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Body Mechanics Sports Massage Therapy- Brian Glotzbach, Don Myers and Jimmy Farris Talk about High Ankle Sprain

Posted by admin | Posted in Injuries | Posted on 20-04-2010

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High Ankle Sprain

High Ankle Sprain is an injury to the syndesmotic ligaments of the tibia and fibula. This involves sprain to the anterior and possibly posterior tibial fibular ligaments. It gets the name “high” because the injury and pain is above the ankle joint between the malleolus. The injury is not as common as an inversion sprain but is more common than eversion sprains. High ankle sprains also typically take much longer to rehab than either inversion or eversion sprains because with every step at toe-off and the foot in extreme dorsiflexion the malleolus separate slightly. Each separation newly sprains the ligaments. The mechanism of injury involves an outward twisting of the foot and ankle. Pain may not be felt just at the ankle but all the way up the leg. It is very common to limit extreme dorsiflexion with a boot for as much as 4-6 weeks.
Special Tests

Squeeze Test – Squeeze the tibia and fibula together at mid calf with the athlete holding the foot in dorsiflexion. Positive test – Athlete indicates pain over the space between the tibia and fibula at the ankle not at the point of compression.
Ankle External Rotation Test – Athlete has the knee flexed and dropped off the side of the table. The therapist stabilizes the leg proximal to the ankle. With the other hand the therapist holds the bottom of the foot and laterally rotate the foot without allowing any rotation of the tibia. Positive test – Pain on external rotation.

Treatment – High Ankle Sprains

Massage therapy is a critical adjunct to standard rehab for a high ankle sprain. High ankle sprains are the toughest ankle sprains to treat. There doesn’t seem to be a general pattern of muscular soreness. The injury involves outward twisting of the ankle which doesn’t usually involve overstretching of the muscular structure in the ankle. In the healing process there may be some adhesion to the long tendons of the anterior ankle, posterior and medial ankle to the deltoid ligament and often pain to the tendons of the posterior tibialis and flexor hallucis longus, any structures that come into direct contact with the syndesmosis joint including the tib/fib ligaments. General lower leg massage is important. Homecare: Cross your legs and press into tender areas in the affected calf muscle and move the foot and ankle in as large a circle as possible while maintaining compression on the tender spot for 8-10 seconds. Continue compressing spots in the lower leg while moving the ankle and foot. You should continue this treatment several times a day until the lower leg tender spots subside. It may take several weeks.

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