Ligament tears & sprains

Cooling and elevating take away swelling and pain. Complete immobilisation, in contrast, weakens: loading within the pain-free range, from the first day, heals faster than resting.

For four to six weeks a stabilising support or brace that prevents twisting but allows bending and stretching. That is the rule today — a cast only with bone involvement.

The commonest reason for the next twist is the lost sense of position in the joint. Standing on one leg, two to three minutes per side daily, over three months — that lowers the risk measurably.

Not every twisted ankle needs a picture. It becomes necessary if one cannot take four steps directly after the accident and at the practice, or if certain bony points are tender.

It is not the date that decides but the function: hopping on one leg without pain and without giving way, at least ninety per cent compared with the other side. Anyone coming back earlier gets injured again more often.

Painkillers and cooling make possible the movement healing needs — the ligament itself heals over six to twelve weeks by itself, if the ends are in contact. Anti-inflammatories are taken for the first days; over weeks they could delay the ligament’s remodelling. A brace stabilises and allows the foot to roll at the same time; full immobilisation in plaster gives worse results in comparisons.

An ankle ligament tear is among the most common injuries of all: about one case per ten thousand people a day. Swelling increases for six to twenty-four hours. A mild tear bears weight after two to four weeks, a complete one after six to twelve. Ligament stability is only back to normal after three to six months — which is why re-injury is most common in the first year. Balance training over six weeks lowers it measurably.

In front of the new cruciate ligament a nodule of scar tissue can form, the cyclops lesion. With symptoms it occurs in 1.9 to 10.9 per cent of those operated, mostly in the first months. The typical sign: the last degrees of extension are missing, sometimes with a click when straightening. If found, it can usually be removed arthroscopically. After several procedures on the same knee, more general scarring is also possible. How to follow swelling and extension yourself is under Meniscus tear.

A twist or a turn, often with an audible crack, then immediate pain. How it happened says more about which ligament is involved than any examination days later.

A very rapid, tense swelling speaks for bleeding into the joint and thus for a larger injury. Swelling that only comes the next day is usually more harmless.

Whether four steps are possible, right after the event and at the appointment, together with a few tender points on the bone decides whether an X-ray is taken. That is a recognised rule and spares many the image.

A feeling of insecurity on uneven ground, repeated giving way, a knee that slips when turning. This instability after weeks matters more than the pain and decides what follows.

An injury produces no high inflammatory values. A hot, strongly swollen joint with fever is something else and tolerates no delay.

A suddenly swollen, reddened joint without a remembered accident is more a gout attack than a ligament injury.

Under blood-thinning treatment an injured joint fills with blood more quickly. That changes immobilisation and follow-up.

Without vitamin D only a fraction of the calcium from food is taken up. It is the value that is most often too low with bone and joint complaints.

The building material itself. Better from food than from a tin: hard cheese, yoghurt, calcium-rich mineral water, almonds, broccoli and fortified plant drinks.

Activates the proteins that build calcium into bone. Green leafy vegetables and fermented foods cover it — under coumarin blood thinning the amount stays steady rather than swinging.

Bone is a third protein scaffold, and the muscles that hold it need protein too. In older people too little protein is more common than too little calcium.

Needed for building calcium in and for vitamin D to work. A lack slows both — even when calcium and vitamin D are supplied in sufficient amounts.

Ligaments are mostly collagen, and without vitamin C it does not cross-link stably. 100–200 mg a day covers the need; more does not speed healing.

10–15 g an hour before the exercise session is the frame studied in small trials for ligament complaints. What actually carries the healing is the staged loading over 6–12 weeks.

Clearly worthwhile and well studied when deficient; fewer data for the wider uses. Fat-soluble — check blood levels at high doses.

Effective when deficient; effects on sleep and stress plausible but moderate. Too much causes loose stool.

Women tear the anterior cruciate ligament several times more often than men, and in certain cycle phases the ligament is measurably more stretchable. No ban on training follows from that, but an argument for jump and landing training — which markedly lowers the rate in studies.

This hormone loosens ligaments — in pregnancy that is needed so the pelvis gives way. But it does not act only there: ligaments at the knee and foot are softer in this time too, and turning an ankle happens more easily.

Ligament tissue needs 6–12 weeks and collagen as building material; vitamin C is needed to cross-link it. 1.2 g protein per kg a day covers the need — in a good nutritional state supplements add nothing beyond that.

Nicotine narrows the small vessels supplying tissue that is already poorly perfused. In smokers healing takes noticeably longer on average.

After an ankle ligament tear balance training is decisive — it clearly reduces repeat sprains in studies. 6–12 weeks is the studied period.

Listed values: 10 · 11 · 12 · 13 · 14 · 15 · 174 · 285 Hz

Listed values: 10 · 11 · 12 · 13 · 14 · 15 · 174 · 285 Hz