IPHREHAB : INFECTION, TYPHOID

IPHREHAB

TYPHOID

• Very common disease in our country
• Outbreaks are known to occur from time to time
• Pollution & Insanitary condition
• Present in animals except S.Typhi
• Transmitted by food, water, Milk
•  May be directly from one person to another

AETIOLOGY

• Caused by Salmonella Group of Organisms
• Reservoir are animals except for S.Typhi which is seen only in human beings
• There are 2000 Serotypes
• Faeco-oral route
• Tranmission through food, Flies & Fomites
• It involves Payer’s patches of small Intestines

CLINICAL PICTURE

• Fever is most common presenting symptom
• Fever is step ladder pattern
• Onset is insidious
• There is Malaise, Headache, Cough,  Drowsiness & Bodyaches
• Constipation common
• Relative Bradycardia
• Rash may appear on fifth day
• Toxaemia is Max. in 2nd Week
• Spleen is palpable
• Toxaemia increases in 3rd Week
• Coma may set in & may lead to death
• Antibiotics give the best results
• Carriers are well known

INVESTIGATIONS

• Complete Blood Leukopenia Increase in Lympho
• Blood Culture +ve  first week
• Widal’s  Test  2nd Week Rising titer is diagnostic
• Urine & Stool Culture

COMPLICATIONS

• Perforation
• Haemorrhage
• Osteomyelitis
• Meningitis
• Myocarditis
• Pneumonia
• Nephritis
• Hepatitis

MANAGEMENT

• General Management :- Analgesics for fever, Antiemetics (Perinorm) for vomiting
• Antibiotics Ciproflxacillin 500mg BD
• Cotrimoxazole 
• Amoxycillin
• Carrier Ciproflox for 4 weeks
• Prevention - Vaccination

IPHREHAB : INFECTIONS, MEASLES AND MUMPS

IPHREHAB

INFECTIONS

MEASLES

• It is caused by Virus ( Paramyxo)
• It is usually seen in children
• One attack give permanent immunity
• It is in in severe form in malnourished person ( in our country)
• Very high mortality
• Incubation period is 10 days

CLINICAL  PICTURE

• Catarrhal Stage    High Fevere    Severe Nasal Catarrh Sneezing, Redness of Eyes- Conjuctivitis Kapolick Spots in mouth
• Cough Hoareseness of Voice Photophobia
• Child is very irritable & in Miserable Stage
• Exanthematous stage  Koplik  spots disappear  Rash appear on 2-4 day  Rash is maculo papular initially on back of   ear
• It rapidly spread over the body – become blotchy
• Rash settle down in one week Fever subside

COMPLICATIONS

• Stomatitis Entertitis Pneumonia Keratitis
• Otitis Media, Conjunctivitis
• Brochopneumonia
• Encephalitis
• Malnutrition Vitamin A deficiecy
• Severe weight loss

MANAGEMENT

• Bed Rest No schooling for 10 days
• Symptomatic Treatment
• Antibiotics
• Prevetion – active immunisation
• Passive immunisation in serious cases  250 mg IM

MUMPS

• Common disorder in our country
• Caused by virus
• Incubation period 18 days
• Spread by droplet infection
• Not very virulent
• Infectivity ver low
• May remain subclinical

CLINICAL  PICTURE

• Fever
• Pain in the jaw
• Trismus
• Swelling of Parotid Gland subside in 2-3 days
• Meningitis Encephalitis
• Pancreatitis
• Orchitis

MANAGEMENT

• Treat the symptoms
• Antibiotics if bact. Infection is present
• In orchitis cases give predisolone 40 mg daily
• Vaccination for prevention- MMR

IPHREHAB : INFECTIONS, DIPHTHERIA

IPHREHAB

INFECTIONS

DIPHTHERIA

• It is disease caused by Gram + Bacteria
• Bacteria produces Exotoxin – which damages Heart & Nervous system
• It is common in India usually affecting children
• Sore Throat is presenting symptom
• Disease spread by droplet Infection

CLINICAL PICTURE

• Incubation period is 2-4 days
• Infection can occur over the Conjunctiva, Genital tract, Wounds & Abrasions
• Fever is high
• Grayish Green Membrane on Tonsils
• Membrane is firm & adherent
• Swelling of Neck (Bull’s Neck)
• Nasal Infection Common 
• Nasal Discharge ++ – May be Bloody in nature
• Husky voice due to Laryngitis
• Respiratory Infection can lead to death
• ECG may show tachycardia & T-wave changes
• Palatal Paralysis
• Accommodation may be paralysed
• Polyneuritis is seen in few cases

MANAGEMENT

• Inform the Public Health Department
• Give anti-toxin 4000-32000 IM
• Benzyl Penicillin -4 lacs Units 6 hourly for one week
• Treat Complications -  Resp. & Cadiac
• Protect Close relatives Erythromycin Immunization.

