Okay, here's the scenario.
You're out doing some yard work, you're going out for your morning jog, or you get hurt
in an athletic event.
Suddenly, you're in pain.
You have no idea what happened, maybe it's a muscle, a joint, or even a bone.
All you know for sure is it really hurts, and you've got to see a doctor.
You take the first available appointment and hope for quick relief.
The doctor whisks you in, conducts the necessary test, and soon you're on your way with a diagnosis,
a prescription, some type of support wrap, and maybe even some type of protective device.
When you're finally out of the initial pain, the questions begin to pop into your head.
What just happened?
What were the tests the doctor used?
Is there anything else that I can do to help myself?
Can I prevent this from happening again?
Hi, I'm Jim Clover.
I'm a certified athletic trainer.
I'm the coordinator of the sport clinker, Riverside, California.
I teach athletic training classes at Riverside Community College, University of California,
Riverside, California Baptist College, and also the Riverside County Office of Education.
I've had a lot of experience working with athletes of all ages and others who have suffered
painful injuries, and I've suffered a few myself.
I've found that situations like this, the medical practitioner does a great job of evaluating
slash diagnosing an injury, but it's sometimes hard for you, the patient slash athlete, to
remember everything that is said, or even to ask the right questions.
When you're in this type of pain and stress, this video is designed to help you.
We'll explain some basic anatomy and terminology used to describe the injuries, and this way
you'll have a better understanding of what the physician and the medical practitioner
has told you.
And because you can stop and review this video as many times as necessary, you'll be able
to use this information to help yourself heal and get back on the road again.
We'll even visit with a well-known orthopedic surgeon, Dr. Jerome Wall, to find out about
the tests the doctors use as far as the diagnosis of the injury, the medications available to
treat them, along with other things that are very pertinent when we talk about these injuries.
Finally, I'll show you some exercises that will help to make the injury site strong again,
plus some ideas about how you can protect the area from another injury.
But remember, always check with your family physician or a qualified medical practitioner
first regarding the injury and the treatment.
And if any time along the way the injury is not getting any better or seems to be getting
worse, it's a great time to go back and see your family physician or a medical practitioner.
Okay, now what we're going to talk about, we're going to go ahead and look at the ankle.
The ankle, as far as all the different injuries, all the different joints in the body, is probably
the one that's most oftenly hurt, and probably everybody that you run into, one time or another,
has sprained an ankle.
So go ahead, and we'll start with the anatomy, because the anatomy is the baseline for everything
else that's going to go on in this video.
The first thing we're going to look at is the bones, and the first bone right here is
the tibia, and the tibia is a weight-bearing bone.
You may have heard before of somebody breaking a fibula, which is on the other side, and
it's a non-weight-bearing bone, whereas the tibia right here is a weight-bearing bone,
which is real important.
The next bone we'll look at is down here at the bottom, which is called the calcaneus.
A lot of people call that the heel bone, but for this information today, we're going to
go ahead and call that the calcaneus.
Then what we're going to look at is right back here in the back.
This is called the Achilles tendon.
This is where it attaches.
The Achilles tendon, like the word, it is a tendon.
So it starts at a bone, and it works up to the muscles, and the muscles will be the gastroc
soleus complex, which we'll see just a little bit.
Then one of the first ligaments on the inside here is the deltoid ligament.
It's a huge mass of ligament that's here right on the inside.
This very seldom, only maybe, say, three to five percent ever gets sprained.
The other side is a bigger problem, though.
This is on the lateral side.
The lateral side of your foot or the outside part of your foot.
There are a couple ligaments that we're going to look at.
There are many, many ligaments in the ankle, but we're only going to look at the ones that
probably get sprained more often.
The first one is right here, and this is the anterior, like it says here, the tibiofibular
ligament.
The ligament goes from bone to bone.
The next one we'll look at is right down here, as you can see, is right in here, is the anterior
ligament, followed by the third one is right down here in the bottom is a calcaneal fibular
ligament.
Okay, those are the main ligaments in the ankle.
Now what we're going to do is we're going to go ahead and look at the musculature of
the ankle.
On the front or the anterior, start picking up on these words, anterior is the front.
The one that's right back here and cuts right around the ankle or the malleolus bone is
the perineus, longus, and brevis, as you can see.
The next one in the front is the tibia anterior, I'm sorry, it's the tibia anterior, and what
this does, this helps to bring the foot up.
