Section 20 Ankle Sprain
Introduction
     The ankle is composed of the lower parts of the tibia, fibula and the facet of the upper joint of talus. The internal and external sides of the joint are fixed by the accessory ligaments. The external accessory ligament is formed by the anterior and posterior talofibular ligaments and calcaneoflbular ligament. The internal accessory ligament is formed by the calcaneotibial ligament, posterior talotibial ligament and tibionavicular ligament (see Fig. 1) to strengthen the stability of the ankle joint and the hinge joint.
     Sprain of the ankle refers to any impairment of the soft tissues around the malleolus (the two rounded protuberances on eachside of the ankle) due to sprain, excluding any fracture or dislocation of the malleolus. A sprained ankle may be caused by one foot slipping during walking, running,jumping, going downstairs and down a slope, which makes the body unstable due to the strong tensile force on the internal or external accessory ligament resulting from the excessive turning in or out of the malleolus, leading to a sprain. Clinically, the most common sprain occurs when an ankle twisted inward damages the accessory ligament of the lateral malleolus.
The Characteristics of the Symptoms of an Ankle Sprain
     The main symptoms of an ankle sprain are pain, distension, limping or complete inability to walk, obvious tenderness over the affected part and a bluish discoloration of the skin in the affected region. If the lateral malleolus is sprained, the pain is obvious in the turning in of the foot. If the medial malleolus is sprained, the pain is obvious in the turning out of the foot, possibly accompanied by a laceration of the ligament. If both the medial and lateral malleoli are swollen and painful, careful examination must be done for an accurate diagnosis. X-ray
examination should be taken if necessary.
Methods for Self-Massage Along Meridians and Acupoints
    1. Pressing the Kunlun Point (BL 60)
    Performance: Sitting position. The foot on the healthy side touches the ground with the knee bent. The thigh on the affected side is raised up and placed over the thigh of the healthy side.
    The thumbs and index fingers are used to forcefully press Ktmltm (located in the depression on the middle point of the line connecting the tip of the lateral malleolus and the Achilles tendon) on the affected side for one minute (see Fig.2)
    2. Pressing the Taixi Point (KI 3)
    Performance: Sitting position. The thumbs and index fingers are used to press Taixi (located on the middle point of the line connecting the tip of the medial malleolus and the Achilles tendon) on the affected side for about one minute (see Fig. 3).
    Kunlun is located on the bladder meridian and Taixi on the kidney meridian. This method is effective in relaxing the tendons and dredging the collaterals.
    3. Pressing Malleolus
    ① Performance: Sitting position. The foot on the healthy side touches the ground with the knee bent. The thigh on the affected side is raised up and placed over the thigh at the healthy side. The fingers of both hands are used to press the tender area on the malleolus first and then to knead the malleolus and the Achilles tendons for about three minutes until pain in the affected part is alleviated (see Fig. 4).
     ② Effect: This method can reduce swelling and relieve pain.
     4. Stroking Malleolus with the Foot
     ① Performance: Sitting position. The foot on the affected side touches the ground and the sole and heel of the foot on the healthy side touches the foot on the affected side and strokes forcefully from the upper to the lower. The sole of the foot on the healthy side is used to stroke the top of the foot on the affected side for a minute first. Then the sole and heel are used to scratch the medial malleolus for about a minute. Finally the top of the foot on the healthy side is crossed behind the heel of the affected side to stroke the lateral malleolus for
about a minute. The stroking should be moderate and soft until a warm and comfortable
sensation is felt in the affected part (see Fig. 5).
     ② Effect: This technique may warm and dredge meridians as well as reduce swelling and relieve pain.
     5. Squeezing and Holding the Gastrocnemius (calf) Muscle
     ① Performance: Sitting position. The foot on the healthy side touches the ground with knee bent. The thigh on the affected side is lifted and placed over the thigh on the healthy side. The fingers of both hands squeeze and hold the calf muscle from the back of the knee to the ankle for about two minutes. The massage should be even and soft, avoiding roughness (see Fig. 6).
     ② Effect: This method can help relax the meridians, and activates qi and blood.
     6. Rounding the Ankle
     ① Performance: Sitting position. The foot on the healthy side touches the ground, the knee bent. The thigh on the affected side is lifted and placed over the thigh on the healthy side. One hand grasps the heel and the other hand grasps the sole to round to bend and pull the ankle lightly. The motion is done clockwise for half a minute and counterclockwise for half a minute from smaller to wider range (see Fig. 7).
     ② Effect: This method is effective in relaxing tendons, dredging collaterals and lubricating joints.
Notes:
     1.Bone fracture or dislocation as well as tom tendons must be excluded before self-massage along meridians and acupoints can be applied.
     2. Self-massage along meridians and acupoints should be done once a day. It is most effective in treating simple impairment of the malleolus ligament.
     3. During the acute stage of an ankle sprain, care should be taken to walk less and rest more. The affected limb should be raised up while sleeping.
     4. Care should be taken to prevent ankle sprains due to slipping when walking or jumping with a heavy load.