Lateral Ankle Sprains

Ankle Stability and Movement Coordination Impairments

Ankle sprains are a very common injury among the younger and physically active population. It is important to know how to properly rehab an ankle sprain to help prevent another one from reoccurring. Look below for some things to consider!

If you do not know the common clinical findings no problem! Click here

Anatomy

Image via Complete Anatomy 2018 by 3D4 Medical

Common Movement Fault

For lower extremity injuries it is important to watch how your patient walks, this can tell you a lot about their movement patterns. A common movement fault seen in people who sprain their ankle is a lack of dorsiflexion. While lack of dorsiflexion is not the only factor that can contribute to a risk of an ankle sprain. If the ankle is stiff and is unable to move into full dorsiflexion it will try and gain that range by taking the path of least resistance. Which could lead someone to roll over their ankle causing a lateral ankle sprain.

Special Tests

The anterior drawer test can be used to assess anterior talofibular ligament integrity. This tendon is commonly injured with lateral ankle sprains. Make sure to assess the uninvolved side before assessing the involved side in order to see what is “normal” for the patient. (Click image to watch 1-2 minute video)

Treatment

After your patient has moved through the acute phase of their injury it is important to gain full range of motion of the ankle. This can be achieved through posterior talocrual mobilizations. Grade I and II mobilizations can be used to reduce pain where Grade III and IV mobilizations can be used to help increase ROM.

Therapeutic Exercise

Balance is very important in the treatment of ankle sprains in order to help the ankle regain proprioception and prevent future ankle sprains. (Click image to watch 1-2 minute video)

Plantar Fasciitis

Heel pain

Plantar fasciitis is one of the most common foot conditions seen in the clinic. It commonly presents with pain with the first steps in the morning or pain after standing for long periods of time. Look below for some things to consider!

If you do not know the common clinical findings no problem! Click here

Anatomy

      Image via Complete Anatomy 2018 by 3D4 Medical

Common Movement Fault

For lower extremity injuries it is important to watch how your patient walks, this can tell you a lot about their movement patterns. A common movement fault seen in people with plantar fasciitis is a lack of dorsiflexion. Force is not evenly distributed through the foot when the ankle does not move through it’s full range of motion. (Click image to watch 1-2 minute video)

Special Tests

The windlass test is a key test to perform when evaluating someone who you suspect has plantar fasciitis. This test is very specific and can rule in the pathology. Pulling the big toe back puts the plantar fascia on stretch and should reproduce the patients pain. (Click image to watch 1-2 minute video)

Treatment

Gaining full range of motion of the talocrural joint is important to achieve to help distribute the ground reaction force as it moves through the body. This can be achieved through posterior talocrual mobilizations. Grade III and IV mobilizations can be used to help increase ROM.

Therapeutic Exercise

It is important to have your patient work in gaining dorsiflexion range of motion at home if you are also working on it in the clinic! This is an example of one of many stretches that can be used to help gain dorsiflexion range of motion. (Click image to watch 1-2 minute video)

Clinical Pattern Recognition: Knee Pain

From anatomy to discovering the patient!

• Prevalence of articular cartilage pathologies is reported to be between 60% and 70%
• Injuries to the menisci are the second most common injury to the knee
• Approximately 80,000 to 250,000 injuries occur to the anterior cruciate ligament (ACL) per year in the United States, with about 100,000 ACL reconstructions performed annually, the sixth most common orthopaedic procedure in the United States.
• Two of the most common multiligament knee injuries involve the MCL and the ACL, and the posterolateral corner (PLC) and the ACL or the PCL.
• • Approximately 70% of all ACL injuries are noncontact in nature
• 95% of patients with PCL injuries have associated ligamentous injuries in the ipsilateral knee
• LCL injuries usually are part of more extensive injuries that involve the posterior lateral corner

See more prevalence information in the Clinical Pattern Recognition: Orthopaedics app here

Meet the 8 common Knee pain patients from the Knee Mobility Deficits Clinical Practice Guidelines!  And Knee stability and movement coordination impairments Clinical Practice Guidelines + More!

