Archive for the ‘ankle sprains’ Category

Landing Mats vs. Skill Cushions

Sunday, April 20th, 2008

Years back, when I lived in Iowa and coached at the U of Iowa, I almost took a job with AAI in Ames.  I was so interested in helping to prevent injuries through better equipment and safety issues.  I just couldn’t see myself sitting at a 9 to 5, so I moved to another university and kept coaching a few more years.

One thing I took from the interview and tour of the facility was that skill cushions are skill cushions and landing mats are landing mats.

I still go into gyms to choreograph or do PT sessions and the gymnasts are still landing dismounts on skill cushions and they still have skill cushions under beams (and it’s competitive season time).

Back in the day, I saw more ACLs and ankles “blow” while gymnasts landed dismounts into skill cushions.  It was like their heel got stuck in the deep “crash mat” (as I call it) and if it was torqued just right, the ankle ligaments or the knee would go!

In the 1970’s, I landed on the side of a “crash mat” under the beam and sprained an ankle for the first time.  I thought we’ve come further than that by now.

I love seeing gymnasts LAND on LANDING mats.

Using Crutches (not!)

Thursday, April 17th, 2008

I never dreamed that walking on a college campus would be hazardous to my health.

Both ankles were bad.  My left ankle was so shot.  I didn’t use crutches after I sprained as a kid (big mistake!), I did use DMSO on it and compete on it, and I sprained it at least 12 times.

When I was going to class during PT school in the mid-1980’s one day, I sprained my left ankle on the side of a curb.  In order to avoid falling flat on my face to the left, in the middle of a busy lane of cars (I used to sprain and my back pack would fly about 10 feet), I compensated and threw my body to the right.  What happened is the somewhat usual bone bruise on the inside/medial side of my ankle (from the bones hitting hard, with no ligaments on the lateral side) and the not so usual thrust of my entire body to the right in a “C”-shaped curve.

I had my typical after-pain with the bone bruise being the problem.  There was no longer any swelling on the outside of the ankle when I did this and I could immediately grab my backpack and walk.  Usually a couple of college students would laugh at me, but this time was different.  When I got to class, one of my professors informed me that she was actually driving by and saw me save my own life by throwing my body the way I did.  Thank God that I was choreographically sound.

Anyway, she announced that I would need to have my ankle reconstructed before I could do an internship at a hospital.  Chances were too great that I would wipe out while I was walking a little old lady post-op fractured hip and pull her down with me and fracture her other hip!

So I had it reconstructed.  Chrisman-Snook style.  http://radiographics.rsnajnls.org/cgi/content/full/24/4/999?maxtoshow=&HITS=10&hits=10&RESULTFORMAT=&fulltext=tendon&andorexactfulltext=and&searchid=1&FIRSTINDEX=0&sortspec=relevance&resourcetype=HWCIT

My PT classmate Donna was there to watch (we had to watch two surgeries sometime before graduation).  I had a spinal because mono still showed up in my system after 10 months!  But, the spinal went to high up (to my eye level instead of around my belly button or so).  I could no longer feel like I was breathing right and I was slurring my speech.  They took the radio headsets off of my ears and put and oxygen mask on, thus the new sound of drills and hammers.  I heard everything!  Donna asked where my lateral ligaments were and the doc said, “Why Donna, she has no trace of any of the three ligaments on the lateral side.”  The bony was shiny.  No remaining shreds of anything.  That’s why the joint opened up 33 degrees (both ankles did that) and I would sprain to the point of clunking the medial side bones together.

Well, the reconstruction went fine on the left.  It was tight.  Far too tight until I went running and stepped in a pothole and ripped some things loose a bit.  It felt and sounded like a green stick trying to break.

It wasn’t until I was pregnant with my first child (Dani- born 6/29/92) that I knew I would have to have my right ankle reconstructed.  During the pregnancy, my right ankle would wipe out and I would quickly throw my right shoulder, like a left twist, and fall flat on my back, in order to land straight down on her.  After that 9 months of cute tricks, watching her toddle around, continued sprains, another pregnancy, delivery of my second kid (Mason- born 6/29/94, yes, the same birthday, two years apart!), waiting for the day he walked, I had my right ankle reconstructed over a Christmas break.  New doc, outcome good, not quite as stiff and tight, and another five inch scar and lots of staples/screws.

There is seriously a grocery store door bell that I “turned on” with all my hardware (knee included) in Columbia, Missouri.  I’m not sure it is still there, but if it is, I’ll find it and once again feel like the Bionic Woman!

Lots of morals of this story.  Take with you the idea of using crutches.

Crutches should be measured for a good fit as follows (because those height markings on those ole’ silver crutches are not always right):

Place one crutch under armpit.  Set crutch tip six inches diagonally out from little toe.  You should be able to fit three to four of your (crutch walker) own finger widths between the crutch and your armpit.  Lose the washrags taped around the top of the crutch.  Avoid leaning forward and slouching over your crutches with your armpits taking all of the pressure.  Had a young guy patient once who got wrist drop (a nerve palsy that eventually went away) from leaning on his crutches.  Pretty bad to have your wrist failing you when you have to walk on crutches.  Finally, make sure that the hand grasp pieces of the crutches are raised or lowered to insure that the elbow bends 30 degrees.  Secure both crutches at these measurements tightly, and you’re on your way.

RULE:  use crutches until you no longer have a visible limp.

PROGRESSION:  two crutches (usually non-weight bearing), then two crutches (partial progressing to full weight bearing), then one crutch on the OPPOSITE side of the injury.  Continue use of two crutches in crowded places (i.e. malls and airports) or in situations where you have to book it (fast).  The one crutch discipline takes time, but it segues beautifully into a non-limping gait.

Angry About Ankle Sprains? (USECA article from Dr. Suzanne Hecht with The Posture Lady) back in 2004 or so.

The First of Many Ankle Sprains

Tuesday, April 8th, 2008

The first ankle sprain happened on a beam mount.  It was a jump to handstand off the spring board onto the end of the beam, walkover out.  I remember trying to keep from falling, but landing on the side of a hard 8-inch mat that was under the beam.  My ankle rolled hard and I felt the first of many ligament “pops” to come.  It swelled with a golf ball lump on the side of it right away, and I was told to get back up there and keep working out.

Today, I really believe that most ankle sprains are preventable.  This one, on the side of the mat,  probably was not.  I also believe that people should treat ankle sprains seriously and stay off of the leg and protect it right after the sprain.

A person may prevent ankle sprains by keeping the hip flexors adequately stretched out, the hip lateral rotators strong and the ankle dorsiflexion at full range of motion.   Most people sprain their ankles when their foot is pointed down (plantarflexed in an open-joint position) versus flexed and close-packed.  Most people sprain their ankles when their hip turn-out muscles are weak, allowing for the femur (thigh bone) to rotate inward and create that pointed foot/sprain action.  Many gymnasts who sprain their ankles (inversion sprains) have short hip flexor muscles and stand and move in lordosis (low back arch).

I had all of these problems.  I went on to sprain my ankles over a dozen times each.