IPHREHAB : HOW TO READ ECG

IPHREHAB

HOW TO READ ECG
Name                        Age                   Sex
Clinical  Diagnosis
Drugs taken
Rate      /mt Rhythm          Axis
P-wave PR interval     sec.
QRS duration ST segment
T-wave
DIAGNOSIS

PERSISTENT JUVENILE PATTERN

PROMINENT U WAVES

P - WAVE:

• IT INDICATES ATRIAL ACTIVATION
• BEST SEEN IN LEAD II & v1
• DURATION 0.08 to 0.11 SECONDS
• IT IS BIPHASIC IN v1
• FIRST RISE IS DUE TO RIGHT ATRIAL CONTRACTION
• SECOND RISE IS DUE TO LEFT ATRIAL CONTRACTION

IPHREHAB : ELECTROCARDIOGRAPHY, ECG, HEART

IPHREHAB


ELECTROCARDIOGRAPHY
BASIC PRINCIPLES


ELECTROCARDIOGRAM

• IT IS SOPHISTICATED GALVANOMETER AND SENSITIVE ELECTROMAGNET
• IT RECORDS ELECROMAGNET POTENTIALS
• IT HAS POSITIVE AND NEGATIVE POLE 

ECG   PAPER

• IT IS DIVIDED IN SMALL AND LARGE SQUARES
• IT IS WAX COATED
• SMALL ARE 1 mm SQUARE
• LARGE ARE 5mm SQUARE
• THEY MOVE AT RATE OF 25 mm PER SECOND

LEADS

• THEY RECORD POTENTIALS
• THERE ARE SIX LIMB LEADS   
•   I   II   III  aVR   aVL   aVF

• THERE ARE  SIX  CHEST  LEADS    
•  v1  v2  v3  v4  v5  v6

FORMATION OF ECG IN HEART:


WAVES:

• P WAVE Indicates Atrial Contraction 
• PR INTERVAL- Time taken by impulse to travel from Atria to Ventricle
• QRS- indicates Ventricular complex  Q is due to interventricular depolarisation  R is due to Apical Depolarisation  S is due to depolarisaion of base of heart
• T is repolarisation of ventricle

IPHREHAB : Group Discussion Methods and Procedures

IPHREHAB

Group Discussion Methods and Procedures

Research has shown that participants in Extension educational programs strongly prefer interactive delivery methods, which allow them to learn new information by seeing, experiencing, and discussing. In working with groups, Extension educators often find it easier to provide opportunities for seeing and experiencing than for discussion. This fact sheet briefly describes methods that can be used to promote effective discussions in learner groups. When used as one part of a broader program delivery system, these methods can be very helpful in facilitating the learning process.

Discussion Methods

Panel. 

In a panel discussion, a small group of individuals (from three to five) who are knowledgeable about a particular subject discuss the topic among themselves in front of an audience. Panel participants make no formal presentations; they exchange ideas through conversation.

Dialogue. 

This method is very similar to a panel discussion, but only two individuals take part in discussing the subject in front of an audience.

Symposium. In a symposium, a small number of speakers who are knowledgeable about a particular subject make short presentations in succession. These presentations usually range from five to fifteen minutes each.

Forum.

This form of discussion allows for participation by the audience. There are several types of forums. The most common are:

Open forum: Members of the audience are allowed to participate at any time during the meeting.

Panel-forum: Members of an audience hear a panel discussion and are then allowed to ask questions or to comment on the subject under discussion.

Symposium-forum: Members of the audience hear presentations by invited speakers and are then allowed to question, discuss, or comment.

Dialogue-forum: Members of the audience are allowed to question, discuss, or comment after the dialogue.

Lecture-forum: After a formal presentation by a knowledgeable speaker, audience members are given the opportunity to question, comment, seek clarification, or discuss the information presented.

Colloquy. 

This method combines a panel discussion with a forum. During the course of a panel discussion, audience members may be invited to comment or ask questions if panel members or the chair perceive a need to clarify points, avoid neglecting an issue, or assure that a misperception is not allowed to stand. Any interruptions of the panel discussion must be focused on the point at hand. When the matter has been resolved, the organized discussion among panel members resumes.

