Have you rolled your ankle before? More than once? Do you experience ankle pain, instability, stiffness, swelling or difficulty in walking? Then this blog will help you understand how physiotherapy can help to prevent reoccurring ankle sprains.
“Ankle sprains are one of the most common musculoskeletal injuries. In all sports injuries, the rate of ankle sprains ranges from 15 to 20%”.1 Engebretsen and colleagues confirm that these findings can be explained since the most important risk factor for an ankle sprain is a previous ankle sprain.2 If you have sprained your ankle, you have an increased likelihood of spraining your ankle again. Physiotherapy can help reduce your risk of re-spraining with a thorough course of rehabilitation.
Depending on the severity and complexity of the injury, ankle sprains are typically managed conservatively as opposed to surgical intervention. The main aims of treatment include: ‘swelling and symptom management, regaining ankle range of motion, muscle retraining and restoring postural control to prevent recurrence’.3 Evidence suggests that, “balance training can be used in an effort to reduce future ankle sprains in athletes with a previous injury”.4, 5 Ankle taping and bracing are two examples of preventative measures that your physiotherapist may utilise to assist you in your recovery.
For more complex or stubborn ankle injuries that take longer to heal than expected, it is imperative that you get an accurate diagnosis from your physiotherapist. If necessary they will be able to refer you for an appropriate scan and/ or direct you to your local GP if a specialist review may be required. An accurate assessment of the severity and extent of every ankle sprain is imperative and it is important not to miss something that should be reviewed by an orthopaedic surgeon. This assessment and diagnosis will help determine how long it may take for you to return to work, your sport or leisure activities, and the extent of rehabilitation treatment required.
Poorly managed ankle injuries can result in an accumulation of scar tissue in the joint space that can impede ankle range of motion, ankle and leg biomechanics and dynamic control. It is critical to seek physiotherapy management early, prior to the formation of this scar tissue. This build up of scar tissue may also have an impact further up the entire lower limb. There is an established link between reduced ankle motion and ACL injury. When assessing jump-landing biomechanics, foot position plays an integral part on ACL loading. “External rotation of the tibia has been shown to MRI-based modeling studies to cause the ACL to impinge on the lateral wall of the femoral inter-condylar notch”.6, 7 “Olsen et al describe noncontact ACL injuries to occur as the knee undergoes internal or external rotation in combination with knee valgus”.8 An injury such as an ACL rupture may impact on your working duties, can remove someone from the sporting game for 12 months time and for some, force them into early retirement from professional sport. It is fundamental that ankle injuries are addressed appropriately to avoid potential complications of a more serious nature.
Lack of ankle range not only can subject you to potential acute injury, but also overuse injuries for example, in runners. Changes in biomechanics of the ankle and foot, over time and repetition can lead to a myriad of dysfunctions and overload of surrounding muscles and joints further up the lower limb as far as the lumbar spine.
Whether you are experiencing pain, difficulty in walking, stiffness, instability, or persistent swelling, in order to prevent recurrence or secondary injuries as a result of a poorly managed ankle sprain, seek a physiotherapist assessment early, no matter how simple the case. This may save you from requiring to return to see us in the future for a more serious injury.
Felicity Martin has a special interest in musculoskeletal presentations, sports coverage and Women’s Health. She has worked with NSW Hockey and will be working with the Norwest Bulls Rugby Club this year. Felicity works full time at our Norwest rooms.
References:
- Petersen, W., Rembitzki, I.V., Koppenburg, A.G. et al. Treatment of acute ankle ligament injuries: a systematic review. Arch Orthop Trauma Surg (2013) 133: 1129.
- Engebretsen AH, Myklebust G, Holme I, Engebretsen L, Bahr R (2010) Intrinsic risk factors for acute ankle injuries among male soccer players: a prospective cohort study. Scand J Med Sci Sports 20(3):403–410
- Stewart, M. Essential foot and ankle. Course Manual. 2015. pp.62
- McGuine TA, Keene JS (2006) The effect of a balance training program on the risk of ankle sprains in high school athletes. Am J Sports Med 34(7):1103–1111
- Verhagen E, van der Beek A, Twisk J, Bouter L, Bahr R, van Mechelen W (2004) The effect of a proprioceptive balance board training program for the prevention of ankle sprains. A prospective clinical trial. Am J Sports Med 32(6):1385–1393
- Fung DT, Zhang LQ. Modeling of ACL impingement against the intercondylar notch. Clin Biomech (Bristol, Avon). 2003;18(10):933–941
- Fung DT, Hendrix RW, Koh JL, Zhang LQ. ACL impingement prediction based on MRI scans of individual knees. Clin Orthop Relat Res. 2007;460:210–218.
- Olsen OE, Myklebust G, Engebretsen L, Bahr R. Injury mechanisms for anterior cruciate ligament injuries in team handball: a systematic video analysis. Am J Sports Med. 2004;32(4):1002–1012
