Ankle Injuries

Ankle sprains are a very common ailment in the active population, whether it’s from playing netball, rugby or even chasing the kids in the park! Most people will try and self manage this themselves at home, however despite their best efforts, this isn’t always successful.

Types of ankle sprains:

The type of ankle sprain sustained is generally determined by the direction in which the ankle rolled or how the patient landed at the time of injury. Commonly there are three types of sprains:

• Lateral ankle sprains occur when the ankle rolls out (causing the sole of the foot to roll in). This damages the small ligaments on the outside of the ankle including the Anterior Talofibular (front), Calcaneofibular (side) and Posterior Talofibular (back).
• Medial ankle sprains occur when the ankle rolls in (causing the sole of the foot to roll out). This damages the ligament on the inside of the ankle – called the Deltoid ligament. This type of sprain is less common primarily due to the fact that the Deltoid ligament is thick and wide which makes it less likely to stretch and give under impact however if forceful enough, the deltoid ligament can certainly be injured.
• High ankle sprains – sometimes called a tib/fib or syndesmosis sprain occurs when there is a sudden upward force which ruptures or injures the ligament that holds the tibia and fibula together.

Ankle Sprain Grading

The severity of ankle sprains is graded in accordance with how much of the ligament has been damaged.

• Grade 1 (mild) – the ligament fibres have been stretched or there is a small tear
• Grade 2 (moderate) – the ligament has torn but not a complete tear
• Grade 3 (severe) – the ligament has torn completely

It is documented widely that ankle sprains, if not rehabilitated correctly, can create long term issues including ongoing balance or strength deficits, recurring sprains or ongoing pain.

Up to 33% of the population who suffer an ankle sprain will report ongoing issues, and up to 64% report that they never fully recover. In fact, 20% of the population between the ages of 18-65, report ongoing issues with their ankle that they attribute to an old injury.

Keeping these numbers in mind, let’s take a deeper look into what could be causing these long term issues, and how we can resolve them.

Following the acute phase of injury, it’s important to restore your ankle range of motion, poor proprioception and balance, and poor strength of the calf and peroneal muscles, all of which often have poor results following an ankle sprain.

The rehabilitation of your range of movement is particularly important as restrictions here can negatively impact your gait and the biomechanics of how you squat, jump, hop; basically everything we do actively. In addition to this, it can increase the risk that you may have recurrent ankle sprains. Likewise, it is equally important to restore your proprioception and balance, and increase your strength in your lower limb muscles. Your first point of contact when walking or running is through your heel (this is called the heel strike in your gait cycle), and all those muscles around that ankle are having to instantly support your body weight plus any additional forces to carry you through the stance phase. Poor proprioception and balance, and decreased strength can all attribute to recurrent ankle sprains as well.

Accurate assessment and rehabilitation of your ankle sprain is imperative to avoid ongoing issues down the line. Rehabilitation will often involve a combination of manual mobilisations to ensure the restoration of your range of movement, and an exercise programme to reduce the prevalence of instability. In addition, exercise therapy involving mobility, strength, static and dynamic proprioception and plyometrics is actually associated with a quicker recovery time, and enhanced outcomes! All of what is required to get you back to being active and doing what you love, as soon as possible!

If you have recently injured your ankle or have an old ankle injury and continue to experience niggling pain, loss of function or concerns, please contact our friendly admin team and they will be able to book you in with one of our physios so that you can effectively rehabilitate your ankle one and for all!

Reference:
Doherty, C, Bleakley, C, Delahunt, E & Holden, S (2017) Treatment and prevention of acute and recurrent ankle sprain: an overview of systematic reviews with meta-analysis. British Journal of Sports Medicine, 51(2), pp 113-125.