The body creates scar tissue as a kind of glue to hold damaged tissues together after an injury or surgery. While immensely helpful in the recovery process, scar tissue can build excessively following an ankle injury or surgery, restricting mobility in your ankle. Physical therapy plays an important role in your recovery from ankle injuries and surgeries by focusing on the safe recovery of motion. Restoring mobility with massage, joint mobilizations and exercise can help prevent the formation of excessive scar tissue.
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Soft Tissue Techniques
Physical therapists use soft tissue techniques, such as massage, to maintain mobility in the muscles surrounding the ankle. Effleurage massage is a gentle, lightly stroking technique and petrissage massage is deeper, with a kneading action. Both aim to stimulate blood flow to prevent the buildup of scar tissue. Myofascial release, another soft-tissue technique that is widely employed by physical therapists, involves scanning the muscles with the hands and applying forces to address areas of restriction. Sometimes, physical therapists can teach you additional soft tissue techniques to perform at home, such as foam rolling.
In many cases, the most stubborn scar tissue forms in the ankle joint itself. When this occurs, a physical therapist will perform joint mobilizations to restore the movement in the joint. Joint mobilizations involve a physical therapist passively moving one bone in relation to another to create improved motion in your ankle. What you think of as the ankle actually consists of several joints, so your therapist may need to perform several types of joint mobilizations throughout your ankle to restore your mobility.
Stretching and Stability
Stretching and stability exercises are important components of a physical therapy program to address ankle scar tissue. Stretching ensures that tight muscles surrounding your ankle are fully lengthened so they cannot limit your range of motion. No matter how much range of motion is gained, your ankle will quickly stiffen unless you stabilize it. Your physical therapist will likely recommend stability and strengthening exercises in a weight-bearing position. Some examples include toe raises, heel raises and balancing on your affected leg.
The specific physical therapy you receive to address your ankle scar tissue varies depending on the nature of your ankle problem. If you had surgery, the surgeon is likely to provide a protocol to guide your gradual return to activity and ensure protection of your ankle. In the case of a simpler injury, such as a non-operative fracture or ankle sprain, your physical therapy may progress more quickly and aggressively. It is important to consult your physical therapist or doctor for recommendations that apply to your specific situation as physical therapy is not a do-it-yourself project.
REFERENCES & RESOURCES
- Columbia University Medical Center Department of Dermatology: Scars
- Journal of the American Physical Therapy Association: A Randomized Controlled Study of Accessory Joint Mobilization on Acute Ankle Inversion Sprains
- Journal of the American Physical Therapy Association: The Biology of Scar Formation
- Journal of the American Physical Therapy Association: Physical Therapy Management of Patients with Total Ankle Replacement
- Journal of Athletic Training: Myofascial Release as a Treatment for Orthopaedic Conditions: A Systematic Review
- North American Journal of Sports Physical Therapy:The Role of Massage in Sports Performance and Rehabilitation: Current Evidence and Future Direction
- Physiopedia: Massage
- American Academy of Orthopaedic Surgeons: Foot and Ankle Conditioning Program
- Kaiser Permanente Physical Therapy Department: Home Program for Ankle Exercises