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Sprain

  • What is it?
    • A sprain, also known as a torn ligament, is an injury resulting in the stretching or tearing of ligaments within a joint.
  • Cause
    • A sudden movement abruptly forcing the joint beyond its functional range of motion.
  • Classfication
    1. Grade 1 ; Midl or first degree sprain
      • Overstretched ligaments
      • No joint instability or No decreased range of motion of the joint
      • The person can continue with the activity with some discomfort
    2. Grade 2 ; Moderate or second degree sprain
      • a partial tear of the affected ligament
      • moderate swelling, tenderness, and some instability of the joint.
      • Difficult to continue the activity due to pain
    3. Grade 3 ; Severe or third degree sprain
      1. a complete rupture or tear of the ligament.
      2. severe joint instability —> Joint dislocation
      3. pain, bruising, swelling
      4. Cannot continue the activity due to severe pain
  • Stages of healing and Treatment
    1. Acute stage (0~3 days)
      1. Symptomes
        • edema, pain, restrictive ROM, color chage(Red, black or purple bruising), hematoma, heating sensation
        • Muscles spasm
        • Sympathetic nervous system firing : Nervous, increase heart rate, blood pressure increase, sweating
      2. Test
        • AF ROM
        • Most of the tests are contraindicat to prevent further tissue damage
      3. Treatment
        1. RICE : Rest, Ice, Compression, Elevation
        2. MLD(manual Lymphatic Drainage)
          • To decrease Edema
          • Towards to the heart
          • Only proximal to the injury —–> Never perform MLD to the distal of the injury)
        3. GTO techniques : GTO, O&I
          • Reduce the spasm, not to remove the spasm : because the spasm muscles protect the injury site
        4. Effleurage and petrissage
          • To increase local circulation —> To increase drainage and venous return
          • To reduce pain and hypertonivity
          • Only work on proxiaml to the injury —> Never perform MLD to the distal of the injury)
        5. ROM
          • Injury joint : Active Free ROM
          • Proxima joint : Mid range Passive Relaxed ROM ( To maintain ROM and to increase lymphatic drainge)
        6. Contraindication : On-side work, distal work
      4. Remedial exercise
        1. Grade 1 or 2
          1. Pain – free active free ROM of the paroximal and distal joints to maintain the range of motion
          2. If there is no secondary muscle strain present, or there is grade 1 or 2 muscles stain only- –> submaximal, pain free isometric exercise to strengthen the muscles that cross the sprained joint.
        2. Grade 3 : contraindication
    2. Early Subacute (3days ~ 12 days), Late Subacute( 13 ~ 21 days)
      1. Symptoms
        1. diminish heating sensation
        2. diminish hematoma. if present
        3. Cololr : brown, yellow and green
        4. adhesion
        5. muscle tightness and hypertonicity
      2. Test
        • AF ROM
        • PR ROM : affective joint tested last
        • AR isometric testing
        • Special tests can perform these stages
      3. Treatment
        1. Early Subacute
          1. Contrast hydrotherapy
            • increasing blood circulation
            • The time of heat is 3 times longer than cold
            • The end must always finish with cold
            • Early subacute : warm —> cold
            • Sprains with casted : avoid hot hydrotherapy proximal to the cast to prevent congestion under cast
          2. MLD(manual Lymphatic Drainage)
            • To decrease Edema
            • Towards to the heart
            • Only proximal to the injury —–> Never perform MLD to the distal of the injury in the early subacute stages
          3. GTO techniques : GTO, O&I
            • Reduce the spasm
          4. Effleurage and petrissage
            • To increase local circulation —> To increase drainage and venous return
            • To reduce pain and hypertonivity
            • On-site work in indicated from the early subacute stage with gently stroking, vibration and fingertip kneading
            • Distal work for the early subacute stage include stroking and muscle squeezing only
          5. Trigger points
            • Muscles slowly becomes tight and develops trigger points
            • injury site itself are now treated directly
          6. ROM
            • Mid range PR ROM : proximal and distal joints to maintain the succussive action and to help increase lymphatic drainage
          7. Remedial exercise
            1. Pain free AF ROM : affected and distal joint
        2. Late subacute
          1. Contrast hydrotherapy
            • increasing blood circulation
            • The time of heat is 3 times longer than cold
            • The end must always finish with cold
            • Laste subacute : heat —-> cold
            • Sprains with casted : avoid hot hydrotherapy proximal to the cast to prevent congestion under cast
          2. MLD
            • The length of time spend decreased due to diminished edema
          3. Effleurage and petrissage
            • Now introduced distally to encourage the healing process
          4. Trigger point
          5. Friction
            • To reduce adhesion
            • All this work is preformed within the client’s pain tolerance
          6. Joint paly
            • the proximal and distal joints if there are hypomobile due to compensation
          7. ROM
            • Pain-free mid range passive relaxed ROM : affected joint and injured joint
            • Injured joint work last
          8. Remedial exercise
            1. Pain free AR isometric/isotonic exercise
    3. Chronic stages(after 21days)
      1. Symptoms
        1. Adhesion
        2. Crepitus may be present
        3. Hypertonicity and trigger points : local to the injured joint and in the compensating muscles
        4. Disuse atrophy
      2. Testing
        1. AF ROM
        2. PR ROM : affective joint tested last
        3. AR isometric testing
        4. Special tests
      3. Treatment
        1. Hydrotherapy
          1. Moist heat : hydrocollator, paraffin wax
        2. Full friction
        3. Fascia
        4. Trigger points
        5. Full ROM
  • Returen to activity
    • Grade 1 sprian : 4 to 5 days
    • Grade 2 sprain : 7 to 14 days
    • Grade 3 sprian : 6 to 8 weeks
1.Which of the following could be used as treatment for client with blue black sprain?




… Answer is B)


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