 Good morning and welcome to Think Tech Hawaii. In my first episode of Movement Matters, I'm Christine Linders, a licensed physical therapist. I've been practicing physical therapy for over 23 years in California, New York, Connecticut and now in Hawaii in a variety of settings such as sports, orthopedics, neuro and on-site corporate platforms. I'm a board certified orthopedic clinical specialist, I'm certified in Applied Functional Science and I have my manual therapy certification. This is my show, Movement Matters. It's designed to bring you the most cutting edge and effective treatment strategies so you can help your body perform better, decrease pain and get back to doing the things that you love. Today's topic is ankle sprains. In the first part of the show, I'll be discussing how ankle sprains occur, what we can do to heal them fast and how to prevent another injury in the future and in the second half we'll be meeting Jessica, learning how she sprained her ankle and the critical exercises she needs to heal her ankle fast and prevent future injury and arthritis. Welcome Jessica. Thanks so much for having me, Chris. I feel so blessed to be here with you. Oh, and I'm so glad to have you. So Jessica and I work together and so it just so happened that she sprained her ankle a few weeks ago and it seems like everybody that I've been talking to lately has been spraining their ankle in beach volleyball at home walking down the street so I thought this was appropriate. So today we're going to be talking about ankle sprains. Ankle sprains in a study in 2016 I looked up in the New York Times comprise 45% of all athletic injuries and of all people athletic or not that suffer from an ankle sprain, 33% that's one third will suffer another ankle sprain in the future which puts them at risk for possible arthritis and more joint damage but worse as people injure their ankle over and over again, they tend to become a little less active over their lifespan because they have pain or they're afraid that they're going to lose their balance. So ankle sprains is a big deal, right? It is a very big deal. I mean I sprained it three weeks ago and I can't tell you I have been very inactive. I've been taking it easy. I've been babying it. I've been resting it. You know I've been doing the rice, you know, I've been resting, icing, compressing and elevating but as far as exercise go it was like how much is too much? What should I do? What shouldn't I do? And so I'm so glad to be able to have this chance to talk to you about it. I know and I also want to ask you has your ankle sprain or what you're feeling from it the last few weeks has it interfered with work or has work aggravated it? How has that been for you? Well work being on my feet as a licensed physical therapist assistant has when I'm on my feet throughout the day very active working with my patients. Yes, I've been wearing an ankle brace to help give me some of that stability that I feel like I'm lacking and I think you brought one here didn't you? I did. I actually brought one of my ankle braces so this is one that I've been wearing at work and so it has like these hard sides on it and so I've been wearing this one at work and then I have another one that just doesn't come up as high and doesn't have that portion on it but I still feel achy at the end of my day. Yeah, that's a problem right there with an ankle sprain is the length of time it takes to hurt but you need your ankle you need your foot you need to walk and I'm glad to see that you're wearing that because it is important to protect the joint and protect the ankle while it heals. So what happens when you sprain your ankle? I think for anyone that is out there that has sprained their ankle or may in the future it's important to know what to do when you're sprain your ankle. I have sprained my ankle so many times as a teenager I think I spent more time on crutches than I did playing sports which is something that I really loved so it's very important to go to your doctor or go to the emergency room or a urgent care center to get checked out you want to make sure you rule out a fracture because if you sprain your ankle and you happen to fracture a bone as well you're going to need some sort of different treatment maybe they will cast you maybe they'll put you in a boot maybe they'll give you crutches and make you not bear weight on it for a while in severe cases people have needed surgery. Right and I mean and again there's different severities of sprain and so sometimes you even need the boot or something with a sprain. That's right that's right so you go to the urgent care you or the emergency room you get your x-ray you rule out a fracture usually people leave on crutches with something similar to what you have an air cast and they let you know follow up with your orthopedic doctor in a week or two whenever you can get in and what I see when people finally get to my clinic is that nothing has been done in that gap of time from when they went to the emergency room to where they got to me so they've been resting and icing and elevating and compressing the rice principle the mnemonic and now they're swollen they haven't used it or moved it and they're a little worse off because of that so that's what I want to show is what to do in the gap from when you sprain your ankle to when you maybe would get to a physical therapist or get to me in the clinic and I find that this gap is so much what I wanted to know after I mean literally like within hours of spraining my ankle I wanted to know well what should I do because