Sprained Ankle Rehab System

H.e.m. Ebook Sprained Ankle Rehab System

The H.E.M. ankle rehab system will get you out of pain and walking normally again in about 3 7 days (instead of the typical healing time of 4 8 weeks with just rest and ice)! And it will get you back to sports and more rigorous activity in about 7 10 days (instead of the typical 1 3 months with just rest and ice)! H.E.M. is the first comprehensive at home rehab program meant to be used by anyone at any level of fitness (ages 10 100)! It requires no equipment (no wraps, braces, tape, etc.) and can be done in just a few minutes a day from home. We guarantee you will get out of pain fast and experience a complete ankle recovery from a sprained ankle. Pain free walking in 3 7 days. Heals All damage from injury. Quickly reduces bruising/swelling. Breaks up scar tissue. Reduces risk of future injury.

Hem Ebook Sprained Ankle Rehab System Summary


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Contents: EBook
Author: Scott Malin
Price: $49.00

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Ankle Sprains

Cfl Ligament

Sprains are injuries to the ligamentous structures of the ankle. About 85 of ankle sprains involve the lateral ligaments medial and syndesmosis sprains make up the remaining 15 . Diagnosis is based primarily on history and physical examination, although radiographs are often helpful. Advanced diagnostic testing is not usually necessary. The family physician must be aware of the many potential pitfalls in the diagnosis of ankle sprain as well. Lateral Ankle Sprains The anterior talofibular ligament (ATFL), calcaneofibular ligament (CFL), and posterior talofibular ligament (PTFL) are the three ligaments of the lateral ankle (Fig. 30-37). The ATFL primarily restricts anterior motion of the talus within the ankle mortise the CFL restricts inversion and the PTFL restricts posterior translation. The most common mechanism of lateral ankle sprain is an inversion ankle injury. Inversion events with the ankle in a plantar-flexed position often lead to ATFL injury (Fig. 30-38), whereas inversion...

Sportspecific Training

The aim of rehabilitation is to restore a sport-specific function to, or above, pre-injury levels. In cricket it could be the perfect bowling action, in tennis the serve, in baseball the throw, in football ball control or in gymnastics landing. This type of training requires knowledge and understanding of the sport's specific demands and is usually prescribed and supervised by a sports therapist in close collaboration with a coach. After surgery or long immobilisation, this final stage of rehabilitation training is the most time-consuming and risky. In the final stage of rehabilitation after healing of an injury, functional training back to full performance level must be gradual, over a period of time that corresponds to the functional requirements of the muscles and the healing process of the underlying injury. This period could vary from a few weeks after a simple ankle sprain to a year after complicated knee surgery. The training has to be specific and, preferably, performed in a...

Syndesmosis Ligament Rupture

SYMPTOMS There is a severe sharp pain around the anterior tibio fibula junction, haemarthrosis and sense of ankle instability after a severe hyperflexion-inversion or eversion ankle sprain. A player cannot continue and will limp off the pitch. This injury is well-known in association with a fracture but occurs frequently in isolation in contact sports such as football and rugby.

Acute ligament injuries

A sprained ankle is the most common sport-related injury, mainly in the younger age groups 48-50 . The injury may occur as an athletic trauma or during activities of daily living. The reported incidence of ankle ligament injuries varies, mainly due to the profile of sporting activities in the population (Figs 6.1.8 and 6.1.9). The incidence in a high-risk sports population is

Case Study 1 Chronic Achilles Rupture

A 28-year-old policewoman injured her right ankle while boxing 3 months prior to presentation in the office. She was pursuing a career as a professional fighter at the time of injury. After reporting to the emergency room, she was diagnosed with a severe ankle sprain and placed into a stirrup ankle brace. At 6 weeks postinjury, she attempted to return to boxing, noting both pain and lack of push-off strength with her right lower extremity. She sought medical attention under her primary care physician who sent her to physical therapy for her ankle sprain. With no notable improvement at 3 months postinjury, she was referred to an orthopedic surgeon.

Acupuncture Tools of the Trade

Al is a truck driver for a large national company and typically puts in a 70-hour workweek. While he was out on his snowmobile, he felt his right ankle begin to ache. By the time he went to bed his right ankle was swollen, and by the next day it was difficult for him to put much weight on it without a lot of pain. He tried driving, but had to cut back and finally stop driving due to his pain. His diagnosis from his physician was an ankle sprain, but meds and physical therapy had not helped him so far. I used a combination of needle and electromagnetic acupuncture to reduce his swelling and ease the pain. Following the first treatment, the swelling had reduced considerably, and during the next three weeks I used Tui-Na massage and external herbal wraps and finally taught him home exercises and bio-magnetic treatments to do daily. His progress was consistent and he can manage any daily discomfort from overwork with his home treatments.

