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Unraveling the Mystery of Ankle Pain #2:

Lateral Ankle Ligament Sprain

Unraveling the Mystery of Ankle Pain #2:

Lateral Ankle Ligament Sprain

Instructor: Ben Benjamin, Ph.D.Instructor: Ben Benjamin, Ph.D.

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Instructor: Ben Benjamin, Ph.D.Instructor: Ben Benjamin, Ph.D.

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Webinar GoalsWebinar Goals

• Explore the assessment and treatment of one of the more common lateral ankle injuries.

• Explore the assessment and treatment of one of the more common lateral ankle injuries.

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LogisticsLogistics• Time: 60 minutes

• Schedule:

• Presentation 40-45 minutes

• Questions 15–20 minutes

• Ongoing questions: Use Question box.If I don’t get to your question, ask me on my Dr Ben Benjamin Facebook page after the webinar.

• Get a pen and paper please

• Time: 60 minutes

• Schedule:

• Presentation 40-45 minutes

• Questions 15–20 minutes

• Ongoing questions: Use Question box.If I don’t get to your question, ask me on my Dr Ben Benjamin Facebook page after the webinar.

• Get a pen and paper please

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PretestPretest1. Which is the second most common ligament sprain in the ankle?

a.) Calaneocuboid ligament, b.) Calcaneofibular ligament, c.) Tibiotalor ligament, or d.) Anterior talofibular ligament

2. Which tendon injury gets confused with lateral ligament sprains? a.) The flexor hallucis longus tendon, b.) The achilles tendon, c.) The fibularis tendon, or d.) The tibialis posterior tendon

3. Approximately how many ankle sprains occur each month in the United States? a.) 50,000, b.) 150,000, c.) 400,000, or d.) 700,000

4. Lateral ankle sprains occur most often to which population? a.) Elderly people, b.) Adults, c.) Teenagers, or d.) Athletic young people

5. The calcaneofibular ligament spans how many joints? a.) One, b.) Two, c.) Three, or d.) Four

6. Which test is the primary test when determining if the calcaneofibular ligament is injured? a.) Passive supination, b.) Passive Inversion in dorsiflexion, c.) Passive eversion in dorsiflexion, or d.) Passive pronation

1. Which is the second most common ligament sprain in the ankle? a.) Calaneocuboid ligament, b.) Calcaneofibular ligament, c.) Tibiotalor ligament, or d.) Anterior talofibular ligament

2. Which tendon injury gets confused with lateral ligament sprains? a.) The flexor hallucis longus tendon, b.) The achilles tendon, c.) The fibularis tendon, or d.) The tibialis posterior tendon

3. Approximately how many ankle sprains occur each month in the United States? a.) 50,000, b.) 150,000, c.) 400,000, or d.) 700,000

4. Lateral ankle sprains occur most often to which population? a.) Elderly people, b.) Adults, c.) Teenagers, or d.) Athletic young people

5. The calcaneofibular ligament spans how many joints? a.) One, b.) Two, c.) Three, or d.) Four

6. Which test is the primary test when determining if the calcaneofibular ligament is injured? a.) Passive supination, b.) Passive Inversion in dorsiflexion, c.) Passive eversion in dorsiflexion, or d.) Passive pronation

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AnatomyAnatomy

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The Primary Ankle LigamentsThe Primary Ankle Ligaments

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The True Ankle JointThe True Ankle Joint

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The Subtalar Joint of the AnkleThe Subtalar Joint of the Ankle

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The calcaneofibular ligament is under greater tension when the foot is dorsiflexed

The calcaneofibular ligament is under greater tension when the foot is dorsiflexed

AssessmentAssessment

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The History FirstThe History First

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SymptomsSymptoms

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Other SymptomsOther Symptoms

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Assessment TestsAssessment Tests

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1. Passive inversion of the heel in dorsiflexion

2. Passive dorsiflexion

3. Passive plantarflexion

4. Heat test

5. Alignment check

6. Palpation

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Passive Inversion of the Heel in Dorsiflexion

Passive Inversion of the Heel in Dorsiflexion

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Passive Dorsiflexion Passive Dorsiflexion

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Passive Plantar FlexionPassive Plantar Flexion

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Heat TestHeat Test

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Alignment CheckAlignment Check

