抝柴（腳踝扭傷）可大可小 Ankle Sprain Part 1

相信一個有運動或跳舞習慣的人，一定見過或親身經歷過腳踝扭傷(Sprain ankle)。
No matter people who do sports activities and/or dance class, would probably experienced or saw someone sprain their ankle. It is one of the very common sports and dance injuries.

Reference: http://tribong-upos.xanga.com/747824693/the-price-of-a-sprained-ankle/

而就算沒有運動的人，如各位愛美的女士們，穿高根鞋也可能會扭傷腳踝。
Even if people who do not exercise, may sprain their ankle, e.g. sprain while wearing ill fit and poor design high heels.

在美國每年有過百萬人因腳踝扭傷而需要做物理治療，甚至做手術。

In the US, millions of people attend to physiotherapist after sprain ankle. Some of the cases with complete ligament torn or bone fracture, surgery is needed to fix the problem.

就我個人臨床所見，很多香港人都小看了這個問題而使之形成了慢性病患及問題，甚至影響日常活動，例如日常走路或上落樓梯等。有時因為活動要千就傷患而影響膝關節甚至腰痛。
不用說會影響跳舞或運動表現水平。

As a physiotherapist, I see many people especially asian who do not treat ankle sprain seriously, (immediately and properly) and ended up becoming a chronic long term problem with persistent pain and limited ankle movement, with recurrent injuries. Most of the time it affects walking gait pattern. Some of the patient will develop compensate pattern and affect knee joint and even induce low back pain. Certainly it is going to affect their sports and dance performance.  .

很多朋友都會問我：“拗柴洗唔洗睇醫生呀？” 
A lot of people will ask me, "Do we need to see medical profession for just ankle sprain?"

有些跳芭蕾舞的病人又會問我：“點知有無骨裂? 要唔要照X﹣Ray？”

Some dancers will ask, "How do I know if there is fracture? Do I need to do X-ray?"

有些病人也會問我：”拗柴係咪拗過又會再拗？"
A lot of my patient will ask, "Why is ankle sprain always recurrent? I sprained the same ankle again and again."

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也有些病人會向我抱怨：“拗過柴之後，感覺隻腳硬係無以前咁好？” 
Also some patients will complain, "The ankle feels not as good as before, e.g. the strength, flexibility and balance was poor."

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其實腳踝扭傷是有臨床分級。即是嚴重程度的分級。今天我會主要為大家講解如何分辨“腳踝扭傷的臨床分級”。

Actually there is different Level/Degree of Ankle Sprain. Medically we classified ankle sprain into different degree of severity. Today I am going to explain it into details.

知道級別便可以：

1. 決定是否需要看醫生及物理治療師

2. 是否需要照X光
3. 要休息多長時間才可以再次運動或跳舞

When you know how to differentiate the degree of ankle sprain, 
you will be able to know whether you need
1. To attend to medical professional e.g. physiotherapist
2. To take X-Ray
3. How long time to rest before you can return to sports and dance activities.

最後都會解釋物理治療如何幫你的腳傷更快更好地康復， 
及腳踝關節位置(alignment)回復正常。
Lastly, I will explain how physiotherapist can help you to recover better, quicker with good ankle joint alignment .

另外也必需提到一點， 就我個人臨床所見：跳舞，尤其跳芭蕾舞的人，踝關節扭傷時多數會比一般人嚴重。
Also as a Dance Physiotherapist, when comparing the same ankle injury mechanism, dancers usually may injured more severely.

這是因為跳芭蕾舞的人踝關節會比一般人鬆，亦即相對上關節的穩定性比較弱。
This can be caused by the hyper mobility of the ankle joint comparing with normal people.

我在往後的題目會繼續詳細討論跳芭蕾舞的人如何保護比一般人鬆的腳踝關節，今次先回到常見的腳踝扭傷種類及臨床分級的主題。

In the episode later, I will continue to talk about how to protect a hyper-mobile ankle of dancers. Let's start to talk about the classification in this episode first.

