become damaged when the ankle is forced into an unnatural position. Although ligament damage frequently occurs during athletics or exercise, ankles are just as often injured stepping off a curb, into a pothole, or onto uneven ground.

The most frequent type of sprain occurs when weight is applied to the foot when it is on an uneven surface, causing the foot to "roll in" or "turn" (inversion). This places the sole of the foot in such a position that it points inward as force is applied, so the ligaments stabilizing the outside part of the ankle become stressed. Many people report hearing a "snap" or "pop" when an injury of this type occurs. Following such an incident, one experiences difficulty walking and, in a short time, the outside aspect of the injured ankle begins to cause pain and swells, sometimes so excessively that people believe it is broken.

Upon physical examination, the ankle will exhibit swelling and discoloration (black and blue) over the outside part of the joint. Touching of the area will result in a variable amount of discomfort. Frequently, there is instability notes on the drawer test (as illustrated in picture below) as the heel structures are moved forward and back as the leg is stabilized. Range of motion (ROM) in the ankle can be limited due to pain and swelling, but strength is not usually affected. X-rays are essential, as the possibility of a fracture must be ruled out.
[Ankle Sprain Anatomy Image]
Anatomy of Lateral Aspect of Ankle:

1. Anterior talofibular ligament (front) - tears first
2. Posterior talofibular ligament (back) - tears second
3. Calcaneofibular ligament (middle) - tears last

[Ankle Sprain Anatomy Image 2]
Degree of Severity of Ankle Sprains:
Grade I

* Mild sprain, mild pain, little swelling, and joint stiffness may be apparent
* Stretch and/or minor tear of the ligament without laxity (loosening)
* Usually affects the anterior talofibular ligament
* Minimum or no loss of function
* Can return to activity within a few days of the injury (with a brace or taping)

Grade II

* Moderate to severe pain, swelling, and joint stiffness are present
* Partial tear of the lateral ligament(s)
* Moderate loss of function with difficulty on toe raises and walking
* Takes up to 2-3 months before regaining close to full strength and stability in the joint

Grade III

* Severe pain may be present initially, followed by little or no pain due to total disruption of the nerve fibers
* Swelling may be profuse and joint becomes stiff some hours after the injury
* Complete rupture of the ligaments of the lateral complex (severe laxity)
* Usually requires some form of immobilization lasting several weeks
* Complete loss of function (functional disability) and necessity for crutches
* Usually managed conservatively with rehabilitation exercises, but a small percentage may require surgery
* Recovery can be as long as 4 months

Treatment and Rehabilitation:

Many problems resulting from sprains are due to blood and edema (swelling) in and around the ankle. Minimizing swelling helps the ankle heal faster. Most sprains heal completely within a few weeks. With increasing injury severity, the rehabilitation process becomes more complex and extensive. Chronic or recurrent lateral ankle sprains usually receive some type of strengthening program and proprioception training due to poor balance on the injured leg.

...
(Article continues in the link)

[drghfx]

So as near as I can tell based on the article above, they only talk about rehabilitation exercises for the Grade 3 sprain.

Looking at RA's new swelling, her rehabilitation efforts seems to have caused her a set back because she is now back with a swelled ankle.

[PinkLady]

So as near as I can tell based on the article above, they only talk about rehabilitation exercises for the Grade 3 sprain.

Looking at RA's new swelling, her rehabilitation efforts seems to have caused her a set back because she is now back with a swelled ankle.

I didn't quote the whole article, only a small portion because it's really really long. If you click on the link, the article actually goes into a lot of detail about rehabbing grade I and II type sprains as well.

Near as I can tell, strengthening exercises for any sprain, no matter the degree, are very similar. I would think you'd have more limited range of motions (ROM) with a more severe sprain, and that it would take more time and persistance to restore full ROM and strength. And it doesn't hurt to do the exercises on a perfectly healthy ankle, it just strengthens the ankle and foot. I usually do both sides anyways so they're even.

The suggested rehab exercises on their own, though, are probably not very useful if you have anything more severe than a grade I sprain, which is where a good physio or chiro would come in.