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Clinical Pattern Recognition

Click on the pain pattern to learn about the patients and develop your clinical patterns

1.     Knee Osteoarthritis- Knee pain and mobility deficits (Watch 1 min video)

2. Hamstring strain- Knee pain and muscle power deficits (Watch 1 min video)

3.  Iliotibial band syndrome – Lateral knee pain (Watch 1 min video | Step-by-Step Guide)

4. Medial collateral ligament sprain- Knee stability and movement coordination impairments (Watch 1 min video | Step-by-Step Guide)

5. Meniscal tear- Knee pain and mobility deficits (Watch 1 min video | Step-by-step Guide)

6. Patellar tendinitis/tendinosis- Knee pain and muscle power deficits (Watch 1 min video | Step-by-Step Guide)

7. Patellofemoral pain syndrome- Anterior knee pain (Watch 1 min video)

8. Pes anserine bursitis- Medial knee pain (Watch 1 min video)

SOURCES:

Logerstedt, D. S., Snyder-Mackler, L., Ritter, R. C., Axe, M. J., & Godges, J. J. (2010). Knee Stability and Movement Coordination Impairments: Knee Ligament Sprain. The Journal of orthopaedic and sports physical therapy, 40(4), A1-A37. doi:10.2519/jospt.2010.0303.

Logerstedt DS, Snyder-Mackler L, Ritter RC, Axe MJ. Knee pain and mobility impairments: meniscal and articular cartilage lesions. J Orthop Sports Phys Ther. 2010;40(6):A1–A35. doi:10.2519/jospt.2010.0304.

Iliotibial (IT) Band Syndrome

 Lateral Knee Pain

Image via PhysioU

Is your patient presenting with lateral knee pain potentially related to a recent increase in frequency of sport or physical activity? If lower extremity biomechanics are subpar, the iliotibial (IT) band may be the source of tissue irritation!

For more clinical findings click here!

Anatomy

Image via Complete Anatomy by 3D4 Medical

Special Tests

The Ober’s test is commonly used to assess the length or stiffness of the IT band! (Click image to watch 1-2 minute video)

Treatment

If pathological tension is present in the tensor fascia latae (TFL) or in the IT band, soft tissue mobilization via foam roll can be beneficial! (Click image to watch 1-2 minute video)

Therapeutic Exercise

Rehabilitation programs should address both tissue source and the underlying mechanisms causing tissue pathology. In the case of IT band syndrome, a common mechanism seen is a femoral adduction/internal rotation movement fault. Assess and treat up and down the chain!

 (Click image to watch 1-2 minute video)

Anterior Cruciate Ligament (ACL) Sprain

Knee Stability and Movement Coordination Impairments

If a patient presents to clinic with a history of an audible “snap” or “pop” that potentially occurred during a sporting event; followed by complaint of knee instability and difficulty with weight bearing they may have sprained or torn their ACL!

For more clinical findings click here!

Anatomy

Image via Complete Anatomy by 3D4 Medical

Special Test

·      As we all know, one test is not enough to completely rule in or rule out potential pathology; however, the specificity of the Lachman test (94) makes it an excellent test to help rule in ACL pathology!    (Click image to watch 1-2 minute video)

Treatment

Treatment of ACL injuries depends on whether or not the patient undergoes surgical intervention along with their prior level of activity and prospective level of activity post injury. Quadriceps strengthening tends to be necessary in both cases; in fact quadriceps strength is the highest predictor of returning to  full activities of daily living in those who underwent ACL repair! (Click image to watch 1-2 minute video)

Therapeutic Exercise

Once full range of motion has been achieved and adequate lower extremity strength and motor control have been established via protocol progression, the next step for patients who plan to return to more vigorous activity would be implementation of plyometric/reactive training. Single limb hop testing can also double as therapeutic exercise! (Click image to watch 1-2 minute video)