every patient that I've ever seen hasn't been in this acute phase that I was currently experiencing so I was like oh what do I do now that's right so the first thing that you should do is use some sort of light compression it could be an ace wrap or something to keep the swelling down I sit frequently and one of my other tips that I've given to people who have recently sprained their ankle when they were a friend of mine or a patient that happened to come in I was seeing them from something else is to heal it short the most common ligament I'll get back to that in a second the most common common ligament sprained is the anterior tallofibular ligament we call it ATFL and if we go to image number one it shows a picture of all the ankle ligaments and if you could see the one that's in the front that's the most commonly torn or sprained ligament in the ankle and so if you see the the bottom of those bones and the upright of the lower leg it's kind of forms a right angle and so that's what I mean by heal it short so when you point your foot that ligament is tension is put on that ligament and that's why it typically is torn because people tend to roll their foot out to the side and it's like their foot is pointed and rolling inward right so when you are in that gap from when you've gone to the emergency room and then you're coming into the physical therapist or your orthopedic doctor you don't want to point your foot you want to do what I call heal it short heal it in that right angle and that's where the brace such as you have or uh ace wrap could help to help you heal it short don't point your foot on purpose everybody wants to because they want to get range of motion but there's ways to move your foot just gently up and down or a little bit up and a little bit to the side without having to point your foot and potentially re-tearing that ligament or tearing the vital scar tissue that is forming in that ligament baby scar tissue we don't want to mess it up that's right that's right and so the other thing that is safe to do that I tell people is doing toe curls if we skip to image number six then we could see a little foot doming which is curling your toes like that that's completely safe to do early on you're engaging all the muscles on the bottom of your foot that get weak when you're either not weight bearing because you're on crutches or you're limping around because your ankle hurts or if you're in a boot you also lose strength in other areas that weren't affected by the ankle sprain so toe curls is another easy thing that you can do which was awesome because you told me about when we met last week and you told me to start doing some toe curls which I hadn't really thought about I was thinking more range of motion and then a little bit of strengthening and so you were like yeah get those toe curls in and I started off and I was doing my toe curls with a towel yeah that's a great idea I noticed that I had a really hard time gripping that towel but now just like three days later I'm I'm doing what I can see progress already that's fantastic yeah so Hawaii do your home exercise program that's the important thing do these little exercises it makes all the difference in the world even while you're watching TV that's a great time to do coat toe curls because you're not thinking about anything right so one of the things that I find puts someone at risk for the chronic ankle sprains the one I'm telling is 30% of people that have sprained their ankle before will sprain it again is they need to get the function back of this critical muscle called the peronius longest so if we go to image number two it shows a picture of a foot and it shows a lot of different tendons and tendon sheaths but the one we're focusing on is the one that's behind the ankle bone if you run your hand down your leg there's that bump right in the middle of your leg right next to your foot these tendons run right behind that ankle bone and their job as a muscle when your foot is rolling inward or you're going side to side is to contract to prevent your foot from going in too far so they're a dynamic restraint for an ankle sprain whereas that ligament the anterior telophibular ligament the mouthful is a passive restraint it's a static restraint non-stretchy tissue but this critical muscle the peronius longest is very important in getting back its function so that you don't become what's called a chronic ankle sprainer or have chronic ankle instability all right well and just really quick so like that area that you're talking about that's right behind the ankle that's exactly where I feel achy at the end of my work day that's exactly where I feel it so that's an exercise and a muscle that we need to train in Jessica so that she doesn't sprain her ankle again so now let's go over to Jessica how did you sprain your ankle okay so I feel really silly but I sprained it twice within four days of one another so the first time was on a saturday I was out playing tennis with my husband and I mean yeah we're just you know hitting the ball I say we're playing tennis it was you know very much just you know trying to hit the ball at each other but anyway so I was like running to my right side to reach out and hit the ball and my foot stopped and my body didn't and so that ankle rolled and I fell down and so the next thing I knew I was on my heiny and so but then after I got I was able to get up and stand and walk and I even felt like I could play a little more tennis so I didn't continue on just very light tennis I didn't really do any running after the balls after