Buzz Session.

The audience is divided into groups of six to eight persons for discussion of relevant questions posed by the leader. One individual from each group may be asked to summarize the group's discussion and report to the entire audience.

Audience Reaction Team. 

Three to five members of the audience are preselected to listen to a presentation and respond by offering a brief summary and interpretation of the information presented. This discussion method can be used effectively in large group settings and when time is limited.

Question Period. 

Members of the audience are provided an opportunity to ask questions of program participants after their formal presentations have been completed. Usually, a time limit is set for each question and for the entire question-and-answer period.

Brainstorming. 

Members of the audience are encouraged to participate by sharing their ideas or suggestions for solving a problem. No discussion of each point is allowed until all ideas have been expressed. Since the intent of this discussion method is to generate a wide range of ideas, no contributor is allowed to defend the information presented. The atmosphere should be open and encouraging.

Discussion Group. 

A group of people meet informally to discuss a topic of mutual concern.

Workshop. 

A small group of people (25 or fewer) with a common interest meet to study, research, and discuss a specific subject or to enhance their individual knowledge and proficiency.

Seminar. 

A group of people who are studying a specific subject meet for a discussion led by a recognized authority.

Conference. 

Large or small groups of people having similar interests meet to hear formal presentations to the entire group; they also meet in smaller groups to discuss specific aspects of the conference's general topic. 

IPHREHAB : PAIN MODULATION AND MECHANISM

IPHREHAB
PAIN MODULATION

• Variability of pain caused by similar injuries.
• Psychological variability.
• Even suggestions of pain relief helpful.
• Existing brain circuits modulate pain transmission pathways.

• One of these circuits has links with hypothalamus, midbrain, medulla oblongata.
• This pathway selectively controls spinal pain transmission neurons through descending pathways.
• Attention, suggestion and opiods work and modulate pain through this pathway.
• Endogenous opiod peptides such as enkephalins and endorphins work through this pathway. 

• Prolonged pain and fear are the most  reliable activating factors for endogenous opiod pathway.
• Released during surgical procedures and even by placebo.

Pain modulating circuits can suppress and enhance pain.

• Both pain-inhibiting  and pain-facilitating neurons in the medulla project to and control spinal pain transmission. Hence pain can be generated without any peripheral nocuous stimuli.
• Increased activity of these circuits is seen during migraine.
• Pain can also be induced by suggestions-psychological factors contribute to pain.

NEUROPATHIC PAIN:

1. Lesions in central and peripheral pathways results in loss or impairment of pain sensation.
2. Paradoxically the damage may also produce pain- diabetic neuropathy, herpes zoster.
3. Also damage to spinothalamic tract or thalamus can also produce pain.
4. Severe and notoriously intractable to standart treatment.
5. Unusually burning, tingling or electric shock like quality.
6. Examination-Sensory deficit in the area of pain.
7. Hyperpathia/allodynia.
8. Topical preprations (5% lidocaine) helpful.

Mechanisms

• Sensitized primary afferent neurons.
• Damaged primary afferent neurons.
• Sensitized nociceptors.-generate impulses in absence of stimulus.
• Increased concentration of sodium channels.
• Sensitivity to norepinephrine.

Sympathetically Maintained Pain

• Causalgia in peripheral nerve injury.
• Pain often begins after a delay of hours to days or even weeks.
• Pain accompanied by swelling of extremity, periarticular osteoporosis and arthritic changes in distal joints.
• Pain relief by sympathetic blockages.

Similar events- reflex sympathetic dystrophy- without nerve damage including fractures, soft tissue injuries, MI, stroke.

Treatment :

• History, Evaluate, examine.
• Remove cause.
• Analgesics NSAIDS, Opiods

IPHREHAB : PAIN cause and why?

IPHREHAB
PAIN

• Unpleasant sensation.
• Localised or not localised.
• Described differently.
• Associated anxiety and urge to escape or terminate the feeling.
• Dualality.