This is the one that brings up.
In a lot of situations we run into, everybody works the muscles in the back of the foot,
back here, but they never do anything to the muscle in the front.
That's a lot of problems, and we're going to see it more when we talk about the rehabilitation.
Now on the back side are the two muscles that we were talking about, and we have the gastrocnemius
and the soleus complex.
The gastrocnemius is the big muscle on the outside, whereas the soleus is the muscle
that's underneath.
Now there's going to be some keys between those two muscles when we talk more in the
athletic training room in just a second.
But those are the main muscles that we have here.
Now what we're going to do is we're going to go to the training room and we're going
to talk about some specific injuries and then go into the rehabilitation.
Hi, how you doing?
Now here's some words that you need to be familiar with, and we're going to start with
the very top.
The first word I want you to be familiar with is called a sprain.
A sprain has to do with a ligament.
A ligament goes from bone to bone.
As you recall with the first things we had, the anatomical pictures, a ligament goes from
bone to bone.
And these are the three ligaments that we're kind of concerned about.
Now as you recall also, a ligament goes from bone to bone, and it's like a piece of leather.
Once you stretch a ligament, the ligament never goes back to the original place.
And that's the problem that you run into.
That's why when we get a little bit farther and we talk about the rehab, that's why the
strengthening of the muscles is very important.
There are three different degrees of sprains of first, second, and third, i.e. one, two,
three.
The first degree is there's going to be a point tenderness, there's going to be a little
bit of swelling, and there's not going to be any increase as far as range of motion.
In other words, when I do the testing on this ankle, it's not going to move at all, which
is a good idea.
Grade one sprains, most generally after you sprain it, you can go right back and maybe
play some more ball after about five, ten, fifteen minutes.
Now grade two is more severe.
Everything gets worse.
The swelling gets worse, you can't move the ankle anymore, you have a lot more pain, and
the biggest key is that when we test the ankle, there's an anatomical stuff box right here
smack dab in the middle.
If I grab the calcaneus, as you recall from the formerly, is I'll try to slide it forward.
On a grade two, what will happen is the ankle will slide forward, but there is an end point.
Whereas with a grade three, which is the next phase, everything is exaggerated from grade
two.
We have more swelling, more deformity, and when we slide it forward, there is no end
point.
So that's a huge key.
So when you're a physician, when you go see your doctor and he talks about a grade three,
a grade three is a very, very bad sprain.
Now the other concern that I always run into when I talk about a sprain is that you could
have a fracture, and the fracture type that they're concerned about mostly is the one
that's called an avulsion fracture.
An avulsion fracture is that you have the ligament attaches to the bone, as you recall.
Now what happens is the ligament pulls off a piece of the bone.
That's called an avulsion fracture.
That's a very small fracture, but that's a big problem.
The other type of fractures that you could have is that you could have a complete fracture,
you could have an open fracture, closed fracture, many different kinds of fractures.
The next thing that we're concerned about is a strain.
Now a strain has to do with a muscle and tendon junction.
Now as you recall, we start with the muscle, go to the tendon, and then go to the bone.
In the Achilles, one of the best ones to look at is you have the gastroxilius complex, goes
right into the Achilles tendon, and then pops right in there at the calcaneus.
Now if you strain that, what goes on is that you stretch the fibers either from the muscle
or the tendon, and once you stretch them, they go back together again, and they build
up scar tissue.
The problem that you run into is that the scar tissue builds up real tight, and now
every time that you stretch, you can re-tear those things, and the length also shortens,
and you lose a little bit of elasticity.
Now there's two other words that I want you to be familiar with.
One is called acute.
Acute means that it just happened, okay, whereas chronic means it happened or it's been around
for a long period of time.
Now some other injuries that we're concerned about here is one is shin splints.
Shin splints is a catch-all word, you hear it all the time, every place you go, somebody
at one time in their life had some shin splints, and where the pain is, it's going to be up
here in the front, around the tibia anterior, or on the inside.
The concern that we run into here also is that you could have a stress fracture.
A stress fracture would be right where the muscles and the tendon go together, and what
will go on, it's like having a hanger, and you bend it back and forth, bend it back and
all of a sudden it starts to feel hot, and then it breaks.
That's what happens with a stress fracture.
