Ligamentous sprain

Ligamentous sprain treatment

which ligament is affected in an inversion trauma of the foot ?

A ligamentous sprain is frequently seen at the lateral aspect of the foot or at the medial aspect of the knee.
By interpreting the test of our clinical examination we can determine exactly which structure is at fault.

A general principle which is paramount here is that mobilization gets the better of immobilization.

Ligamentous sprain (2)

1. Acute sprain

To reduce the post-traumatic inflammation : deep friction or triamcinolone (follow RICE for the first 5 days).
To prevent the formation of adhesions, deep friction and progressive mobilization.

For an acute lesion of the medial collateral ligament at the knee and the lateral ankle ligaments (anterior talofibular, calcaneocuboid and calcaneofibular ligaments) we proceed as follows :

progressive deep friction : 30"-3'-5'-7'-10'/session (we need to be very gentle in the acute phase in order not to make it worse)

progressive mobilization, without causing any pain

marching/proprioceptive exercise.

2. Chronic sprain

Under the analgesic influence of the deep friction, adhesions are ruptured by manipulation ; the patient maintaines the new range of movement by incorporating a home exercise program.

Exercises ?

As described above, the main treatment always includes movement as well in an acute or a chronic lesion. With acute lesions we have to be careful not to move too much in the first 5 days. With chronic lesions it is possible that during the first days of treatment, we provoke an increase of symptoms : this is a normal reaction for a chronic lesion which has not healed appropriately ; the healing mechanism is re-triggered again.

The therapist provides specific movement by using deep transverse friction.
This happens an average of 3 to 5 times per week. It is imperative for a good healing that the patient, in between treatment sessions, carries out some home exercises to further optimize the tensile strength of the new scar formation. Such exercises are also clearly described by McKenzie.