• Acute pain associated with behavioural arousal and stress response
• Increased BP, pupil size, plasma cotisol
• Local muscle contraction (limb flexion, abdominal wall rigidity)

PERIPHERAL MECHANISMS

1. Primary Afferent Nociceptors
2. Peripheral nerve containing three different types of axons-motor, sensory, sympathetic post ganglionic.
3. Cell bodies in dorsal root ganglion.
4. Two processes, peripheral and central.
5. Primary afferent are Aδ & C (unmelinated) axons.
6. Fibers present in skin and deep somatic and visceral structures.
7. Most of these fibers respond maximally only to intense painful stimulus and produce subjective experience of pain when electrically stimulated
8. This defines them as primary afferent nociceptors.
9. Nociceptors respond to many different stimuli- heating, intense mechanical stimuli (pinch), irritating chemicals.

Sensitisation

• Intense, repeated and prolonged stimuli to an inflamed tissue lowers the threshold for activating primary afferent nociceptors.
• Frequency of firing is higher.
• Mediators like bradykinin, PG’s, LT contribute. 
• Even innocuous stimulus can produce pain

• Clinically important as it contributes to tenderness, soreness, and hyperalgesia.
• Sensitisation has importance in visceral tissue.
• Normally viscera is insensitive but in presence of inflammatory mediators, the sensitivity increases especially to mechanical stimulus.
• Such afferents are termed as silent nociceptors

Nociceptor induced inflammation

• Neuroeffector function
• Contan polypeptides in peripheral terminals - substance P.
• Released from primary afferent nociceptors causing v/d, degranulation of mast cells, chemoattractant and increases production and release of inflammatory mediators.
• Tissue protectors due to these mechanisms.

CENTRAL MECHANISMS

• Spinal Cord and Referred Pain
• Afferent Axons enter dorsal root→ dorsal horn → spinal neurons.
• Each afferent neuron contacts many spinal neurons and each spinal neuron receives convergent input from many primary afferents.
• Convergence takes place and this underlies the phenomenon of referred pain.

Ascending Pathways

Afferent neuron → Spinal neurons → contra lateral side → spinothalamic tract → thalamus (several regions) → cerebral cortex (several regions).

Spinothalamic tract is crucial as damage causes impairment in transmission of these sensations.

IPHREHAB : Vertebrae and Spinal Cord Segmental Levels

IPHREHAB

Vertebral vs. Cord Segmental Levels

The spinal cord is situated within the spine. The spine consists of a series of vertebral segments. The spinal cord itself has "neurological" segmental levels which are defined by the spinal roots that enter and exist the spinal column between each of the vertebral segments. As shown in the figure the spinal cord segmental levels do not necessarily correspond to the bony segments. The vertebral levels are indicated on the left side while the cord segmental levels are listed for the cervical (red), thoracic (green), lumbar (blue), and sacral (yellow) cord.

Vertebral segments. 

There are 7 cervical (neck), 12 thoracic (chest), 5 lumbar (back), and 5 sacral (tail) vertebrae. The thoracic vertebrae are defined by The spinal cord segments are not necessarily situated at the same vertebral levels. For example, while the C1 cord is located at the C1 vertebra, the C8 cord is situated at the C7 vertebra. While the T1 cord is situated at the T1 vertebra, the T12 cord is situated at the T8 vertebra. The lumbar cord is situated between T9 and T11 vertebrae. The sacral cord is situated between the T12 to L2 vertebrae.

Spinal Roots. 

The spinal roots for C1 exit the spinal column at the atlanto-occiput junction. The spinal roots for C2 exit the spinal column at the atlanto-axis. The C3 roots exit between C2 and C3. The C8 root exits between C7 and C8. The first thoracic root or T1 exits the spinal cord between T1 and T2 vertebral bodies. The T12 root exits the spinal cord between T1 and L1. The L1 root exits the spinal cord between L1 and L2 bodies. The L5 root exits the cord between L1 and S1 bodies.

The Cervical Cord. 

The first and second cervical segments are special because this is what holds the head. The lower back of the head is called the Occiput. The first cervical vertebra, upon which the head is perched is sometimes called Atlas, after the Greek mythological figure who held up earth. The second cervical vertebra is sometimes called the Axis, upon which Atlas pivots. The interface between the occiput and the atlas is therefore called the atlanto-occiput junction. The interface between the first and second vertebra is called the atlanto-axis junction. The C3 cord contains the phrenic nucleus. The cervical cord innervates the deltoids (C4), biceps (C4-5), wrist extensors (C6), triceps (C7), wrist extensors (C8), and hand muscles (C8-T1).

The Thoracic Cord. 