The other key behind this is that if you have a stress fracture, it's not going to show
up on the x-ray for at least three weeks, and the reason for that is because it's such
a small fracture, and you have to have a little bit of a calcium buildup before it'll show
up on the x-ray.
Some other problems you'll run into as you get older, when you're young, like Aisha,
you'll have Achilles tendonitis, and Achilles tendonitis is an overuse, and then as we get
older, where that Achilles tendonitis buildup, buildup, buildup, we have scar tissue there,
and now we get into what they call the Achilles tendon rupture, and that's when this whole
thing will sever.
You'll hear people talk about it, it sounds like somebody hit them over the back of the
leg with a baseball bat.
It's a terrible, terrible injury to go through, and that's one of the problems that we run
into from there.
You can run into all kinds of tendonitis from behind the back here, and like I said before,
tendonitis is, once again, you go back to the leather scenario, it's like if I had a
piece of leather right here, and I go back and forth, back and forth, on the underside
of the leather, there's all kinds of micro tearing, that's what tendonitis is.
So now what we're going to do is we're going to go ahead and change the training room around
a little bit now, and we're going to go and show you some first aid hints.
Okay, now we're going to go over some basic first aid, once you have the sprain or the
strain.
It goes back to the acronym ICE, or ice, which is ice compression elevation.
We're going to try to do those three things right here today.
We also have a younger athlete today as compared to the older ones we have a lot of times in
these sets, and the reason for that is to show you that as far as the first aid, there's
really no major differences at all.
What we're going to do is we're going to go ahead and put on the Kramer wrap, and this
is done.
We always start from the bottom and go towards the heart, so whenever we put on the Kramer
elastic wrap, we always wrap it this way.
When I'm doing this right after the injury, I'm going to go ahead and wet down this a
little bit.
That way it'll add a better conductor as we go through here.
So we'll start from the toes.
How tight do we put this?
The biggest concern we have is that when we squeeze our toenails, that the blood comes
back.
If the blood doesn't come back, well, we have some problems and we're going way too tight.
And the other way to find out is you just kind of ask them, is this too tight?
And eventually they'll say something, I guarantee you.
So we'll go ahead and we'll put down one layer of this on, and then we'll either use one
or two of the Kramer products, and one is the Flexi-Cole, which is I think everybody
has this in their freezer someplace or another, which is a great idea to have.
And you just, when you're spraying an ankle or something, you just put this down right
on top.
Or the Kramer's new product, which is called Duo-Temp, and Duo-Temp is real interesting
in as far as what it does is once you put this in a sink, you fill it up with water,
and then you can throw it in the freezer, and once it's in the freezer, it will freeze
and become ice, or you can throw it in a microwave, and once it's in a microwave, it can then
become a warm wrap.
So then we go around all the way to the top, and then come back down.
When do we use the heat?
When do we use the cold?
Well, the cold is the first 24 to 48 hours, or until the swelling has stopped or subsided,
and then we use the heat as soon as the swelling has completely subsided, and that's when we'd
use that.
So we just put this down here exactly like that.
Okay, now once we let this on, we leave it on for no longer than, say, 20 to 30 minutes.
We keep it elevated.
When we do the elevation, it's above the heart, and then once we take it off, one of the things
that we are able to do, or one that we highly recommend, is that the idea behind the ice
is to keep the swelling down or not to have it come back.
Once we take this off, we can then get some felt or some foam, and we make these U-shaped
pads right around both of the malleolus, or the ankle bones, and then we go ahead and
take the Kramer elastic wrap and wrap it back up again for the rest of the day, along with
elevation.
This is the best way how to take care of the basic first day from the start.
And one more bit of information that's very important is that you're going to ice it for
the 20 to 30 minutes, then off for an hour, then you'll ice it again for 20 to 30 minutes
during the waking hours.
When you're asleep, you go ahead and put the Kramer elastic wrap on, and you'll be fine.
Make sure that you understand the tightness of that.
If they go to sleep and it's way too tight, it's going to be a bad situation, so probably
in most scenarios, I'd probably tell you to go ahead and leave the Kramer elastic wrap
off overnight.
Now what we're going to do is we're going to visit with Dr. Wall, an orthopedic surgeon,
on some of the diagnostic evaluations and tests that the doctors use.
Thank you, Jim.
We're going to be talking about now our ankle injuries, and when do you see the doctor?
