Thursday, August 29, 2013

Getting Back on Your Feet After an Ankle Sprain

In the U.S. alone, 23,000 people sprain their ankle each day, resulting in 1.6 million doctor office visits annually. The direct and indirect costs (e.g., lost days from work) associated with treating ankle sprains exceed $1.1 billion annually. To make matters worse, these numbers do not take into account the long-term disability often associated with ankle sprains. In a 10-year follow-up of patients suffering ankle sprains, 72 percent showed signs of arthritis in the ankle joint. Ankle problems can even be a source of dysfunction and pain in the lower back!

Given the serious long-term consequences associated with ankle sprains, it is important to identify which individuals are prone to injury. Although numerous factors have been proven to correlate with the development of ankle sprains (such as high arches, impaired balance, tight calves, and decreased cardiovascular fitness), by far, the best predictors of future ankle sprain are prior ankle sprain and being overweight. In fact, overweight athletes with a prior history of ankle sprain are 19 times more likely to suffer another ankle sprain. Because force centered on the ankle can exceed seven times body weight, even a few extra pounds will greatly increase your potential for ankle sprain.
Conversely, previous ankle sprain can result in impaired coordination and calf tightness that can increase your potential for reinjury. In a three-dimensional study of motion in the foot and ankle while walking, individuals with a prior history of ankle sprain had reduced ground clearance during swing phase in the foot was tilted in excessively when it hit the ground.

ankle sprain Regardless of the degree of ligament damage, the goal of treating an ankle sprain is to restore strength, flexibility, proprioception, and endurance as quickly as possible during the first few days following injury. The following is a popular treatment protocol for managing ankle sprains that should be discussed with your doctor of chiropractic if you suffer a sprain or are prone to sprains. Your doctor may utilize the following to help you get back on your feet.

Phase 1: Unable to bear weight
  • Compressive wrap with U-shaped felt balance around fibula. Change every four hours
  • Active abduction / adduction of toes for five seconds; repeat 10 times
  • Write out alphabet with toes, five times per day
  • Stationary bike, 15 minutes per day
  • Ankle rock board, seated (off-weight-bearing), 30 circles, performed clockwise and counterclockwise two times per day. Perform on uninjured ankle while standing for three minutes. This has been shown to increase proprioception in the contralateral limb
  • Mild grade 3 and grade 4 mobilization of the joints of the foot and ankle
Phase 2: Can walk with minimal discomfort; sprained ankle has 90 percent full range of motion
  • Mobilize all stiff joints in the lower extremity and pelvis
  • Band exercises in all planes; three sets of 25 in each direction
  • Double-leg and then single-leg heel raises on the involved side, three sets of 10 reps, two times per day
  • Standing closed-eye balance, 30 seconds, five times per day
  • Standing single-leg ankle rock board, one minute, five time per day
  • Closed kinetic-chain exercises
Phase 3: Can hop on involved ankle without pain
  • Running at 80 percent full speed; avoid forefoot touch-down
  • Mini-tramp; three sets of 30 jumps forward, backward and side to side. Begin on both legs; progress to single-limb
  • Plyometrics on a 50 cm and 25 cm box, positioned 1 meter apart. Jump from one box to the ground, then to the other box, landing as softly as possible. Three sets of five reps.
Besides the standard exercise routines, it is also important that problems with balance be addressed. The simple addition of an inexpensive foam balance pad can significantly lessen the risk of injury. In one study, there was a 77 percent decrease in the rate of reinjury when overweight athletes with a prior history of ankle sprain performed balance training on a foam stability pad for five minutes on each leg for four weeks. Another study from the Netherlands found that individuals treated with balance-board exercises reduced their subsequent reinjury rates by 47 percent.

Because foam pads and balance boards do not put your foot through a full range of motion, I recommend a rock board that forces your foot to tilt in more than it tilts out (which is how your ankle is designed to move). The board places your foot in the position of a future sprain and then forces you to use your muscles to pull yourself out of the risky position. At first, perform this exercise while seated; after a few days, it can be done while standing.

The improvements in proprioception associated with balance-board training can be enhanced by skin taping.
Perhaps the best way to restore proprioception is with manipulation of the calcaneocuboid and talocrural joints, which can be done by your doctor of chiropractic. The importance of incorporating manipulation into a protocol for managing ankle inversion sprain is supported with research in which manipulation resulted in an improved progression of forces throughout the foot during stance phase. In performing a placebo-controlled study of 52 athletes presenting with grade 2 ankle sprains, these authors determined that ankle adjustments produced a clinically significant redistribution of load throughout the foot.

