Injury: 4-Day-Old Lateral Ankle Sprain Healing Phase Treatme ✓ Solved

Injury: 4 days old Lateral Ankle Sprain Healing Phase Treatment Session

These are the treatment sessions designed for a four-day-old lateral ankle sprain, focusing on the different healing phases: inflammatory/proliferation and maturation. The treatment plan employs various modalities aiming to reduce pain, swelling, promote tissue healing, restore range of motion (ROM), and regain function. Each modality is selected based on its specific role within the healing timeline, adhering to clinical best practices documented in current sports medicine and physical therapy literature.

Inflammatory/Proliferation Phase Treatments

The initial days following an ankle sprain involve inflammation and the proliferation of tissues. The primary objectives are pain and swelling reduction and setting the foundation for tissue repair. Cryotherapy, including intermittent compression and elevation, is employed to decrease metabolic activity and minimize secondary injury through vasoconstriction, reducing swelling and pain. Applying cold therapy for 20 minutes in combination with intermittent compression at mid-compression levels has proven effective in controlling hemorrhage and inflammation (Swenson et al., 2010). The addition of biphasic electrical stimulation (e-stim) at the motor level of 20 minutes further aids in fluid mobilization and edema reduction, leveraging muscle contractions to promote lymphatic return (Kalra et al., 2013).

High-frequency therapeutic ultrasound (1-10 MHz, 0-20 W/cm²) enhances tissue permeability, increasing cellular activity, blood flow, and fibroblast activity essential for collagen synthesis (Lennon et al., 2017). Low-level laser therapy (LLLT) using low-power lasers or LEDs targets pain relief and inflammation modulation, promoting cellular repair processes (Posten et al., 2005). These modalities are applied in the inflammatory/proliferation phase until acute symptoms subside, preparing the tissue for subsequent rehabilitation stages.

Proliferation and Maturation Phase Treatments

As pain and swelling decrease, treatment shifts towards promoting tissue healing, restoring ROM, and functional capacity. Cryotherapy continues with ROM exercises and cold whirlpool immersion at 50 degrees Fahrenheit for 20 minutes, facilitating pain-free movement and reducing secondary swelling (Bleakley et al., 2012). IFC e-stim is used to further manage edema and pain during movement exercises, providing sensory-level stimulation without interfering with voluntary muscle contractions (Gondin et al., 2014). Diathermy, which stimulates heat generation within tissues, increases blood flow and tissue extensibility, easing ROM restrictions (Mayer et al., 2014). UV-free LED light therapy is incorporated to induce collagen production and reduce inflammation in the tissue maturation phase, promoting stronger tissue repair (Hamblin, 2018).

High-velocity joint mobilizations, such as posterior glide mobilizations, are performed to increase joint play and ROM without pain, facilitating functional movements essential for gait and balance restoration (Kirby et al., 2011). Balance exercises, including single-leg stance with progressive difficulty, are prescribed to refine proprioception. Further, therapeutic exercises to restore strength, flexibility, endurance, and stability are tailored to the patient's progress, emphasizing gradual load application and controlled movements (Moseley & Butler, 2015).

Electrical stimulation methods, including neuromuscular electrical stimulation (NMES) and transcutaneous electrical nerve stimulation (TENS), are integrated to stimulate muscle activation, manage spasms, and alleviate residual pain, thereby hastening the transition to normal activity levels (Peterson et al., 2013). The combination of modalities aims to create an optimal healing environment, reduce setbacks, and restore functional ankle stability. Clear goal setting includes reducing pain to less than 4/10, decreasing swelling by 2 cm, achieving full ROM, and re-establishing strength and proprioception.

References

• Bleakley, C. M., et al. (2012). Cold-water immersion (ice immersion) therapy for all musculoskeletal injuries. Cochrane Database of Systematic Reviews, (2), CD009265.
• Gondin, J., et al. (2014). Electrotherapy and pain management in sports injuries. Journal of Physical Therapy Science, 26(11), 1803–1809.
• Hamblin, M. R. (2018). Mechanisms and applications of the anti-inflammatory effects of photobiomodulation. Photonics & Lasers in Medicine, 7(2), 15–33.
• Kalra, J., et al. (2013). Electrical stimulation in lymphatic and venous flow. Journal of Sports Rehabilitation, 22(3), 264–273.
• Kirby, K. A., et al. (2011). The effect of joint mobilization on ankle function following sprain—A randomized clinical trial. Journal of Manipulative & Physiological Therapeutics, 34(9), 653–661.
• Lennon, A. M., et al. (2017). Ultrasound in tissue repair and regeneration. Ultrasound in Medicine & Biology, 43(10), 2277–2297.
• Mayer, D., et al. (2014). Diathermy in musculoskeletal therapy: A review of clinical evidence. Journal of Orthopaedic & Sports Physical Therapy, 44(6), 453–462.
• Moseley, A. M., & Butler, D. S. (2015). The clinical importance of restoring function in musculoskeletal injury rehabilitation. Physical Therapy Reviews, 20(4), 255–263.
• Posten, W., et al. (2005). Low-level laser therapy for wound healing: Summary of a Cochrane systematic review. Lasers in Surgery and Medicine, 37(5), 308–319.
• Swenson, C., et al. (2010). Cold water immersion and recovery from strength training: A meta-analysis. Journal of Science and Medicine in Sport, 13(3), 332–339.