Well, basically, everyone has the right to see a doctor anytime they so choose, but normally
we recommend at least a conservative program is tried before that.
However, if you would have a severe deformity or significant pain or your symptoms are really
not improving, that is a good time to see the doctor.
When you do so, the things that are important in determining what is going on is getting
a good history, the who, what, why, and where.
Once you know exactly what happened, where the pain is, you can better go on to the next
part of the evaluation, which is the physical exam, and examining the ankle, it is very
important that you look at all the areas, not only about the ankle, but also about the
upper leg, including the knee.
What will be done after a physical examination is to get some x-rays.
In this particular view we have here, we're looking at the ankle straight on, and this
is an ankle where you have the lower leg bone, which is the tibia.
You have the bone, which is the fibula on the outside, and then you have the talus,
which is one of the main ankle joint bones.
Normally what we do is we get various positions, because what we're looking for is to make
sure that the area in the ankle mortis, or the area which joins the bone of the talus
with the bone of the tibia and the fibula, are equidistant.
Many times when you have a bad sprain or strain, which Jim Clover talked about before, ligaments
can be disrupted.
In this particular diagram, what we're looking at are the major ligaments around the ankle.
The ligaments that are probably the most important and most commonly injured are those along
the outer side of the ankle.
What we're looking at here is the fibula, and we're looking at the ligament that attaches
from the fibula to the talus.
This particular ligament is by far the weakest of all the ligaments in the ankle itself and
is the most easily injured.
Typically that particular injury would occur when someone is walking forward or running
for that matter.
They step on someone else's foot or on a shoe and roll their ankle over, experiencing a
pain and pop in the front of the ankle.
Typically this is a relatively minor problem.
However, if the force is great enough as they're moving forward, what will occur is that you
will get a rolling over of the ankle.
On this model, we will take off the upper layer, which is to represent the skin, and
what we're looking at are the various tendons and ligaments, which we will remove for the
manner of this discussion, bringing into view the bony structures.
This again is the foot and the ankle region, the tibia and the fibula.
So what you'd be looking at is that if you're sustaining an inversion injury, what occurs
is the ankle rotates and what will occur is the ligament where my thumb is right here
would be stretched and then pulled apart.
Now if that force continues, the bone on the opposite side, which is the medial malleolus,
will fracture.
And what would that look like?
Well, if we look at an x-ray of the ankle, what we see is that the bone structure by
the talus, which is the ankle bone, has actually rolled.
It has ruptured the ligament here, but it has also created a problem with the fracture
and has pulled off a piece of bone.
In this particular case, this is a very significant problem, which needs to be treated by surgery
where you would insert a screw and a plate.
Again these are significant injuries and by far not the most common, but ones that we
typically see.
What about that individual who's had this inversion injury where they've turned their
but they don't have a fracture but they have persistent problems with giving way?
At that time, you would get an x-ray and what you would do is you would actually stress
the ankle joint and in this particular x-ray, you're looking at the normal right ankle putting
stress rolling in inward in the way the injury was caused and we can see that there's really
no opening.
However, on the left side, when we add the stress, the same way that we would do an inversion
the ankle mortis is opened up indicating a chronic instability that can occur in the
ankle.
The other problems that we need to discuss are the injuries where you don't have a complete
fracture but rather an avulsion, meaning that you actually pull a fragment of the bone off
and by far, it's a very common problem as you get a little older and you have some ankle
problems and you go to the doctor and they say you've broken your ankle before and the
answer would be no, you don't recall that but what occurs is that where the ligaments
attach, there is a small area of bone right at the very tip or at the very margin where
the tip of my finger would be and what happens is that when you have this stretching or pulling,
a part of the bone actually comes off and that would be an avulsion type of fracture.
Another potential problem that we see, especially in runners, are stress fractures.
Recently we had a young man who has been training for the Boston Marathon and right
before the major race, he seems to want to increase his mileage and then develops pain
in the lower leg and what can occur is that the constant repetitive trauma can actually
cause a fracture.
When you have a difficulty like that, one of the ways of diagnosing that is by getting
a bone scan and in this representative bone scan, what we're looking at are views about
the knee and in this particular area where we see the area is darker, that indicates
there's been an increase in vascularity and what that can indicate in this lower portion
of the tibia, I'm sorry, the upper portion of the tibia is that there actually is a stress
fracture which you will not see by x-ray but only by the bone scan.