Pain Relievers Osteoarthritis Acetaminophen

Yet no benefit to ligament strength was shown 3 to 4 weeks after the injury.52,53 In human subject testing, the Kapooka Ankle Sprain Study is perhaps the best investigation of the effects of NSAIDs on ligamentous injury. Following treatment with pirox-icam, the military recruits in the study noted better pain relief and a faster return to physical training compared to placebo. However, the authors noted some evidence of local abnormalities such as instability and reduced range of movement with NSAID therapy.54 The cyclooxygenase-2 (COX-2) enzyme mediates production of prostaglandins involved in tissue inflammation, while prostaglandins that protect the mucosal lining of the gastrointestinal tract are made via COX-1 pathways. NSAIDs are nonspecific in their inhibition of COX-1 and COX-2. Therefore, a new class of medication, COX-2 inhibitors, was designed to specifically target the COX-2 enzyme and improve the side effect profile of earlier NSAIDs. Two studies of ankle sprains in human...

Tendon Tears and Ruptures

Peroneal tendon tears commonly occur in athletes and have the same mechanism as lateral ankle sprains, plantarflexion, and inversion. These injuries often are combined and must be considered especially when, after sufficient time for an ankle sprain to heal, complaints of persistent lateral ankle pain and swelling still exist. Bassett and Speer,7 in a cadaveric study, showed that peroneal tendon tears occur at between 25 and 15 degrees of plantarflexion as the peroneus longus impinges against the tip of the fibula and as the peroneus brevis impinges against the lateral Attritional or longitudinal tears in the peroneus brevis tendon may occur without any particular inciting event or in patients who have a history of recurrent lateral ankle sprains. These tears typically occur in the retromalleolar region. Sobel et al,8 in an anatomic study of 124 fresh cadavers, found 11.3 with attri-tional tears of the peroneus brevis tendons centered over the tip of fibula and within the groove these...

Soft Tissue Impingement

Soft-tissue impingement lesions in the ankle should be part of the differential diagnosis in patients with persistent symptoms following an ankle sprain. Most patients with a routine ankle sprain demonstrate considerable improvement with 6 weeks of conservative therapy.1 Patients without radiographic changes and symptoms of pain, catching, instability, swelling, stiffness, altered gait, or activity limitation should be carefully evaluated for soft-tissue impingement lesions. Soft-tissue impingement lesions can be classified based on the anatomic location. Most soft-tissue impingement lesions in the ankle occur in the antero-lateral aspect of the ankle joint. The Bassett lesion represents impingement of the anterolateral talar body on the distal fascicle of the anteroinferior tibiofibular ligament3,4 (Fig. 67-1). Patients with a Bassett lesion will have a history of an inversion ankle sprain and present with chronic anterolateral ankle pain with normal radiographs. Pain and or popping...

Dislocation and Subluxation

Acute dislocation or subluxation of the peroneal tendons is an uncommon injury that has a traumatic cause. Sport participation is responsible for about 92 of acute peroneal dislocations. Skiing has been reported to cause approximately 66 of the sports injuries.10 Peroneal tendon dislocation may be difficult to distinguish from an acute ankle sprain, but it is rare for both to occur simultaneously. The acute dislocation is caused by a sudden forceful dorsiflexion with simultaneous violent reflex contraction of the peroneal muscles. With skiing injuries, the mechanism has been described as forceful peroneal contraction occurring with sudden deceleration and ankle dorsiflexion as the ski tips dig into the snow. Acute injuries frequently exhibit ecchymosis, tenderness, and swelling over the lateral aspect of the ankle and may look similar to a high ankle sprain. Most patients are unable to describe the mechanism of injury, as opposed to lateral ankle sprains, where most are able to...

Clinical Features and Evaluation

Patients with isolated chronic lateral ankle instability typically presents with complaints of periodic giving way and a history of several previous severe ankle sprains. Although these intermittent episodes are typically associated with a brief period of pain and dysfunction, most patients with isolated instability are essentially pain free between episodes and do not experience mechanical symptoms. If pain is present between episodes of giving way, secondary diagnoses must be considered (Table 66-4).23 A complete physical examination of the ankle should include assessing the joint above (knee) and below (subtalar). Lower extremity alignment should also be assessed hindfoot varus predisposes the ankle to inversion injury. Hindfoot midfoot mobility should also be evaluated, as it is not uncommon for tarsal coalition to present as recurrent ankle sprain.

Chondral and Osteochondral Lesions of the Talus

Like soft-tissue impingement lesions of the ankle, chondral and osteochondral lesions of the talus will usually present after failed conservative treatment of a presumed ankle sprain. The clinical presentation will be similar to soft-tissue impingement lesions and may include pain, swelling, instability, or catching.8 The physical examination is usually nonspecific, and point tenderness over the lesion may be the only finding. A careful assessment of the lateral ligaments should be made since instability of these ligaments will have implications in the treatment of the talar lesion.1,9 Radiographic examination includes anteroposterior, lateral, and mortise views of the ankle. Stress views can be obtained if lateral ligament laxity is detected on physical examination. Lateral lesions result from inversion and dorsiflexion of the ankle causing impaction between the anterolateral talus and the fibula. The lesions are typically thin, wafer-shaped osteo-chondral fragments located over the...