that point but definitely I still continued with my activity and then the following Wednesday I was in my house getting ready to warm up for some exercises and I was doing some side shuffles and so as I was side shuffling to the right again it was like my foot stopped and my body didn't and again I ended up falling over and this time it felt so much worse than it did on the tennis court and I could almost immediately feel swelling within just a few minutes I saw bruising I mean I was immediately just icing and sitting on the floor and the workout was done oh no so the first the first time you sprained it you're able to get back and play tennis did you did you get some good shots uh maybe maybe no he was being really nice and trying to hit the ball right to me okay that's good that's right in that dead zone right he's a great husband and that he just really helps me out there whatever I need help that's fantastic well in that instance thanks to your Peroni's longest muscle that we were talking about you didn't actually injure the ligament you're able to get up and keep going but it probably put that muscle a little bit at a disadvantage so now fast forward you're doing a workout in your living room you're moving to the sideways and you actually did damage that ligament and that's what we're talking about with the chronic ankle sprains and that's the point I want to make to the viewers today is that you could have a small little ankle roll and you brush it off and you're fine and then have another one soon because something could not be functioning well in your foot after the first minor injury that you had so that's that's important that's important so when jessica we met last week for dinner and I said okay let me look at this ankle sprain of yours and so if we go to picture number three what I like to look at in someone the first time I see them after I take the history is what they look like when they walk and I know this is a difficult picture to see but her right foot if you drew a straight line from her big toe up is more turned out to the right and so that's the injured foot that she has is the the foot on the right side so I watch people walk because they've been limping I'm looking for abnormal mechanics that maybe led them to have a sprain if it wasn't an injury or if they were more prone to a sprain and so if you can see that picture it's really subtle and so that's the little things that I look for in the clinic that I can correct to help her better so a correction for this if this is you is to turn your foot in you want to look down at both of your feet and turn them so they're more straight or at least to match the good side that way you get the proper functioning of all the muscles right and so we notice that we notice that right away so if you go to picture number four it's from the back and so if you look from the back of Jessica you can see her right foot there's a little bit more of an angle to that messy line that I drew I'm sorry about that but you could see a little bit more of her pinky toe on the side and that's another indication that somebody is walking with their foot out and we need to have them turn it in just a touch in order for everything to fire all the way up the leg to her glute and let me tell you when you drew the lines and took the pictures and showed me these pictures I was just floored and I loved seeing the pictures that's fantastic because that's the thing I can't see on myself that's fantastic that's why you go see a physical therapist exactly we're going to take your break where I'm talking with Jessica Ellison this is movement matters we'll be back for more on what to do to heal your ankle sprain fast and get back to doing what you love hi I'm Rusty Kamori host of Beyond the Lines I was the head coach for the Punahou Boys varsity tennis team for 22 years and we're fortunate to win 22 consecutive state championship this show is based on my book which is also titled Beyond the Lines and it's about leadership creating a superior culture of excellence achieving and sustaining success and finding greatness if you're a student parent sports or business person and want to improve your life and the lives of people around you tune in and join me on Mondays at 11am as we go Beyond the Lines on Think Tech Hawaii aloha aloha y'all my name is Mitch Ewan I'm from the Hawaii Natural Energy Institute and I'm the host of Hawaii the state of clean energy we're on every Wednesday at four o'clock and we hope that we have interesting guests who talk to us about various energy things that are happening in Hawaii all the way from PV to windmills to hydrogen most of my heart electric buses and electric vehicles so please dial in every Wednesday at four o'clock on Hawaii the state of clean energy aloha welcome back to Think Tech Hawaii this is Movement Matters I'm Christine Linders a physical therapist this is Jessica Ellison a physical therapist assistant and today we are talking about ankle sprains so we're going to pick back up we left off Jessica sprained her ankle twice in a week and we're talking about why that happens and how you're going to prevent a future ankle injury so what we're talking about right now is Jessica came and we looked at her foot so this is what I saw in my exam so if we go to picture number three we'll see that her foot is just turned a little bit further out on the right that's one of the biomechanical faults that I like to look at when I'm working on someone because you can correct something so small to make a huge difference and that is an abnormal mechanic if