Tuesday, August 20, 2013

What to Do About Whiplash- Prevention and Treatment Strategies

Whiplash is the most common injury associated with motor vehicle accidents, affecting up to 83 percent of those involved in collisions, and is a common cause of chronic disability. The Quebec Task Force (QTF) on Whiplash Associated Disorders defines whiplash as "bony or soft tissue injuries" resulting "from rear-end or side impact, predominantly in motor vehicle accidents, and from other mishaps" as a result of "an acceleration-deceleration mechanism of energy transfer to the neck." It is estimated that as many as four per 1,000 people may experience a whiplash-related injury and associated pain syndromes. The overall economic burden of whiplash injury, including medical care, disability and sick leave, is estimated at a staggering $3.9 billion annually in the U.S. alone.
The mechanism of injury suggests that whiplash may occur as a result of hyperextension (excessive backward bending) of the lower cervical spine (neck) in relation to a hyperflexion (excessive forward bending) of the upper cervical vertebrae, producing a force of impact "whipping" through the body. The result is soft-tissue damage, inflammation and muscle spasm.
whiplash skeleton Whiplash is associated with a wide variety of clinical symptoms including neck pain, neck stiffness, arm pain, jaw pain, headaches and paresthesias (tingling/numbness), problems with memory and concentration, and psychological distress. Symptoms of whiplash may not present until several weeks after the causative incident. Frequently people experience little pain and discomfort in the early stages. However, after several weeks the body begins to manifest symptoms. It is this delayed onset of symptoms and lack of early treatment intervention which may cause the condition to become chronic and debilitating.
Whiplash Prevention
While a whiplash injury may be unavoidable if you're involved in a crash, there are simple but effective precautions you can take to minimize the risk. As they say, an ounce of prevention is worth a pound of cure.
Head restraint: If more than one person uses a car, it is better to adjust the head restraint for each driver and make sure that it's positioned according to the convenience of each driver. Not adjusting the head restraint for each driver greatly increases the likelihood of injury. The head restraint must be locked when driving. If the head restraint is not locked, it may move during an accident, taking away protective support when needed most and resulting in substantial injuries to the neck.
Evidence suggests that being the driver increases the chances of head injury by double and also shows that women suffer from whiplash injuries more than men because they tend to sit more upright and closer to the steering wheel. A study by Brian Stemper, PhD, assistant professor of neurosurgery at the Medical College of Wisconsin in Milwaukee, found: "Auto head restraints positioned less than 2.4 inches (6 cm) from the back of the head kept ligament stretch within the physiologic range - meaning that no injury would occur. However, as the restraint distance increased beyond 2.4 inches, the ligaments began to exceed failure thresholds, meaning that whiplash injury was more likely to occur."
Seat belt: Although the seat belt in and of itself will not prevent whiplash, it does help to prevent your body from lurching completely forward during a car crash, even a low-impact crash. The simple act of buckling up is responsible for approximately a 60 percent reduction in accident fatalities. So buckle up to save your life and protect your neck.
Neck exercises: Whiplash affects the neck muscles. The stronger the muscles, the less affected by sudden movement your neck will be. Engage in neck exercises to strengthen the soft tissues of the neck. Exercise won't prevent whiplash, but it can make you less susceptible to the forcible forward and backward neck jolts. Isometric resistance exercises for the neck are easy to do and highly effective in strengthening the supportive musculature of the neck. Your doctor can provide you with specific neck-strengthening exercises.
Treatment Options
Whiplash injuries are difficult to treat for many reasons. Complex interactions of psychosocial, legal and physical factors make effective treatment highly variable. However, there are many therapeutic options available to help whiplash related injuries. Initial treatment traditionally includes a soft cervical collar to restrict cervical range of motion and prevent further injury. Overall rest and motion restriction may hinder progress in the long run, so it is best to seek out professional help in resolving symptoms. That's where your chiropractor comes in.
Chiropractic: Chiropractors are the single largest group of practitioners treating whiplash injuries, and they do it well: For example, one study found chiropractors were effective at relieving whiplash pain more than 90 percent of the time. Chiropractic care focuses on relieving soft- tissue spasm, inflammation and pain by restoring proper motion in the spinal column. Due to the force impact of whiplash, the spinal column can misalign and cause pain. By performing manipulation to the spinal column, chiropractic can help restore normal function and movement to the affected areas.
neck adjustment Depending on their treatment style and your specific case, your chiropractor may decide to utilize additional treatment options in addition to chiropractic, either in their office or via a referral. Here are some of those potential treatments, all with the single goal of relieving your pain and managing your whiplash symptoms in the most effective way possible – and without requiring pain-relief medications, which are perhaps the most common "treatment" option for whiplash sufferers, despite the fact that they provide only short-term relief and may create more problems than solutions in terms of the potential side effects.
Massage Therapy: Massage is one of the most effective therapies for releasing muscle tension and restoring balance to the musculoskeletal system. Massage therapy can help relax the muscles, increase and maintain range of motion, decrease stress and tension, increase circulation, and prevent and break down scar-tissue formation. Ideally, therapy should start as soon as the acute, inflammatory phase is over (about 72 hours after the injury). A massage technique called cross-fiber friction can be used to encourage the body to lay down the connective tissue in the same direction as the originally damaged tissue. This proper alignment causes smaller amounts of the connective tissue to be needed and allows for a fuller range of motion upon recovery.
Physical Therapy: Physical therapy is an effective treatment option for whiplash, especially when combined with other treatments, such as bracing. Physical therapy techniques can help restore proper function and movement of damaged tissues. Physical therapy includes both passive and active treatments. Passive treatments help relax you and your body. They're called passive because you don't have to actively participate. You'll probably start with passive treatments as your body heals and/or adjusts to the pain. But the goal of physical therapy is to get into active treatments. These are therapeutic exercises that strengthen your body so that your spine has better support.