What To Do For an Ankle Sprain in the First 24 Hours
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Hey MDMCers here’s what’s happening. Michael here, prompted to make a video, based on a text I just got from Phil MDMCer who had an ankle sprain happen with one of his clients in his facility, doing a speed ladder drill. And maybe this would be a YouTube video or not. But it’s something that has great context to it. And I want to share with you what we do when this happens. Because no matter how long you’ve been a movement practitioner for there is going to be something that happens in a session. Just as there’s no doubt, it’s not a matter of if it’s just a matter of when, and the longer you’re in the business, the longer you have to deal with this kind of stuff. It’s just part of the game. So hence why we like to be so well educated and be a movement Master is to be able to help our clients and our athletes in the moment. Certainly a doctor can help out too, but why can’t we be able to be able to help out immediately because it’s right in front of us right then and there. So I’m gonna share with you what we do when ankle sprain happens in our facility. And then more importantly, what we do through movement, right, and what we do the next day and the day after that, so that athletes get the help that they need as soon as possible. So here’s the context, going through a speed ladder drill. And as you’re going up more often or not, you know, the ankle sprain is an inversion ankle sprain. So inversion as we’re going through our chain reaction. Biomechanics is when the foot isn’t over supination, right over supination. the calcaneus is E verted. The talus is up and externally rotated the tibia and fibia is an it’s an external rotated position to the knees and an outward rotated position, the foot is in a very firm spot. And basically, as it gets through that pattern, it can’t decelerate itself, it the the mass momentum is too too great. The peroneus longus, it banned lateral TfL, glutes, they don’t have the brake pedal responsiveness to slow that pattern down to wherever the the foot is, and the ankle rolls. And there becomes too much tension through just make it simple, the outside ligament right on that ankle. And it gets into a stressed scenario where there’s a fray. Now, it could be a fray, it could be just an over pool, like you know, when your color of your shirt is a little bit stretched out over pool or all out just boom, it’s gone. Now all those are different grades of ankle sprains. And they should be treated differently expecially if the ankles gone, in a sense, right? So total free, that’s medical attention that needs to be taken care of. But more often or not. It’s an Ooh, whoa, whoa, whoa, you know, it’s like I got a little limp going on. And maybe some bruising happening throughout the day. Definitely some swelling happened throughout the day. So what do you do in that session? In that moment? Well, you take care of them, right, you definitely gotta manage that person, the athlete with the utmost care. And if you’re in a group setting where you got to, obviously to get them into safety, make sure there’s not balls coming around, you know, plates going around, you know, get him into safety. And then honestly, we have ice on facility to apply as soon as possible, because we want to control the swelling, it will swell, swelling is a good thing. But you do want to control it and just make that person feel taken care of. Because at that point, the sessions pretty much over that depending on the grade, but for the most part, it’s approach over and then you have to manage what’s what’s going on. But as that’s done, the conversation you have with that athlete is not about doing nothing and resting. Right. So there’s two concepts I want to bring on rice. And what that means rice means essentially, rest means elevation, it means compression, it means ice, I did it out of order, excuse me, Rest, Ice, Compression and Elevation. And so rest do nothing. Literally don’t let the thing rest in he’ll ice what we just talked about compression is keeping that area in a in a in a shoe for the short term at the very least, right? But also a compression sleeve in the elevation is that when it’s in rest, you want to have it higher than the heart because blood pulls down low. So even my foot right here is not higher than my heart. So you want to be in a seated position with the leg higher than the heart to allow pulling to not happen down in the lower extremities as you’re not doing muscle action. Because muscle action is a pump right? The soleus be found here is literally that considered a second heart because it literally pumps muscle muscles to pump blood back up as you’re in movement. So it’s kind of important, hence why a lot of weddings and military services people lock out they’ll just pass out because the heart has a hard time literally pumping blood back up fighting the system. Not to digress too much more. But