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PalpationPalpation

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PalpationPalpation

PalpationPalpation

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TheoryTheory

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Calcaneofibular Ligament SprainPositive Tests

Calcaneofibular Ligament SprainPositive Tests

MI: Passive Inversion of the heel in dorsiflexion is painful (this is the major indicator)

AUX: Passive Dorsiflexion of the ankle is painful and often limited

AUX: Passive Plantarflexion of the ankle is painful and often limited

AUX: Heat Test is positive. The injured ankle is often hot or at least warmer then the other one 26

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Passive SupinationPassive Supination

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Calcaneofibular LigamentCalcaneofibular Ligament

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Calcaneofibular LigamentCalcaneofibular Ligament

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Calcaneofibular LigamentCalcaneofibular Ligament

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Calcaneofibular LigamentCalcaneofibular Ligament

Fibularis/Peroneus TendonFibularis/Peroneus Tendon

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Resisted EversionResisted Eversion

Two Varieties of Ankle SprainTwo Varieties of Ankle Sprain

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Most Ankle Injuries Occur in SportsMost Ankle Injuries Occur in Sports

• 700,000 per month

• 11 Million per year

• 700,000 per month

• 11 Million per year

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How it HappensHow it Happens

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Stirrup Muscles

Tibialis Posterior & Fibularis Muscles

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How it HappensHow it Happens

• Jumping

• Running

• Soccer

• Basketball

• Football

• Racquet Sports

• Jumping

• Running

• Soccer

• Basketball

• Football

• Racquet Sports

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TreatmentTreatment

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Friction TherapyFriction Therapy

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Calcaneofibular Ligament FrictionCalcaneofibular Ligament Friction

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Myofascial TherapyMyofascial Therapy

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PICTURE

Massage TherapyMassage Therapy

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Exercise TherapyExercise Therapy

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Exercise TherapyExercise Therapy

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Exercise TherapyExercise Therapy

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Exercise TherapyExercise Therapy

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AIS Ankle Exerciser AIS Ankle Exerciser

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Exercise TherapyExercise Therapy

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Exercise TherapyExercise Therapy

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QuestionsQuestions

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Facebook.com/DrBenBenjaminFacebook.com/DrBenBenjamin

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Post-testPost-test1. Which is the second most common ligament sprain in the ankle?

a.) Calaneocuboid ligament, b.) Calcaneofibular ligament, c.) Tibiotalor ligament, or d.) Anterior talofibular ligament

2. Which tendon injury gets confused with lateral ligament sprains? a.) The flexor hallucis longus tendon, b.) The achilles tendon, c.) The fibularis tendon, or d.) The tibialis posterior tendon

3. Approximately how many ankle sprains occur each month in the United States? a.) 50,000, b.) 150,000, c.) 400,000, or d.) 700,000

4. Lateral ankle sprains occur most often to which population? a.) Elderly people, b.) Adults, c.) Teenagers, or d.) Athletic young people

5. The calcaneofibular ligament spans how many joints? a.) One, b.) Two, c.) Three, or d.) Four

6. Which test is the primary test when determining if the calcaneofibular ligament is injured? a.) Passive supination, b.) Passive Inversion in dorsiflexion, c.) Passive eversion in dorsiflexion, or d.) Passive pronation

1. Which is the second most common ligament sprain in the ankle? a.) Calaneocuboid ligament, b.) Calcaneofibular ligament, c.) Tibiotalor ligament, or d.) Anterior talofibular ligament

2. Which tendon injury gets confused with lateral ligament sprains? a.) The flexor hallucis longus tendon, b.) The achilles tendon, c.) The fibularis tendon, or d.) The tibialis posterior tendon

3. Approximately how many ankle sprains occur each month in the United States? a.) 50,000, b.) 150,000, c.) 400,000, or d.) 700,000

4. Lateral ankle sprains occur most often to which population? a.) Elderly people, b.) Adults, c.) Teenagers, or d.) Athletic young people

5. The calcaneofibular ligament spans how many joints? a.) One, b.) Two, c.) Three, or d.) Four

6. Which test is the primary test when determining if the calcaneofibular ligament is injured? a.) Passive supination, b.) Passive Inversion in dorsiflexion, c.) Passive eversion in dorsiflexion, or d.) Passive pronation