New approach to rehabilitation of ankle sprains

New approach to rehabilitation of ankle sprains Blog

Any strain can stretch or tear the supporting ligaments in the ankle. The resulting ankle sprain or sprained ankle quickly becomes painful and swollen. While initial focus is on reducing that pain and swelling, physiotherapy is necessary to fully rehabilitate this extremely flexible, load-bearing joint. All physiotherapy, however, is not the same.

Overcoming Two Key Challenges

Proprioception. The first key issue for ankle sprain rehabilitation is proprioception. For smooth, accurate movement, the brain must be able to understand what its body parts—particularly extremities—are doing. For ankle proprioception, the mind must be able to gauge an ankle’s functionality without resorting to actually having to watch the joint.

Strength. A second focus of ankle sprain rehabilitation is stabilizing the ankle joint by strengthening associated muscles. The goal is to not only recover joint use but also strengthen the area sufficiently to prevent a future ankle sprain.

Traditional Therapies Insufficient

Traditional therapies have yielded only a 50-50 chance of successful rehabilitation versus the recurrence of a sprain. These conventional approaches often rely on manual resistance, strength work and wobble boards. However, the physical exercises are often too generalized, overlooking the specialization necessary to

  •  fully rehabilitate an ankle and
  •  restore effective levels of body awareness and control in high-risk situations

New Concept for Ankle Sprain Rehabilitation

To both rehabilitate and prevent further ankle sprains, researchers and scientists at CEVRES Santé created the Myolux concept. It is a specialized approach to physiotherapy that blends strength with agility for improved neuromuscular control in a dynamic context.

  • Focus is on the subtalar joint, the bones in the heel of the foot that connect to the ankle. The ligaments and muscles stabilizing the ankle surround this joint and are key to both its strength and stability.
  • The tool used to exercise this specific area is a pair of articulators. These articulators are specifically designed to destabilize the rear of the foot while allowing the ankle joint to safely perform therapeutic exercises vital to a range of agile locomotion: from walking to running or changing direction, for example.
  • The strategy is to train, or reprogram, the brain to automatically and correctly
    • anticipate the foot making contact with a surface and
    • execute proper form to unload body weight

Detailed Assessment and Neuromuscular Ankle Rehabilitation

The Myolux concept’s articulators are uniquely designed to safely re-create demanding conditions that might otherwise cause an ankle sprain. The result is customized exercises that engage every aspect and layer of the entire joint and the neural pathways that control them:

  • ligaments,
  • tendons,
  • muscles,
  • joint capsules—sacs protecting synovial joints—and
  • tissues.

Through repeated exercise, the brain learns to rapidly identify potentially injurious or risky movements that occur in demanding situations. At the same time, secure yet challenging exercises with the articulators strengthen the muscles essential to stabilizing the ankle on all axes.

This concept of physiotherapy comprehensively embodies four key elements essential for optimizing fibular muscle strength:

  • Exercises focus specifically on the strength and agility of fibular muscles.
  • Exercises are active and in the standing position. Therapies correlate to the specific athletic situations likely to result in trauma.
  • Exercises incorporate resistance levels that are consistent with high-risk scenarios. The goal is for fibular muscles to be able to compensate for forces encountered at or exceeding full body weight.
  • Exercises are geared for versatility in rapid muscular response. Therapies address both eccentric and concentric modes of muscle contraction—muscle lengthening versus shortening while contracted.

A Solution for Dynamic Agility

This customized articulator approach conveys a rare combination of ability to

  •  heal
  •  improve performance and
  •  protect against future injury

Together, targeted proprioception and increased muscle strength can enhance the communication and coordination between mind and body.

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In this instance, an athlete was originally diagnosed with minor quadriceps muscle strain and was treated for four weeks, with unsatisfactory results. When he came to our clinic, the muscle was not healing, and the patients’ muscle tissue had already begun to atrophy.

Upon examination using MSUS, we discovered that he had a full muscle thickness tear that had been overlooked by his previous provider. To mitigate damage and promote healing, surgery should have been performed immediately after the injury occurred. Because of misdiagnosis and inappropriate treatment, the patient now has permanent damage that cannot be corrected.

The most important advantage of Ultrasound over MRI imaging is its ability to zero in on the symptomatic region and obtain imaging, with active participation and feedback from the patient. Using dynamic MSUS, we can see what happens when patients contract their muscles, something that cannot be done with MRI. From a diagnostic perspective, this interaction is invaluable.

Dynamic ultrasonography examination demonstrating
the full thickness tear and already occurring muscle atrophy
due to misdiagnosis and not referring the patient
to proper diagnostic workup

Demonstration of how very small muscle defect is made and revealed
to be a complete tear with muscle contraction
under diagnostic sonography (not possible with MRI)

image

Complete tear of rectus femoris
with large hematoma (blood)

image

Separation of muscle ends due to tear elicited
on dynamic sonography examination

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