The thoracic vertebral segments are defined by those that have a rib. These vertebral segments are also very special because they form the back wall of the pulmonary cavity and the ribs. The spinal roots form the intercostal (between the ribs) nerves that run on the bottom side of the ribs and these nerves control the intercostal muscles and associated dermatomes.

The Lumbosacral Cord. 

The lumbosacral vertebra form the remainder of the segments below the vertebrae of the thorax. The lumbosacral spinal cord, however, starts at about T9 and continues only to L2. It contains most of the segments that innervate the hip and legs, as well as the buttocks and anal regions.

The Cauda Equina.

 In human, the spinal cord ends at L2 vertebral level. The tip of the spinal cord is called the conus. Below the conus, there is a spray of spinal roots that is frequently called the cauda equina or horse's tail. Injuries to T12 and L1 vertebra damage the lumbar cord. Injuries to L2 frequently damage the conus. Injuries below L2 usually involve the cauda equina and represent injuries to spinal roots rather than the spinal cord proper.

In summary, spinal vertebral and spinal cord segmental levels are not necessarily the same. In the upper spinal cord, the first two cervical cord segments roughly match the first two cervical vertebral levels. However, the C3 through C8 segments of the spinal cords are situated between C3 through C7 bony vertebral levels. Likewise, in the thoracic spinal cord, the first two thoracic cord segments roughly match first two thoracic vertebral levels. However, T3 through T12 cord segments are situated between T3 to T8. The lumbar cord segments are situated at the T9 through T11 levels while the sacral segments are situated from T12 to L1. The tip of the spinal cord or conus is situated at L2 vertebral level. Below L2, there is only spinal roots, called the cauda equina.

IPHREHAB : SENSORY AND MOTOR LEVEL OF DERMATOME

IPHREHAB

A dermatome is a patch of skin that is innervated by a given spinal cord level. Figure 2 is taken from the ASIA classification manual, obtainable from the ASIA web site. Each dermatome has a specific point recommended for testing and shown in the figure. After injury, the dermatomes can expand or contract, depending on plasticity of the spinal cord.

C2 to C4. The C2 dermatome covers the occiput and the top part of the neck. C3 covers the lower part of the neck to the clavicle (the horizontal bone that goes to the shoulder. C4 covers the area just below the clavicle.

C5 to T1. These dermatomes are all situated in the arms. C5 covers the lateral arm at and above the elbow. C6 covers the forearm and the radial (thumb) side of the hand. C7 is the middle finger, C8 is the lateral aspects of the hand, and T1 covers the medial side of the forearm.

T2 to T12. The thoracic covers the axillary and chest region. T3 to T12 covers the chest and back to the hip girdle. The nipples are situated in the middle of T4. T10 is situated at the umbilicus. T12 ends just above the hip girdle.

L1 to L5. The cutaneous dermatome representating the hip girdle and groin area is innervated by L1 spinal cord. L2 and 3 cover the front part of the thighs. L4 and L5 cover medial and lateral aspects of the lower leg.

S1 to S5. S1 covers the heel and the middle back of the leg. S2 covers the back of the thighs. S3 cover the medial side of the buttocks and S4-5 covers the perineal region. S5 is of course the lowest dermatome and represents the skin immediately at and adjacent to the anus.

Ten muscle groups represent the motor innervation by the cervical and lumbosacral spinal cord. The ASIA system does not include the abdominal muscles (i.e. T10-11) because the thoracic levels are much easier to determine from sensory levels. It also excludes certain muscles (e.g. hamstrings) because the segmental levels that innervate them are already represented by other muscles.

Arm and hand muscles. C5 represents the elbow flexors (biceps), C6 the wrist extensors, C7 the elbow extensors (triceps), C8 the finger flexors, and T1 the little finger abductor (outward movement of the pinky finger).

Leg and foot muscles. The leg muscles represent the lumbar segments, i.e. L2 are the hip flexors (psoas), L3 the knee extensors (quadriceps), L4 the ankle dorsiflexors (anterior tibialis), L5 the long toe extensors (hallucis longus), S1 the ankle plantar flexors (gastrocnemius).

The anal sphincter is innervated by the S4-5 cord and represents the end of the spinal cord. The anal sphincter is a critical part of the spinal cord injury examination. If the person has any voluntary anal contraction, regardless of any other finding, that person is by definition a motor incomplete injury.

It is important to note that the muscle groups specified in the ASIA classifications represent a gross over simplication of the situation. Almost every muscle received innervation from two or more segments.

