Treatment of post-traumatic ankle ligament adhesions – case report

Abstract

Ankle sprains are the most common sports injuries, but they also happen to people that do not do any sports at all. Most of them are inversion-type traumas which could harm soft tissues like lateral collateral ligaments, capsule and peroneal tendons. The vast majority of these injuries are grade ͕ sprains where there is no clinical instability. Very often treatment is based on conservative protocols, i.e. RICE (rest, ice, compression, elevation), immobilization and avoiding weight bearing. Besides the above procedures, in the following period of time some modalities are planned, and there is not enough attention paid to regaining function after the acute stage. Such a conservative approach over a longer period of time should be reserved for fractures and grade ͗ sprains because immobilization leads to loss of proprioception and the formation of inelastic scar tissue caused by ligamentous adhesions. It takes about ͚ weeks to form adhesions, and clinically those patients complain about pain, sometimes also with swelling, after some exertion. One treatment option is deep friction and manipulation of adherent lateral ligaments to break the adhesions. The aim of this paper is to show an alternative treatment option which is safer than manipulation. The authors propose the use of a shockwave therapy in combination with a home exercise stretching programme in positions reproducing the trauma mechanism to remodel the scar tissue. Additionally, there should be proprioception exercises for prophylaxis and regaining normal function