now this thing’s this thing called mice. So there’s rice and then mice and potentially the only one letter is changed. That’s the first one instead of rest, it’s movement. And this is the crux of this video, what I really want you to get is this movement, Ice, Compression and Elevation, get the ice going, that’s great gets the compression going, that’s great. Get the get the whole taking care of the body, right? That’s very important. But you want to start moving. And this is what we talked to our our athletes in the facilities that we want to see you tomorrow, that like what I just sprained my ankle, yes, I want you to come in tomorrow. And if you’re in a group training facility, this is an awesome opportunity to really provide more value. Now what I mean by value is this term called upselling. And upselling is not a way just to make more money off someone’s injury, it’s provide more opportunity. What I love about our industry is the better that we do as a practitioner financially, should I mean dollar for dollar, minute by minute correlate to the better opportunity to results that we give, but that to me, that’s a true, awesome sustainable practitioner is that they, the more money they make, the better their clients do, there’s no disconnect between those two. So I really believe that it’s opportunity for you to provide opportunity to that to the athlete. And what you want to do is you want to assess where movement is lacking. So if you want to do mice will move well how do you move it hurts to move. That’s not necessarily true, it hurts in some movement patterns. And certainly, an E version sprain is going to show some some some very weaknesses in movement. And uh, typically, it’s going to be in plantar flexion and E version. But you see how I did that I did plant affection and the version, that’s with an open chain, my foots not connected to the ground. So you haven’t fit on a table, point their toe and roll in, that’s probably going to hurt because that’s how they actually sprained it, and contact. But we have, we know the ankle can move through six distinct movement patterns. And I just described two of them. So it gives me at least the opportunity to check the other four to get movement that is pain free. Now, why is movement so important in this mice concept and what we really practice and how I would go through a session with somebody that actually sprained their ankle literally no more than 24 hours ago, to help them progress and heal as fast as possible. So I’m trying to make this as simple as possible. This is literally, I got the text message like 10 minutes ago, just want to make a video to make it happen. So this one, this one happens, I’m going to see somebody I’m have them literally stand. And I’m gonna say can you rock your body forward and backwards, literally, as a body shift backwards on under the heels. So I just lift my toes almost kind of rock too far for them back. And I’m just assessing how that feels very, very small motion, they more than likely walked into the facility, or on some crutches right? But they had some pressure on that foot. And I says How does it feel? And typically, as they come forward, they say it feels fine. But I do you feel some kind of pinching in the front? And when they go back as Lou, that’s a little it’s a little bit wit, if Yeah, I don’t I don’t necessarily like it. But it’s not painful, because it’s such a small motion. Well, this is more dorsiflexion as it come forward. And this is more plantar flexion. As I go backwards relative at the ankle, I say okay, great, thanks very much. And then I’m looking for movements that do not hurt. So we found one that was forward a little pinch, but not necessarily pain. I’m gonna go side to side with that shift. Now let’s say it’s the right ankle, I’ll just keep using the right ankle when they go this way, right? That’s relative pronation, or ankle inversion to the E version, excuse me. And that should be relatively fine. But when they shift this way to say, Oh, I don’t want to put my head over my foot, because that’s going to start getting being that supination or heel inversion. And that’s an inversion sprain. So okay, so I got two motions out of the four that I know can be very possible for movement for the mice. Strategy. What about when I rotate the hips. Alright, so looking at my right foot, when I spin my hips to the left, I’m getting much more into pronation or inversion me, I say that we’re e-version. As I go this way, and as has been my hips to the right with my right ankle sprain, I’m gonna get done more supination or inversion. So I at least have know that I have three strong movements that are going to be the opposite motion of that ankle. I got rotation, opposite side or left of a right ankle sprain. I got hips translation to the left or the opposite side of my right ankle sprain. And I have forward motion. Okay, so I got three motions that more than likely you have to test that are going to be pain free.