腳踝扭傷可主要分為：
Types of ankle sprain:

1．向內扭傷 Inversion Ankle Sprain

2．向外扭傷 Eversion Ankle Sprain

3．高位扭傷 High Ankle Sprain (中文名是暫譯)

Reference: http://legacy.owensboro.kctcs.edu/gcaplan/anat/notes/Image577.gif

而我所見的腳踝扭傷是有第4種：
As I found in the clinic, for Dancer's ankle sprain, there is a 4th type of sprain,

4．跳芭蕾舞中足尖舞常見，先向內再向外扭傷: Sickle in and then out
4.  It happens usually when performing high demi point, dancers accidentally sickle in and then out.

Ankle Sprain when high demi pointe or en pointe, Inversion Sprain followed by Eversion Ankle Sprain when en pointe or demi pointe. It happens because of the hypermobility of the ankle joint. It sometimes involve fracture of the 5th metatarsal bone.

一般來說，向內腳踝扭傷(Inversion Ankle Sprain)是最常見的。
But the most common one if inversion ankle sprain.

腳踝扭傷主要分三級：

The severity of the ankle sprain can be divided into 3 grade.

Reference: http://www.beantownphysio.com/pt-tip/archive/ankle-sprains.html

第一級 Grade 1	輕微疼痛、腫脹，關節仍穩定，仍可正常走路。 受影響結構：韌帶拉傷及輕微斯裂 Slight pain and swelling, ankle is stable and walking is capable Structure involved: Slight Ligament inflammation
第二級Grade 2	中等程度疼痛、腫脹，關節活動略受影響（有”關節錯位“及不穩定），走路有些 困難，踝關節有輕微不穩定。 受影響結構：韌帶有中等程度斷裂 Moderately painful, swelling and ankle movement is restricted (ankle alignment is changed and not stable), difficulty walking and unstable ankle joint.  Structure involved: Ligament moderately partially torn and inflammation but still intact Reference: http://orthopedics.ygoy.com/ankle-sprain-grades/ 第二級腳踝扭傷，次日會出現瘀傷。 For Grade 2 ankle sprain, there will be hematoma in the next day in the morning, which knows like bruising, but actually it is the bleeding of the soft tissue and the blood is drain to the lower part of the ankle due to gravity. So the "bruising part" is usually not painful to touch.
第三級Grade 3	嚴重疼痛及腫脹，關節不穩定，無法走路，關節活動 度大受限制。 受影響結構：韌帶高程度斷裂或完全斷裂，甚至有骨節 Severe swelling, edema, unstable ankle joint, walking is impossible and ankle joint movement largely restricted.  Structure involved: ligament partially or complete tear, maybe fracture of bone Reference: http://www.drugs.com/health-guide/ankle-sprain.html  Reference: http://www.bone-and-joint-pain.com/treating-ankle-sprains.html 第三級腳踝扭傷，一般會有水腫(edema)及次日開始出現瘀傷。 For Grade 2 ankle sprain, there is massive edema and hematoma around the whole ankle. 此情況一定要照X﹣RAY。有時骨頭輕微斯裂，受傷當日第一時間照片未必見到。 但如果大量水腫持續超過一星期，便建議再照X﹣RAY確診。 In this case, X-ray is needed. Sometimes "Hairline" fracture cannot be seen in the X-ray taken in the injury day. If edema persists more than 1 week, another X-ray is needed to confirm if there is any fracture. 所有下肢骨折都需要最少5星期完全休息。 For all lower limb bone fracture, we will need at least 5 weeks complete rest  for the bone to heal.

所有腳踝扭傷都需要最少三星期完全休息，給時間使韌帶傷口復原，才可以考慮重回活動。
For all ankle sprain, we need at least 3 weeks complete rest from any exercises for the ligament to heal. 

下一節會教大家：

1. 腳踝扭傷後有什麼事情在頭48小時不應該做 及 需要做以減輕傷勢；

2. 一般市民錯誤處理筋骨受傷的後遺症；

3. 如何可以幫助腳踝更快復原及；

4. 如何預防下一次腳踝扭傷的機會。
In  part 2, we will talk about:
1. What should be done in first 48-72 hours to help the ankle to heal better and what should not be done
2. What is the common myth about ankle sprain and how it affects healing
3. How to make ankle sprain better quicker
4. How to prevent ankle sprain recurrent.

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