[at-l] The twist on sprains and strains

[yamakage at earthlink.net (Robert Seiler)]

Amy,
Sorry to hear about your ankle problems. Here?s some information that you
may find helpful. I don?t know how much knowledge you have on the subject,
so I?ll start with the basics.

When talking about sprains it is in reference to damage to ligaments.
Ligaments are the connective tissue of the body that connects bone to bone.
They were not designed to be flexible, they are to provide stability.
Therefore there is little range in regards to their viscoelastic properties.

Soft tissue will respond to a stretch ? whether intentional or unintentional
? in one of three ways. The elastic range is where the tissue returns to its
normal resting length. A stretch into the plastic range will ?permanently?
deform the tissue, as if there is any such thing as permanent. If you exceed
the plastic range the tissue will tear or rupture.

If the tissue tears, and we?re talking about ligaments, the medical
community categorizes them into degrees of severity. A first degree sprain
occurs when just a few of the fibers are torn. Second degree is when more
than a few are torn. And third degree is a complete tear. All sprains affect
the structural integrity of the joint involved.

Ligaments are avascular tissue, which means that they do not have a direct
blood supply and obtain their nutrients from nearby tissues and the
interstitial fluid. This means that they will heal very slowly ? if at all.
Complete tears of ligaments do not heal on their own.  If your body needs
that ligament to stabilize the joint for your activities then you are
probably looking at a surgical opinion. This is common with knee injuries ?
ACL, medial meniscus, medial collateral ligament. It is not the usual case
with ankle injuries.

The most common ankle sprain is the sprain of the anterior talo-fibular
ligament. It is located on the anterolateral aspect of your foot/ankle.
Usually torn by plantar flexion and inversion. To see this motion cross your
legs and use your hand to pull your little toe towards your navel. It is
possible to have a functional ankle without this ligament being intact. You
will however have to be acutely aware of stability issues.

I don?t know how severe your injury is, but your best bet would be to see a
physiologist or physiatrist. If you cannot find one in your area try a
conservative orthopedic specialist ? but be aware that surgeons, by the
nature of their profession, typically see cutting as a solution.
Chiropractors are bone guys. They do help some people some times, but
usually not with soft tissue conditions. In my world, physical therapists
are usually not very helpful either. If you have an aversion to the
allopathic route then look for a competent massage therapist or
acupuncturist. If they are ethical they will tell you if they can help or
not. They can also be a good resource for referrals to the allopathic guys.

The following is not intended to be medical advice to you or anyone else. It
is what I do with myself and my athlete clients who present a sprain or
strain:

First, I?ll perform some orthopedic tests to try and determine the severity
of the injury. If I believe that it is within my scope of practice I?ll
proceed -  if not I?ll refer out.

Next I?ll try to give the client a timeline.
If they are dealing with a fracture, typical recovery time is six weeks for
the bone and another six weeks to rehab the soft tissue atrophied by the
time in the cast.
Muscle strains are usually ok in about six weeks.
If you have a sprain you are looking at twenty-four months until it is as
good as it is going to get, and it probably will not return to as good as
new.

Proceeding from there, if there is inflammation ? swelling usually
accompanied by palpable heat ? I?ll suggest some time off and contrast
bathing. That would be alternating between ice and warm compresses, three
minutes for one three minutes for the other. If there is a lot of heat I?d
increase the time of cold and decrease the time for heat. Contrast bathing
causes a pumping effect by alternately causing vasoconstriction and
vasodilatation. Be careful with just using ice. For the first few minutes
the cold will cause vasoconstriction, but after 15 or 20 minutes it will
cause vasodilatation and increase vascular permeability, thereby increasing
inflammation.  There are some things that can be done while you are
inflamed, but they can be hazardous, so I?ll leave them out of this
discussion.

After the inflammation is gone you need to focus on your body awareness.
Learn how to differentiate between good pain and bad pain. Remember, pain is
your friend. It will tell you if you are pushing hard enough to do any good
and also tell you if you are pushing too hard and increasing your injury.

The injured person needs to move. First the surrounding tissues, then the
affected tissues. If you aren?t there yet then move the opposite side  -
some of that work will actually transfer over. When moving the affected
side, gentle and conservative are the operative words. Be patient, but
remember that if you don?t move you won?t move. The sooner you can get going
the shorter your rehab will be if you refrain from re-injuring yourself.

Eventually, you want to get back to your desired activity. I know this flies
in the face of someone who gave their 103 percent a while back, but you need
to do event specific training. If backpacking in the mountains is your
shtick then you should start with some light hiking on an even foot bed.
Slowly work up from there until you are stumbling through the Pennsylvania
rocks with your normal load ? without pain. This is both for rehabilitation
and for injury prevention.

Add a stretching program to your training. You don?t want to stretch
ligaments, but you do want to stretch the surrounding tissues. Stretching
improves performance, abates pain, decreases the likelihood of injury or
re-injury, and increases proprioceptive awareness. That awareness will help
your body in making the decision as to whether it should allow the joint to
continue in its motion or find a way to bail ? falling if necessary.

BTW, it is typical for the allopathic guys to only look at the specific
structure. I invite you to take a more holistic approach. In a sprain there
will be more than just ligament damage. The muscles in the area will spasm
in an attempt to immobilize the joint. They will need to be treated. Ankle
injuries also can affect more than just the ankle. The change in gait can
affect the same or opposite knee, which can translate to the hip, to the
back and even make it as far as the neck. Additionally, traumatic injuries
anywhere on the body usually affect your head. Be open to the holding
patterns that tend to develop in your mind. Classical Chinese Medicine
defines old age as inflexibility... Of the mind.

Aids to training: 
You may want to tape the ankle to limit the mobility of the ankle. Check out
a good trainer for advise an to learn how to do this properly.
If you have a Chinatown near by see if you can find some ?dit ? dat?
liniment. The belief amongst martial artists is that it can help resolve
injuries and strengthen connective tissue. It usually contains stuff like
alcohol and squashed scorpions. I think that the commercial preparation
called Zhen gu shuei leaves out the bugs.

Step carefully,

Bob
ATW ?97
 
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