Ankle sprains are one of the most common sports injuries in Australia Ankle sprains are one of the most common sports injuries in Australia. A recent study(1) looking at injuries in 70 popular sports showed that; the ankle was the most commonly injured body part in 24 of the 70 sports studied the ankle was overall the second most commonly injured body site (after the knee) ankle sprains are the most common type of ankle injury ankle injuries are very frequent in common Australian sports including rugby, soccer, Australian football, netball, hockey, basketball & squash. Ankle injuries don’t just happen during sport. They also come from tripping on uneven pavements (this is especially relevant for women wearing high heels!), slips on stairs or gutters, or just running around with the kids in the back yard. Many people think of ankle sprains as just simple injuries however they have an extremely high recurrence rate of up to 73%(2). This makes them a major cause of ongoing pain for many people. Recurrent sprains can stop your normal walking, daily social & work activities, sport or wearing heels (although this may not be such a bad thing!). They can also lead to more serious injuries to your joint, cartilage & bone.
The 2 Biggest reasons for Recurrent Sprains
Research clearly shows two important reasons why recurrent ankle sprains are so common;
1. Reduced balance & joint position sense(3,4)
Your ligaments, tendons, joint capsules & joint surfaces are important parts of your balance system. They are vital links for your body’s “proprioception” – your awareness of what position your body is in without having to look at it. For example, you know whether your fist is clenched or open without having to look at it – this is proprioception. So when your ligaments & joint structures are are damaged during a sprain your balance & proprioceptive feedback system is badly affected. Think of it as having really slow reaction times.
2. Reduced outer ankle (evertor) muscle strength(3,4,5)
As you can see on the diagram,your evertor muscles run down the outside of your shin & ankle. They work with your ankle ligaments to stabilise your ankle and stop it rolling in. Patients with chronic ankle instability have weakened evertor muscles. This means that not only do you lose ankle stability because of ligament damage, you also weaken the muscular part of your ankle stabilising system. Put these two together & it is easy to see why once you’ve had one significant sprain you are much more likely to have another. You can think of ankle instability as being caused by a broken balance reflex loop:
So how can you reduce your chances of spraining your ankle again?
The main message for you from this research is; If you sprain your ankle, as well as managing the acute pain you MUST then retrain your balance & strength to prevent chronic instability. Just because the pain goes it doesn’t mean that your ankle is strong again! Your first line of treatment should be the normal Rest Ice Compression Elevation Diagnosis (RICED) regime. An early visit to your physio is important to get your movement back as fast as possible(6,7), reduce swelling & inflammation, and also to refer you for an x-ray if needed. We minimise the disruption to your life & work by keeping you taking weight through your ankle & maintaining as much movement as possible. Taping &/or a brace is sometimes used. A short course of non-streroidal medication such as Voltaren is effective in the early stages(6). However they should only be used for a few days because they can slow your body’s healing & give you a false sense of recovery, which means you may return to activity too early & cause more damage. Early treatment to restore your toes-towards-knee movement (dorsiflexion) as fast as possible is an important clinical guideline(7) because it helps you bet back to your normal activities much faster. Importantly, if you don’t fully restore this movement it increases your risk of further sprains, fractures & chronic instability(4,6). Once the acute pain has gone your ankle will still be weak due to your broken balance reflex loop. Now is the time to get strong & stable again to stop future sprains. Your physio will take you through a neuromuscular retraining program specifically designed to restore your balance (proprioception) & your muscle strength. This fixes the broken balance reflex loop & reduces your risk of re-spraining your ankle & developing chronic instability.
Am I too late?
The earlier you get treatment the better. Delaying brings more;
- disruption to your lifestyle, social, sport & work activities
- loss of balance
- risk of developing chronic instability
But it’s never too late! Just as we can “get back into the gym” after having not exercised for a long time, you can retrain your balance & strength even if your sprain was some time ago – it may just take a little longer. Stiffness also usually takes a little longer to resolve. But the end result – being able to do to all the things you love to do because you have a strong & stable ankle – is well worth the effort! For more information or to book an appointment visit our Contact Page or call your nearest Precision clinic.
References & More Info
Solid research supports all of what we do & the information that we provide for you. The references used in this edition are; Fong et al, A systematic review on ankle injury and ankle sprain in sports. Sports Med. 2007;37(1) Yeung et al An epidemiological survey on ankle sprain.Br J Sports Med 1994;28 Willems et al, Proprioception & Muscle Strength in Subjects With a History of Ankle Sprains & Chronic Instability,J Athl Train. 2002,37(4) Hertel J. Functional instability following lateral ankle sprain. 2000, Sports Med. ;29 Hartsell, & Spaulding, Eccentric/Concentric ratios at selected velocities for the invertor & evertor muscles of the chronically unstable ankle. J Sport Rehabil., 200; 9 Bleakley et al, Some conservative strategies are effective when added to controlled mobilisation with external support after acute ankle sprain: s systematic review, Aus J of Physio, 2008, 54 Van Dijk Management of the sprained ankle, Br J Sports Med., 2002, 36 Your local Precision clinic would love to provide you with more information on how to maximise your health, energy and performance ability. Please feel free to contact us to learn how our range of services can assist you in achieving your individual health and performance goals. Our promise at Precision Physio is to deliver world-class services through cutting edge clinical programs and facilities. Our unique approach combines progressive rehab and training systems to maximise results and help every client achieve their health and performance goals.