In treatment of ankle and lower leg injuries, one of the most important things is maintaining
muscle integrity and tone.
If you do have a fracture, the extremity has to be casted but we cast them for a lot
shorter period of time than we did before.
We also want to get the individual moving so we use range of walker boots and by using
this range boot, we can actually allow the foot and ankle to start moving.
The other activity again is the surgeries we talked about.
The surgeries would be indicated only when you would have a situation where you have
instability of the ankle or the bony structures.
If you have a tendon that's ruptured that's of major importance in stretching and strengthening,
you would also want to consider repairing that particular structure.
But by and far, the most important thing is getting the individual back to the highest
level of function in the shortest period of time so they can go on with their life
and their sports activities.
Thank you, Dr. Wall.
That was some great information and very usable information.
Now what we're going to do is we're going to go ahead and to get into different phases
of rehabilitation.
There are three distinct phases of rehabilitation.
They kind of all intermingle together.
The thing that you must understand with this is that when you talk about first, second
and third degree sprains, they really don't correlate with the phases.
Say for example, you have a first degree sprain, you could make through all the phases in one
to two days.
Where say for example, if you have a grade three sprain, it could last anywhere from
six months to a year.
That's where the differences are.
What we need to do now is we need to think about phase one.
A couple things we have to have happen here at phase one.
One is we want to increase the flexibility and the next thing is we want to start some
strengthening exercises and the strengthening exercises that we're going to use is called
isometrics.
Isometric means that there's a contraction without any motion.
So what we're going to use, we're going to use our young athlete here and we're going
to have her push in four different directions.
Now with my high school athletes, what I have them do is before every class period, I'm
going to have them do a set of ten.
That way if they have six class periods in a day, we're going to have them do six sets
of ten.
So in this situation, I'm going to go ahead and have her count to five.
So we start here on the outside.
I'm going to go ahead and move out here.
Now go ahead and push out this way Sydney.
Go ahead and count.
One, two, three, four, five.
Now we're going to go ahead and push up.
One, two, three, four, five.
Good.
Now we push in.
One, two, three, four, five.
And the last one is we go ahead and push down.
One, two, three, four, five.
Good.
Now as you can see is that everybody kind of speeds up and slows down.
If I ask somebody to do it for a count of five, what I'll do is if I want them to do
five seconds, I'll ask them to do ten and then hopefully we'll make it the same.
Now we're going to try some flexibility and the way this flexibility works is we'll go
ahead and have this foot forward, this foot back.
There you go.
And now we're going to have them stretch two different muscles.
One is the gastrocnemius, which is this big one here.
That's when the leg's straight.
It should keep her heel on the ground, toe pointed forward.
That's the gastrocnemius.
The second muscle is when we go ahead and bend the knee a little bit.
When we bend the knee, now it's the soleus, okay?
That's the muscle underneath.
Thank you very much.
Go ahead and sit down.
Very good.
After each one of these, if we have a good workout with phase one, we'll go ahead and
ice it down for ten to fifteen minutes afterwards.
Now we'll go into phase two.
Phase two, we're going to try to do some more strengthening and the way that I've found
it works really good as far as strengthening is that we'll go ahead and try a little surgical
tubing.
What we're going to do is we're going to go ahead and lasso around her toe and the more
I pull this out, the more resistance she's going to have.
Her heel will stay straight and then she'll go ahead and pull it out.
So go ahead and pull it out and then back slowly.
Now what a lot of kids will do, or athletes or anybody, is they'll bring it back fast.
But as you can see here, it's out slow, back slow.
You'll get as much strength gain coming back in as you do going back out.
Good.
Now what we'll do is we'll go ahead and take it to the other side so that will strengthen
the muscles on one side.
Now we'll do it on the other side.
So go ahead and pull out.
Good.
Very, very good.
You can tell she's done this some time before.
Now we'll go ahead and we'll do the gas pedaling and this is the one Aisha knows real well
is we'll take this up and then we'll have her push it down.
Good.
All the way up.
Good.
Up.
And now the exercise that very few people do but is very, very important, we'll lay
this along the top and we'll pull some resistance out and we'll have her push up.
This strengthens the muscle in the front which is the tibia anterior.
Too many times people forget about this.
Another way how she can do this, the tibia anterior, is when she's sitting in class or
around she'll go ahead and do a toe tap.
