After the last blog post, I thought why not keep it logical for once and look at the unfortunate alternative – broken ankle. With an ankle break the rehab is pretty similar to that of a sprain following a period of immobilisation, with a bit more caution and patience required. With breaks there are different things to consider and a number of things that the hospital don’t tell you – how to cope with daily life. It would be great if there was some sort of manual but unfortunately there isn’t. So, in this post I will attempt to provide some useful advice and guidance on some of the aspects they don’t prepare you for.
A, B or C?
Firstly, it is important to know the type of break you have as this can change your outcomes and recovery. It is most common for the fibula to break on the outside of your leg, however if you have decided to do something spectacular other bones can also be involved. Basically, the more bones you break the more unstable your ankle. With the common lateral malleolar fracture (fibula) it can be classified into three types – A, B and C. Type A tends to be stable, type B has variable stability and type C unstable. It is also common for ligaments to be involved with a rolling mechanisms – just to make it more challenging. If your ankle has decided to have a right good twist and possibly dislocate this can also lead to a bimalleolar (2 bones) or trimalleolar (3 bones) fracture.
Surgical v non-surgical
The stability of your break will impact the treatment that you receive. If it’s unstable it’s likely to be surgery with your new accessory being a lovely piece of metal.
If it is stable you will likely be put in a cast or removable boot. This will also be the case following surgery. What you will be given is dependent on your injury and consultant.
I have experienced both a cast and removable cast – if you are given a choice I would advise picking removable. A cast has its place when you really need the stability but if you can get away with it, a removable one, in my opinion is much nicer. Although it may be a little more painful and unstable it is easier to manage and allows you to move a lot earlier – preventing the dreaded stiffness.
One thing to consider with immobilisation is showering – I’m not going to lie, it’s difficult. You need to prevent your cast from getting wet otherwise it will weaken. I would recommend getting a cast cover rather than going all art attack with a carrier bag and sticky tape. I found this cover good enough, and its cheap.
If you have a shower that’s big enough a plastic chair on a non-slip mat is useful or having a loving friend or partner who is willing to help. Don’t be ashamed, it’s not the time to be embarrassed – some people are grateful to have a glamorous assistant.
Crutch like a pro
If the break wasn’t enough you have now become a walking tripod with no idea how to move.
When it comes to crutches you are usually handed them with minor instructions and end up looking like a baby giraffe. Just remember they are given to you for a reason – use them!
It is important to try and walk with a normal gait as much as possible, otherwise you will overcompensate and cause other injuries.
Just another tip, rain and crutches are enemies. Please remember to wipe them on the mat or its going to end in tears.
Weight-bearing – one step at a time
Be prepared, its hard learning to walk again. Remember to be patient and kind to yourself, listen to the doctor’s advice and take it step by step, from non-weight-bearing with two crutches, to partial weight-bearing, one crutch, and then no crutches.
As I said earlier it’s important to maintain a normal gait, think about moving your hip and knee. Your injured side should move in line with your crutches, don’t just swing your leg in the opposite direction.
In the early stages you should start with your injured foot off the ground, but as you are allowed to bear weight you should begin putting your foot on the floor in a heel toe motion, again moving with your crutches. It will probably feel weird as the nerves in your foot start to wake up – stick with it, it will ease. If you are worried please don’t be afraid to call your fracture clinic.
When starting to put pressure through your ankle think of it in percentages, 10%, 25%, 50%, 75%, 100%. Try not to rush it, it may feel uncomfortable but it should not be painful, only move onto the next stage when you can complete the previous one without any problems on a regular basis.
Other things to consider
Unfortunately with injury there are other aspects which can be affected depending on how you recover.
Even though you do have an injury it is important to keep active where possible, exercising the muscles around your break such as your quads and hamstrings to prevent muscle wastage. It is also a good chance to work on your upper body strength. There will inevitably be some muscle atrophy so try not to overdo it – just keep as strong as possible without compromising your recovery.
You will also find that sleeping can be a bit of a nightmare, try and prop your leg onto a pillow possibly with a surrounding pillow fort to prevent any knocking.
It’s likely that there will be some pain and quite a bit of stiffness in a morning – just take your time and try and move your joints a little before getting out of bed. It is important to try and maintain as much mobility as possible during the injury process to try and limit the stiffness.
Buckle up, it’s going to be a bumpy ride
With any injury it’s not just the physical things which can affect you, it is accompanied by a whirlwind of emotions. It can be very frustrating to lose your independence and even your basic daily activities never mind your sport.
I would really like to talk about this more, but unfortunately there isn’t enough room here – this will be covered in a separate blog. Please just remember to talk to people and don’t be afraid to ask for help.
On the road to recovery
During the rehab process it is important to listen to the health professionals. You know your own body and what you are able to do but please be careful.
Make sure you wear sturdy protective shoes and keep working on your balance, stretching and strengthening.
A common thing people ask about is driving. Do not drive if you aren’t completely comfortable, most insurance companies say that you should be able to do an emergency stop. I would advise you to check with your insurance just in case.
Once your activity has increased you have a decision to make, do I return to sport or not? It is a very hard choice and one that should not be taken lightly. As I mentioned earlier it is not just physical aspects you have to consider, it’s the mental ones too – it’s very common to have the fear. Remember you should be proud of what you’ve come through no matter what your decision.
If you do make the decision to return, it’s not going to be instantly the same, it’s going to take time. Ease yourself back in gradually and don’t beat yourself up about all the things you can’t do, be positive you have had a serious injury – focus on what you can do.
Most people consider whether to use a support or not when returning to sport, there is no real right or wrong answer, it is what feels best for you. I personally prefer to have my mobility and rely on my muscles, but it gives me peace of mind that something is there to provide protection from the impact. If this is what you prefer, these guys do some pretty awesome stuff 😉 you should check them out https://armourflexsport.com/ankle-guards/
Hopefully this has provided you with some helpful guidance in attempting to cope with your break. If anyone has any helpful tips or experiences they want to share please comment below.
Physio Blog - by Amy Brown
As well as skating for Newcastle Roller Girls, Amy is also a sports therapist and has a keen interest in most sports. She has worked in various settings including professional football, women’s premiership rugby, 2012 Olympics and superleague netball. Having undertaken a range of postgraduate training, Amy is also a Kinesio taping practitioner and member of the Society of Sports Therapists.
Alongside providing injury prevention, treatment and rehabilitation within sport she also works in private clinics treating both athletes and the general public.
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