Ankle Sprains for the Dancer
Ankles are one of the many body parts that have the highest incidence of injury by the performance of dance. Ankle sprains are one of the most common sprains occurring to the dancer. Even though structurally the ankle may be considered a moderately strong joint, it is subject to sudden twists, especially when the dancer steps on some irregular surface. Serious injury occurring to joints or bones result initially from impact forces, with carelessness and fatigue playing a major role. Late in the practice day or just before an opening performance when the dancer is trying most for perfection, seems to be the time when most serious injuries occur. The older the dancer the more susceptible he or she is to serious joint and bone injuries. Many ankle injuries may be directly attributed to dancing on a too hard surface, or a too soft surface. Going to pointe before a dancer is ready can also be detrimental because if proper strength is lacking, sprained ankles can result. The sprain is primarily an injury to the ligamentous supportive structures of a joint. It seldom occurs without affecting muscle tendons crossing the joint. The sprain is categorized into first, second, and third degrees of intensity. The intensity of a sprain is best determined by the extent of the dancer^s disability as well as the tenderness elicited by feel or palpation and the amount of hemorrhage and swelling present. A dancer with a second or third degree sprain must routinely be referred to a physician for x-ray examination and diagnosis, because fracture is commonly associated with a twisted joint. A joint that has lost its ability to function for more than several minutes must be considered to have either a second or a third degree sprain. The highest incidence of injury is to the outside aspect of the ankle and is called inversion sprain of the ankle. This happens when the dancer turns the foot inward, placing an abnormal stretch on the outer ankle ligament. for the dancer with flat feet and/or pronated feet, inside sprains are more common and more serious. Usually a dancer has a high level of flexibility in the ankle region, and it takes a great deal of force to actually cause a sprain. If this force is great enough, ligaments will be torn and even a part of the outer ankle bone may be pulled away. The center talus bone may roll underneath and strike against the internal ankle bone, causing a fracture on the inside of the ankle. Repeated sprains can lead to an osteoarthritic condition in any joint of the body. The medial, or inside sprain represents a different problem than the lateral ankle sprain. Even though it occurs less often, it is more serious than a lateral ankle sprain because injuring the inside ligaments also affects the inner longitudinal arch. With this eversion sprain of the ankle, there is injury to the deltoid. Often dancers who have had medial sprains experience difficulties. It is suggested that along with regular rehabilitation regimens, the dancer with inside sprains engage in a program of arch and foot conditioning. An ankle sprain is treated with ice. The area will usually swell with discoloration. The best immediate first aid is to put an ice pack on the ankle and elevate it. Crushed ice can be held on the ankle with an elastic wrap. Ice, pressure, and elevation should be used to control hemorrhage and swelling in the joint. Icing a joint injury is important because injured joints rapidly swell with the effusion of blood and serum. Some compression is needed to minimize swelling. Sometimes the injury can be temporarily helped if you put a compress of undiluted Burrow^s solution on the ankle and wrap it in a plastic food wrap for an hour. Alternate this with ice until the swelling goes down. The ankle will still ache, but the compress draws out the inflammation and allows blood to circulate and heal the ankle. If the sprain turns a yellowish this means the sprain is in the process of healing. Some physicians may routinely apply a cast to a second-or third degree sprain for a week or longer to ensure proper repair. Other physicians will apply a tape support to the sprain and instruct the dancer to engage in no weight bearing for 2 to 3 days. Pain won^t lessen if you still dance. You have to stop dancing, treat the ankle and rest. Joint immobilization assures a speedy recovery. This is often followed by a program of physical therapy. Strapping is the best preventive procedure, because as in all sprains, once ligaments of the ankle have been stretched, exercise cannot restore joint and stability. Ankle strapping provides mild support to the ankle joint and still allows for foot and ankle mobility. Use 1-and 1/2-inch tape and tape adherent. Another technique used by itself or with ankle strapping is application of an adhesive felt horseshoe. This can be used with the chronically swollen ankle. Using 1/4-inch adhesive felt, a horseshoe is cut to fit around the outer or medial malleolus. Elastic material shouldn^t be used for ankle support because it doesn^t adequately stabilize a joint but it can be used to hold another bandage in place when there is swelling. Because it is almost impossible to control the dance environment when touring, some companies carry their own portable suspended dance floor. It is generally agreed that there is a lower incidence of impact injuries such as sprained ankles when suspended dance floor systems are used. A good test for the dancer to determine whether an ankle support should be worn is to jump up and down on the affected foot several times. An ankle that has recovered from an injury will usually allow the dancer to spring into the air and support the body on landing.