Sprains are all too common regardless of age and gender or any other differentiating factor. Be it sport related or improper posture during the most common tasks, a sprain can happen to anyone. While some sprains can be managed at home, it is advisable that you book an appointment with your physiotherapist.
It’s easy to assume that you can return to your favourite activity once the pain and swelling has subsided. However, prevention of re-injury is the most important goal with rehabilitation. Read on to know how physiotherapy can help you recover from the sprain and help you return safely to your favourite activity.
What is a sprain?
A sprain is caused by stretching or tearing of ligaments. Commonly affected joints are the ankles, knees, and wrists. While symptoms can vary depending on the severity of injury and the joints involved, in general, sprains include the following symptoms.
- Pain around the involved joint
- Swelling and redness
- Unstable joint which severely limit movements
Sprains are caused by direct trauma to the joint. This can occur as a result of sport injuries, motor vehicle accidents etc.
While sprains are most often sudden and seemingly unprovoked, there are a few risk factors that can be kept in mind- environmental factors like a slippery terrain, fatigue can cause poor posture while carrying out familiar activities, and ill-fitting sport equipment all increase the likelihood of sprains.
Why is a ligament important?
- Ligaments are bands of collagen tissue that connect bones to each other. The purpose of the ligament is to stabilise the joint while in motion.
- As you can probably imagine, different joints allow for different levels of movement. For example, your shoulder can move forward- back, inward-outward, and sidewards whereas the knee, for the most part can and should only move forward and back.
- The ligaments are the strong fibrous tissue that ensure a particular joint is not moving more than it should and only in the direction that it should. They are, essentially, holding the bones together in place.
Given this context, let’s introduce a big and important word- proprioception.
- Proprioception is an important sensation much like touch and pain. It is otherwise known as joint position sense. What this means is that when proprioception is intact, with your eyes closed you can tell the position of, your elbow, for example- if it is lifted over your head or folded in front of your body.
- Your ligaments that play an important role in enabling this sensation that not only helps you move confidently but also helps you plan your movement. Ligaments are crucial to the neuromuscular system.
- In the case of injury, a ligament is either torn or stretched far beyond its ideal capacity. This can occur around halfway or closer to the bony structure. In addition to pain, this compromise leaves you vulnerable to further injury. That’s why it is vital that you seek out a physiotherapist immediately.
In addition to diagnosing the grade of your injury, your physiotherapist will recommend gentle movement patterns to heal the injury as soon as possible.
Grades of ligament sprains:
Ligament sprains can either be a tear of a few fibres or a complete rupture of the ligament. Depending on the level of tear and stability of the joint injuries can be categorized into three grades:
- Grade 1- In this case there are micro-tears that are most often invisible on imaging and do not cause any functional instability.
- Grade 2- This time the ligament is partially torn or ruptured which causes visible swelling, tenderness, warmth but still doesn’t cause instability.
- Grade 3- A grade 3 injury is the most severe form of ligament injury with a complete rupture, severe swelling and significant instability of the joint in question.
Physiotherapy management of sprains:
As your physiotherapists, even before we expand on how we can guide your recovery here are 3 things you must keep in mind about recovery from ligament sprains-
- Contrary to popular belief, rest does not mean immobilization. Gentle movement is vital to expedite the body’s natural healing process.
- Pain-free does not mean 100% return. Most important predictor of future injury is previous injury. While we understand your distress, we must emphasize that returning to sport or other exertive activities immediately is a big no. As your physiotherapists, we will be carrying out ongoing functional assessments through this process. We will clear you to return to your favourite activity when there is no further risk involved with that decision.
- Depending on severity of injury and age, sprains can take anywhere between 2-12 weeks (about 3 months) to heal completely, in some cases longer. With ligament injuries, patience is key.
With that in mind, let’s look at rehabilitation strategies according to the different stages in the recovery process.
Early physiotherapy and rehab: (tentatively week 1-3)
- Immediately after injury or if you are suspecting a ligament injury you will want to follow first aid protocol.
- For the first 3-4 days following a sprain it highly recommended that you incorporate the RICE protocol- Rest, Ice, Compression and Elevation.
- Optimal loading is another objective at this stage of recovery. For example, if you have an ankle injury, exercises for the calf muscle can help to reduce swelling. In such cases, optimal loading is preferred to complete rest.
Any residual stiffness or compensatory strategies can be addressed through a variety of manual therapy techniques.
Mid to Late physiotherapy and rehab: (tentatively week 4 onwards)
Physiotherapy objectives at this stage revolve around strengthening, plyometrics and return to activity.
Strengthening exercises:
Your physiotherapist will educate and prescribe exercises for stretching and strengthening muscles around the injured joint. This, invariably, is determined on a case-by-case basis.
Additionally, pain relieving modalities such as Shockwave Therapy may also be used to hasten the internal recovery process.
A neuromuscular re-education program may also be included in your prescription to improve that vital sensation we talked about earlier – proprioception.
Plyometrics:
At a later stage, when baseline functionality has been achieved, your physiotherapist will include a plyometrics program. This is a ramped-up version of the regular strength program, and it is mainly focused on speed, agility, and strength. It is a type of training used by athletes to get back their pre-injury shape and form.
Return to activity:
The goal is always to get you back to optimal health and movement, but you also have to be wary of reinjury.
Your physiotherapist will clear you to return to your preferred activity, it is vital that you wait until you are given the green signal to do so. This is done using objective measurements developed from research and evidence-based treatment protocols. These measurements will determine the level of fitness post injury to make a safe and effective decision.
At Revere we are offering the best physiotherapy services with a specialization in individualized and manual therapy methods. We are a team of compassionate and committed rehabilitation professionals who respect you, your time, and your body. We want to offer you the best of care and ensure a thorough recovery.
Reach out to us at info@reverephysio.com with questions regarding the process or our therapists.
We offer free 10 minute consultations to help you determine fit. Call us at 604-566-5108.
Book an appointment right away if you feel ready to do so.
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