we go to picture number two it's from the picture number four I apologize picture number four it is from the back of her ankle and you could see the ankle on the right where I drew these little lines on her ankle there's an abnormal angulation to her heel and the toe out influence which is what I noticed from the front is very subtle but you can look over towards her pinky toe and you could even see the ring toe there so that's telling me she's walking with her foot turning out which indicates that the muscles in her lower leg and even all the way up to her glutes aren't firing properly and I don't want her to have a future sprain right neither do I please let's prevent that for you because you like to walk and I know I love to walk we did diamond head together yes when I first got to Hawaii and I loved that we loved it and we keep talking about going on more hikes and my husband and I love we living in downtown Honolulu here we love walking around to all the different restaurants and shops and things like that so walking is vital in my life right now it's wonderful and I I want you to be able to do it you want to be able to do it yeah this is paradise that we live here in Hawaii and we want we're here because we want to enjoy those things right absolutely okay so let's look at picture number five this is something else I like to look at when I'm seeing someone with a lower body injury and that's their single leg balance so Jessica had an injury on her left leg in the past so I tested that first and she was a little what I call in technical terms wobbly but when I got her on her right leg as you see here it's the fact that her upper body is leaning the other way that shows me something's wrong as well in addition to her being wobbly on that ankle so I like to look at single leg balance because those little ligaments in our ankle they contain organs that give your brain information about how fast the joint is moving how far a joint is moving and if it's in danger and that's what would elicit that cronious longest muscle to fire to say hey my ankle is moving too far too fast for too much range I need to fire that muscle and try to stop them from spraining their ankle and that's why I look at the single leg balance right because we want to fire up those proprioceptors we want them to work properly because those are the things that give our brain information about where we are in space right it's so many things firing at a time and so much to happen and so it is it's definitely training so now I have to ask you because in the clinic we have people stand on those foam pads and the bozu balls which are those half things have you stood on that I stood on a bozu ball very briefly I actually pulled mine out of the closet and pumped it up very good very good on Sunday and so um yeah I stood on it very very briefly I decided not to really uh do too much without um knowing exactly what I shouldn't shouldn't be doing I wanted to make sure that I I cleared it with my my PT that's right that's what I'm so glad to hear you say that because I think what people sometimes can do with an ankle sprain is do a little bit too much and maybe think it's not as severe especially when you've gone to the doctor you don't have a fracture and you think oh it's a sprain it doesn't sound that bad it feels that bad but it doesn't sound that bad so it is important to know how to rest it heal it short rest ice compression elevation that's the rice for anybody who doesn't know so very good what I felt though is that it was like I had enough knowledge to get me in trouble like I knew enough okay we want to get flexibility we want mobility and then we want strength and so I was just like well I can walk on it and so actually um after that Wednesday spring Thursday I actually went and uh walked in the pool so my darling has a pool and I actually went and did aqua walking and so I walked forwards I walked backwards I did side stepping for 30 minutes oh and I was hurting the next day I was hurting that night and so yeah so I I needed you right away I apologize so I think what you want to tell everybody is so awesome like this gap period of what I mean so this is just so important and I feel so passionate about this you know that we as we're giving some knowledge but make sure that you use this knowledge wisely that's that's so perfect and that reiterate the heal your tendon short do the toe curls keep your ankle safe wear the ace wrap wear the ankle brace that jessica brought in show that has some stability on the sides because you know your proprioceptors aren't going to be firing because you've torn that ligament or you've injured that ankle all right so that brings us to the treatment what do we do so number one I correct how people walk I don't want you to limp I want you to turn your foot straight so it matches the other one if you're a person that's both toeed out you look down and you make them look the same okay you turn the injured one to match the other one that's important because we all have different body structures same thing goes with your pigeon toad and you're walking with one foot out you have to try to match right your symmetry symmetry is key that's the word absolutely symmetry symmetry that's simple to correct and most people will tell me wow I when I turn it in I feel that I'm really turning it way in but when I look down like you said with the pictures when I look down my foot's actually straight so go easy wear your ankle brace to support it because you definitely want to prevent injury but start moving better so if we go to