I’ve gotten to someone who had a bad enough spring that only one of those movements was pain free. five of the six where I don’t like it, only one word. And that’s where we start. We only six start with success. This is the biggest takeaway I want you to to grab from this videos start with success. So let’s say success is those three dorsiflexion translation, the opposite side, and rotation, the opposite side was that not just movement. Of course it was right. That’s the beautiful part of this thing. I moved my pelvis this way. And when I shifted back home, I shifted in a plane of motion that was going towards the ankle sprain, but not to it. As I went forward, I went to dorsiflexion, more relatively speaking, and then back into plantar flexion, as much as my pelvis goes backwards, and as I rotate, I’m getting much more of the pronation, I’m coming into the supination. But I’m not going into supination I’m not going in, but I’m using the movement of supination. And all that movement, pumps, blood flow, all that movement. And here’s the most important part reactivates damage proprioceptive input from that ankle. And the MDMC course, I make a video on this exact topic of that when you injure or sprain a ligament, you literally are fraying inner internet, Ethernet cords, right, all those hard wired Ethernet is out there. And when you do that, what do you think’s going to happen, the signal is going to be delayed, it’s going to be offset, it’s going to be weird. And that’s why when someone who sprains an ankle, often, they often spread it more, just as a shoulder dislocation, when you dislocate a shoulder once they opted for dislocated more happens, because not only has the ligament been stretched, and ligaments heal way slow way, the way slow because the lack of the blood flow to that area. But also the communication lines aren’t being retrained. So what do you do with the movement pattern? Well, literally I would have that person in the facility, stand or sit right, don’t be afraid to just hey, let’s just sit down and go through those same patterns, right? I’m in a true stretch here. You can do that on any chair you want. But I’m just moving through my patterns. Even moving through my patterns, even me rotating through my pelvis right now is literally shifting how my knees and how my TIB fib work, and I’m a little smaller in your screen. But you don’t have to be standing to do those things. Or if you are standing, you’re just on support, like something to give them support. And you start moving them through those reps. And that’s really simply then that’s the movement parse part. Then you have your eyes, you have your compression, you have your elevation. Afterwards, I probably do about a half hour session because that’s all we’re really really getting with is teaching them how to do this at home as often as they can avoiding pain because you want to send movement down which is blood flow. You want to send movement down because that retrains proprioceptive input to get communication lines built back as early as that sprain is. Post sprain it Lilia started to re heal itself, you want to re heal itself with proper proprioceptive input, because you do not want it to do it again and again. And again. There’s also something that I found as very helpful is going after the peroneus longest or lateral leg, because that was the decelerating muscle tissue that just didn’t have it in them, they just didn’t do it well enough fast enough, may or may not be for lack of training, just because the the massive momentum were just too too great. So I start foam rolling those zones. And I literally start foam rolling the peroneus longus expecially because it is a massive player in that inversion deceleration. So it’s probably pissed off bad because it really got a few 100 pounds of force driven through it, and it just couldn’t manage it. So it’s like a massive e centric load that failed. If you’ve been in a lot of benchpress and you got that huge load, hit your chest, your pecs, your triceps, your anterior delt, we’re trying to decelerate that in a failed it’s still got a lot of work though in fact, much more load than an a contract, concentric press. So I’m in that I’m gonna start full mourning that and that may be very, very painful for them. So you have to decrease the amount of intensity or pressure on that as you start to free up that movement pattern. Now continue into the IT band, but it may displace it I like to roll if it if it’s over tight if it’s over compressed, but the controller of the IT band is the TFL and the glute medius minimus, and even the glute max all those feet in and integrate into the IT band. So the it that is not the focus. It certainly is the lateral hip complex. And that is simply just again, I’m using a ball which may be too too much, but a roller to get in there to start to loosen that up and how you foam roll is a whole different video. But it’s the easiest way I can say light foam roll light, not too too hard. Okay, you can also start to stretch out this area Now how are you going to stretch out these muscle groups without going into, into inversion, you kneel, you kneel down, you’re not gonna get the peroneus longus. But you can definitely get the lateral hip. So I kneel down, I cross over. And you can see already see how