And as you're sitting there at home right now, if you start doing some toe taps it won't
take you but say 15 seconds until you have that thing fatigued out.
Now some different protective devices that Kramer has are what I have back here.
Now we have the lace up ankle braces and this one here has some metal stays around the outside.
This is a very good one.
Say for example you don't know how to tape an ankle, well this would be a great way how
to go.
The next way that you could go is that you could add the laces to it and this even adds
a little bit more support.
Remembering back to once that you sprain a ligament, the ligament stretches, it never
goes back to the original set.
So you need to use these kinds of products.
The next one which is one that Aisha uses is called the active ankle and this is the
one she has on right here.
This has a lot of support and she goes ahead and she plays basketball with it and track
and whatever else she wants to do.
It's a great piece of equipment.
You can also go back to the basic things and you can do the tape and the pre-wrap which
is another completely, another different video.
Then they have the sprain ankle orthotics.
This is a new product just made out by Kramer and the idea behind this is that when you
sprain your ankle and we're going to head and kind of play with this for Aisha is if
she steps down what she'll do is she'll step on somebody else's foot.
The ankle turns in.
What we want it to do is by using this orthotic with the foot it puts a little lift on the
inside so this way it makes it a whole lot tougher for the ankle to turn in.
It's a great product.
The last bit of rehab that we're going to have her do is that we forget about a lot
of times is the proprioception and balance so go ahead and stand up.
We'll have her stand on one foot and now what I'm going to do is we're working on
the balance and I'll go ahead and give her little taps in different directions and the
idea behind this is once you sprain your ankle you lose a lot of your proprioception and
balance.
This becomes like an eagle and it'll be able to claw down on the ground.
This is really important.
So go ahead and sit down.
Thanks.
Now what we're going to do is we're going to rearrange the training room a little bit
and then we're going to come back and take a good look at phase three, our final phase
of rehabilitation.
Now we're going to go into the phase three world.
The phase three world of rehabilitation has to do with going back to normal.
Normal may be anything from going back to your gardening to going back to that weekend
game of basketball to going back to activities.
Normal has to do with going back to normal strength, normal flexibility, normal endurance
which is a big key in phase three and also make sure that when you're doing all these
things that you have the proper protection on like all the Kramer products.
Now we're going to have Chris kind of walk through these things and they're a little
tough but we're going to go ahead and challenge them off.
One of the goals that we have here is we want to get back to the balance activity.
So the first thing we're going to do is we're going to have an X drawn out here on the
floor and we're going to go ahead and have him bounce around the square.
Works on proprioception, works on balance.
Now we'll go opposite corners and this is just a warm up.
If we were going through rehabilitation he would do this for a minute at a time cue.
Now what we're going to do is we're going to go ahead and do one foot and I'll go ahead
and help him bounce through this.
Now opposites, good.
Like I said another good exercise to do the same thing and I'm sure you've all done it
one time or another is using this with a jump rope.
A great way to go.
Now we're going back to the athletic move.
Whatever that athletic move is be it's you're a badminton player, a tennis player or a football
athlete.
What we want to do is Chris is a linebacker so go ahead and stand there.
I don't want you to run through me but I'm going to add some resistance to him so I want
him to find out how much resistance that foot goes.
Go ahead push.
Push off.
Push off.
Okay good job Chris.
Now let's go ahead in the last part what we want to do here is we want to get his confidence
up.
Part of phase three is to get your confidence up.
In other words what we want him to do is that when he goes back to his activity be it the
weekend basketball, be it football or whatever it is that when he comes across I want to
be able to make sure that he can take a hit.
We'll walk across and we'll just give him a little jar, boom.
This way what it does is it gets that confidence up and gets him ready to go out there and
play again.
Now what we've done here today is we have walked you through an ankle injury.
We started at the very beginning with we talked about the bones, the muscles, the ligaments
in the tendon.
Then we walked into the different injuries that we run into as far as an ankle.
Then we visited with Dr. Wall, an orthopedic surgeon and then we went into the different
phases of rehabilitation, phase one, phase two, phase three and out the door.
We also gave you some great ideas as far as products for ankles.
We have the different kinds of ice that Kramer makes.
We have the different kinds of protective devices that we use for the ankles to support
it because you have to remember that once you've sprained that ankle the ligament is
stretched forever.
So it's very important to keep those lace up ankle braces on.
So best of luck to you and we'll see you later.