picture six again that's the toe curls that's the easiest thing to do I tell people curl your toes like you said Jess on the sofa curl them stand on one foot curl them while you're watching dishes curl them while you're sitting curl them while you're having dinner curl your toes curl your toes curl your toes you need those intrinsic muscles all along the arch of your foot so that while you're healing from your ankle sprain you don't get things like plantar fasciitis or achilles tendonitis because you still need six weeks to heal that ligament right you have to keep it safe for at least that period of time so that you heal it short while you're doing toe curls and while you're doing number seven which is TheraBand E version I like to add that as early as I can as long as there's no pain so this green band is a little tough it's a moderate it's a moderate one it was the one that you have so yellow band with a TheraBand brand is the easiest and sometimes what I'll have is in this image it looks like I'm moving my foot out to the side but what you can do in an early ankle sprain is just hold your foot straight up so it's a 90 degree angle with the band and then just hold your foot into the band so that's what's called an isometric contraction like you're not moving yeah you're just not letting the band pull your foot you're activating it just enough to pull it it keeps it safe it activates the peronis longus it activates your anterior tibialis on the front it activates all the muscles that you need and even better the isometric contraction does what I've called a pump and drain I think I heard that somewhere before I call it the pump and drain so you just contract and let it relax contract and let it relax and that works on the area below the skin the fascia where all the scaffolding is underneath your skin and all the fluid travels under our body so as you contract and relax all that fluid goes out so it helps with edema reduction it helps with the reorganization of the scar tissue and the collagen that is rushing in there because you have an injury yeah and I know that it works because the last time I blew out my ankle it was probably four or five years ago I was in a beach volleyball tournament a girl fell under the net I won the point though and I stepped and my whole leg rolled over on her foot I heard a crack and I had I was right in the middle of the summer in Connecticut I had volleyball tournaments every weekend both days driving down to New Jersey and I had a stick shift and it was my right ankle so I did the pump and drain I took the week off from work because I'm standing all day long I got myself a boot I wrapped it at night I kept it in that position to heal it short and I did from the beginning toe curls I did pump and drain and when we talk about pressing your leg out in the early stages you're pressing a nickels worth of force just enough to engage the muscle just enough just enough right and then as you go through that day one two three week four week five then you're really pushing because it's pain-free the muscles are strong pain is your guide don't do it if it hurts you have to have little small movements make all the difference in the world right oh absolutely I totally agree but I am glad to hear that you got the point I did get the point this girl was a my friend that I'm a volleyball partner and I call her the olympic she was Polish I'm Polish as well beach volleyball player she had us 10 to 0 jump serving us off the court we finally got the pass set it up hit the ball they dug it and it was coming over the net on one and I went up to block it and she came up with me but I won the joust but I lost my ankle my ankle lost the joust I won the joust okay so let's look at image number eight so this is important right now and it's stretching your calf what happened okay great so this is going to stretch your calf and why we do this is we want to make sure that you have the adequate ankle range of motion it's safe you're not straining the ligament that's your gastrocnemius and your soleus on the back and oftentimes people from limping or that bone that's right underneath your lower leg bone will get pulled a little bit forward when you tear that ligament so you want to make sure you have enough range for it to sit back where it needs to be and then picture number 10 this is working on the other muscle picture number 10 is working on balance so this model has very good balance her ankle is completely healed so I often tell people hang on to a surface put your hand on the surface pick the other foot up and then just tap your hand on and off so that you can work on balance yeah and be safe because you still need to protect your ankle you can also put the brace like Jessica showed your ear cast early on if it doesn't hurt and work on your balance right away you're not going to harm your body right working on balance use pain as your guide and to balance on a stable surface before I go to that bowsuit ball yes start with a stable surface do it on your floor a hardwood floor all right so I hope that Jessica and I helped you all learn more about your ankle and how to keep it healthy how to rehabilitate it if you've injured it especially if you're in that gap and please go see a physical therapist this is movement matters I'm christine lenders this is jessica ellison thank you so much thank tech for having us on today thank you so much this was wonderful to be on this was awesome I just can't wait to hear how everyone loved it me too me too we'll have to provide that for everybody in our next show exactly