this leg starts to go into more abduction. And with abduction driving into the sagittal plane, forward and backwards and into the rotational plane, I’m getting that load right through this zone. And you can make that more focused, as you get through it. As you can see, I’m here I’m in a much more of a right foot. plantar flex, so you may have to watch out for that you may have to go into here or even put some sort of roller behind there, to rest the foot onto the ankles in a neutral spot, right, still gotta mind that ankle back there. And I’m gonna start opening up that lateral hip, because I want to be able to slide my pelvis to the right with the right ankle sprain, gain access to that motion, and all three planes of motion all the way through there. Because when I come back up, I’m going to be still limping for a few days potentially. And I don’t want that limp to create another movement compensation that you just have to train out once the ankle gets fully healed in four to six weeks. Right. So that’s about the standard healing process four to six weeks, even six to eight weeks, depending on the severity of an ankle sprain. But you want that hip to stay loose, because you want that pelvis to go through that relative motion, even if you don’t get that motion all the way down at the ankle. So you don’t want to create another problem as it feeds up the chain. Now, I brought a few other tools here. One is the this is the game changer. This is a baps board. This is a game changer in the ability to assess ankle motion in an isolation. So if you don’t have a BAP sport, I don’t say I recommend it. But you’re certainly recommended for an ankle sprain. Because you can put your foot directly on the board and the bass sport is designed to follow exact biomechanical very close by mechanical movement of the ankle complex. As I get much more plantar flexion than I do, I get dorsiflexion, I can get relatively equal, right and left motion or lateral kind of you call that kind of supination or pronation supination. But I also get that amazing abilities to roll through motion. And as they go through this pattern as they’re gonna, they’re probably going to want to avoid that side of it. Because you can see that’s much more of an inverted position or supinated position, but they can certainly practice a half roll and a half roll and just stay on the inside. And they’re getting that ankle rolling pattern but they’re never going into the dysfunctional or injured space. Again, proprioceptive input is your biggest focus via movement, right via movement. That’s why the mice concept is much better than the rice concept. Because you want to literally be retraining movement as soon as possible. It’s, you’d be excited to know that even after total hip replacements, total knee replacements, you know, outpatient clinics, they want that patient out of bed as soon as possible, because they realize that that hip needs to get integrated into physics as much as possible the preceptors need to start realizing there’s something different going on here. Because if they used to do it bedridden for several weeks and the recovery from that bedridden was way greater than just the recovery of the actual surgery itself. So movement pain free again you got to find your your pain free via your six patterns and start working through that you may find it extremely difficult for them to go into an an E version or pronation you may have to have actually sit them down to do this because this is too intense. Typically we do this with with it with a handheld and if you do not have a baps for but you have some sort of like balance, balance board, right a Bosu I BOSU works to right I’m not saying it’s not going to work, right? But even this one, right, you want to get that relative movement down there, back and forth to start stimulating as much motion as you can. Okay, a lot information there for you. Hope that starts to kind of help you digest where to go with an ankle sprain.
I mean literally acute ankle sprain how you can offer. If you do group training, that’s a good opportunity to go to personal training. Or if you do personal training, good opportunity to keep that client in your doors, not because you want to take more money from them because you have something to offer them versus just I’ll see you in a few weeks and hope it gets better. And then when they come back, it is better but now they’re detained physically they’re detained proper sceptically, and they haven’t been getting onto the routine so they’re mentally drained as well because they love coming to your physical facility. They love training with you. And now they’ve just been eating a few more Manrico Cheetos on the couch, whatever the case is. So, action action, action, movement, movement, movement, pain, free pain free Bree, grab on to those proprioceptors who have been damaged, started training more. This is a great opportunity for commentary and particular individual case studies to bring him in. And I would love to chat with you more all about it. So let’s see what we got. If this does make it to YouTube, hey, hit that like button, hit that subscribe button. We got a bunch of context. We’d love to share an open source with you. And we’ll see you guys soon.
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