Nature of sports injuries

As an example, studies from European team handball show that there is a high incidence of anterior cruciate ligament (ACL) injuries, especially among female players. Myklebust et al. 26 and Strand et al. 27 have found an incidence of 0.91 and 0.82 per 1000 player-hours for women during competition in Norwegian team handball, compared with 0.10 injuries per 1000 player-hours in soccer 28 . This means that the rate of ACL injuries in handball almost equals the rate of ankle sprains in volleyball 29,30 . Since one can predict a high frequency of future disability and functional impairment after an ACL rupture, an ACL injury is a much greater source of concern than an ankle sprain.

Indications and Contraindications for Surgical Reconstruction

Resonancia Magnetica Pulmonar

Fig. 10.4. (A) In this 43-year-old runner who had sustained an ankle sprain 9 months prior, MRI revealed an incomplete rupture of the Achilles tendon. (B,C) The gap was filled with hypertrophic scar tissue, which led to the clinical diagnosis of tendonitis Fig. 10.4. (A) In this 43-year-old runner who had sustained an ankle sprain 9 months prior, MRI revealed an incomplete rupture of the Achilles tendon. (B,C) The gap was filled with hypertrophic scar tissue, which led to the clinical diagnosis of tendonitis

Acute injury

After an acute ligament sprain of the ankle, compressive strapping is often recommended to control oedema (McCluskey et al 1976). Very few studies have been published to evaluate the efficacy of taping to achieve limb or joint compression, with Viljakka (1986) and Rucinski et al (1991) arriving at conflicting conclusions as to the effect of bandaging on acute ankle oedema. Two Cochrane reviews have helped in our understanding of the best approach for treating acute ankle sprains. First, Kerkhoffs et al (2002a) analysed results from 21 trials of acceptable quality. They provided clear overall evidence that it is better, in terms of return to work and sport, pain, swelling, instability, range of motion and recurrence of sprain, for patients to be treated with various ankle braces or supports rather than total immobilization. A second Cochrane review (Kerkhoffs et al 2002b) then tried to give some insight into the best type of brace to use after an acute ankle sprain. However, in nine...

Illness behavior

Your first thought might be that his behavior is simply the physical effect of his broken leg, but that is not the whole story. Suppose he only had a sprained ankle. If you knew this, you might wonder why he was lying in the middle of the road waiting for an ambulance. However, he was knocked down and must have had a terrible fright. His ankle may Now consider how two different patients cope with a sprained ankle. Let us suppose that each has a severe sprain with marked swelling and a lot of pain but no fracture or ligament instability. One patient will be completely unable to bear weight and will need crutches for a week or so. The other will laugh or be insulted at the very suggestion of crutches. Instead, he will insist on having the ankle strapped up so that he can try to get ready for an important game of football next weekend. They each have a similar physical injury, but what they do about it is very different. Now let us move on a year. Suppose that the man with the sprained...

Taping And Bracing

Athletic ankle taping can increase the ankle eversion moment (resistance to inversion) however, the protective benefits decrease over the initial 10 to 40 minutes following application.9 The application of tape or braces may change the orientation of the talocrural, subtalar, transverse tarsal joints, and first metatarsophalangeal joint, thereby influencing neuromuscular responses. Combining ankle taping or bracing and high top shoes can enhance joint protection, but it may also reduce perform-ance.10 Use of a lace-up ankle brace with low top shoes may provide optimal protection without adversely affecting performance. Ankle or foot taping may have both mechanical and proprioceptive benefits however, long-term use may lead to dependence and weakening of capsuloligamentous, musculo-tendinous, and osseous structures that are protected by the brace as the tissues may be shielded from both beneficial as well as injurious loads. Prescriptive taping for enhanced propriocep-tion and...


Swelling and tenderness are usually more precisely located than in a typical sprain. There is very little tenderness and swelling over the anterotalofibular or calcaneofibular ligaments, with tenderness more proximal than a usual ankle sprain. The lateral and medial malleolus must be palpated to rule out fracture, and the entire fibula must be palpated to rule out proximal fracture (Maisonneuve's fracture).

Anterior Drawer Test

After an ankle sprain, the anterior drawer test is used to evaluate the integrity of the ATFL and, to a lesser extent, the CFL. It is most useful in cases of suspected chronic ankle instability. Brostrom7 showed that this test's sensitivity was relatively low in the acute setting secondary to guarding. First, have the patient relax the affected extremity with the knee flexed. Then, stabi-


Several different methods of ankle taping have been described. Alternative methods include rigid or semirigid ankle braces, some of which give good external support to prevent ankle sprain and to protect ligament reconstruction. An effective and functional alternative to ankle tape is the air-stirrup, a non-rigid prefabricated shell with an inner lining of air bags. It has been shown to provide good protection by reducing the range of ankle motion. The air-stirrup can be recommended, especially during early tissue healing and full functional recovery (1-12 weeks after injury).