In summary, the spinal cord segment serve specific motor and sensory regions of the body. The sensory regions are called dermatomes with each segment of the spinal cord innervating a particularly area of skin. The distribution of these dermatomes are relatively straightforward except on the limbs. In the arms, the cervical dermatomes C5 to T1 are arrayed from proximal radial (C5) to distal (C6-8) and proximal medial (T1). In the legs, the L1 to L5 dermatomes cover the front of the leg from proximal to distal while the sacral dermatomes cover the back of the leg.

IPHREHAB : ANKLE SPRAIN CAUSE AND TREATMENT

IPHREHAB

ANKLE SPRAIN:

An ankle sprain is a common injury and usually results when the ankle is twisted, or inverted. The term sprain signifies injury to the soft tissues, usually the ligaments, of the ankle. On the lateral side of the ankle, there are three ligaments that make up the lateral ligament complex. These include the anterior talofibular ligament (ATF), the calcaneo–fibular ligament (CF) and the posterior talofibular ligament (PTF). The very common inversion injury to the ankle usually injures the anterior talofibular ligament and the calcaneo–fibular ligament. The ATF ligament keeps the ankle from sliding forward and the CF ligament keeps the ankle from rolling over on its side.

Causes of Ankle Sprain

ANKLE SPRAIN

A ligament is made up of multiple strands of tissue–similar to a nylon rope. A sprain results in tearing of the ligaments. The tear can be a complete tear of all the strands of the ligament or a partial tear, where a portion of the strands of the ligament are torn. The ligament is weakened by the injury which depends on the degree of the tear. The lateral ligaments are by far the most commonly injured ligaments in a typical inversion injury of the ankle. An inversion injury simply means that the ankle tilts over to the inside (towards the other foot), and the pressure of all your body weight is forced onto the outside edge of the foot. This causes the ligaments on the outside of the ankle to stretch and possibly tear.

Symptoms of Ankle Sprain

Initially the ankle is swollen, becomes painful, and may turn eccyhmotic (bruised). The bruising, and the initial swelling, is due to ruptured blood vessels from the tearing of the soft tissues. Most of the initial swelling is actually bleeding into the surrounding tissues. This initial swelling due to bleeding then increases due to edema fluid leaking into the tissues as well over the next 24 hours.

Diagnosis of Ankle Sprain

The diagnosis of an ankle sprain is usually made by examination of the ankle and x–rays to make sure that there is no fracture of the ankle. If there is a complete rupture of the ligaments suspected, your doctor may order stress x–rays as well. These x–rays are taken while someone twists or stresses the ligaments.

Treatment of Ankle Sprain

Elevation will help control the swelling.

Gentle compression and ice will control swelling.

Mild pain relievers will help with the pain.

Crutches will prevent weight bearing.

Healing of the ligaments usually takes about six weeks. The swelling may be present for several months. A physical therapist may be suggested to help you regain full function of your injured ankle.

Treatment may vary depending on how bad your ankle sprain is.

 In each case, the first line of treatment is to calm the inflammation and halt the swelling. 

The RICE (Rest, Ice, Compression, Elevation) principle can help address each of these needs.

Rest: 

A brace or splint will keep the ankle in a safe position, helping you avoid more strain to the sore area. In severe cases, you may require a pair of crutches to limit weight through the foot.

Ice:

Cold therapy, in the form of an ice pack, can aid in slowing the inflammatory process and in limiting pain.

Compression:

An elastic wrap can compress the sore area, keeping the swelling to a minimum.

Elevation:

Keeping the ankle elevated above the level of your heart will help drain the extra fluid (edema) back into the blood system and reduce swelling.

Range of motion exercises:

As healing gets underway, it is important to begin a series of movement exercises for the range of motion (ROM). At first, you’ll work on simply bending and straightening the ankle. These exercises will keep the ankle from becoming stiff.

Strength progression: 

Next, you’ll begin strengthening the muscles around the ankle. Isometrics may be chosen in the early stages of rehabilitation. These are strengthening exercises in which the muscles are working but the joint stays still. Isometrics allow you to exercise with the ankle at different angles, helping you stay away from painful positions of the ankle. These exercises provide the benefit of reducing overall pain and swelling.

Balance exercises:

Balance exercises are especially important following an ankle ligament injury. Remember, healthy ligaments send information to the brain about the position of a joint. Once a ligament has been injured, these nerves are unable to receive and send the needed information to the brain. Balance exercises help retrain the new nerves and help you regain your proprioceptive sense around the joint.