From sprained ankles to unstable ankles to ankle fractures.
Ankle sprains – Most of us have had one at some stage in our lives twisted our ankle on an uneven surface – some many more times than others ! They can range from the mildly irritating simple ligament sprains to torn ligaments and then in worst cast the recurrent unstable ankle.
In most cases, the pain passes, and the ankle seems to feel ok and so we just move on with our lives and forget about it…until we do it again. This is a common iss ue and usually a pattern we see in how people inititially looked after their ankle sprain.
They do say bad luck comes in threes – but let’s all agree to not test that theory.
Statistics vary, but up to 40% of people go on to suffer repetitive ankle sprains and ongoing symptoms – termed Chronic Ankle Instability (CAI).
The good news is, whether you’ve sprained your ankle once, or whether you have already developed CAI, you can still improve your ankle control and reduce your risk of re-injury in the future.
Who’s at risk of ankle sprain or injury?
Studies have shown the following factors that are important in ankle sparains. These are also the factors we have the greatest influence over;
- Giving wayMechanical instability (laxity on testing).
- Pain and swelling.
- Loss of strength at the ankle , hip and core.
- Recurrent sprains.
- Functional instability (poor performance on balance and proprioception tests).
- Fear of uneven grounds.
- Decreasing level of exercise and withdrawing from sport.
Other factors which have been shown to strongly predict an ankle sprain are
- younger age.
- female gender.
- greater height.
- low and high BMI.
1) Should i get an x-ray for my ankle sprain ?
The first question we usually get is should i get an xray done? In the initial or acute phase there are a set or rules we use to determine if you need an x-ray known as the Ottowa ankle rules.
If there is pain felt at the sites A, B,C or D and you can’t take any more than three steps with out assistance then that indicates an x-ray is useful to rule out a fracture.
Here’ s an explanation about how to decide if you need an x-ray for your sprained ankle
2) ICE and strapping for and ankle sprain / injury.
This seems to be becoming a controversial topic these days with people disagreeing on its use. However the use of ice with an acute injury has really stood the test of time in getting people back on their feet,( forgive the pun).
A good protocol is;
10 – 15 mins in an bucket of water and ice 3- 4 x day.
During early stage rehab periods of 3-5 mins icing between rehab exercises or drills have proven useful.
For more information regarding the latest acute injury management check out our blog
3) Range of motion, mobility at the ankle following ankle sprain
Especially in the case of recurrent ankle injuries the mobility of the injured side is very important. Individuals with less range at the affected ankle are at increased risk of further sprains.
As a rule of thumb there should not be more than 2-4 cm difference between the two ankles in the knee to wall test. Ideally we like it equal.
You can read more and get mobility exercises here
4) Stronger ankles are happier ankles.
Exercises are usually graded depending on the severity and stage of recovery. Its not just about the muscles of the foot and ankle that need to be considered but the whole lower limb and even the core muscles in the trunk.
As a rule of thumb the in the early stages we use easier and less complicated exercises that focus more around the and progress to more complex exercises that may include jumping and landing drills in the later stages of rehab.
A stronger core or hip is also important in controlling the body from going too far over the ankle when it rolls underneath us. This may prevent or at least reduce the injury potential. Read more here
5) Ankle exercises to restore balance.
Proprioception is an aspect of training that many people neglect – it can be described as the ability to know where your joints are in space.
It’s an incredibly important part of balance. Proprioceptive training has been shown to reduce the rate of recurrence of ankle injury in people who have experienced previous injury.
There’s a quick basic test you can do on yourself at home called the star excursion balance test (or a shorter form called the ‘Y’ test.
This tests your dynamic control and balance of your hip knee and ankle. Compare both legs and see how you go. You should be able to maintain full control and balance throughout and reach an equal distance with both legs.
6) Returning to sport or hobbies after ankle sprain.
Often forgotten is the need to rehab the whole lower limb and not just the ankle.
The following skills need to be assessed to see if they are required for successful rehabilitation back to the lifestyle of the individual following this injury;
- Hip and core strength.
- Adavnced balance skills.
- Skipping, jumping and change of direction in running
- The ability to land and take off effectively.
- Maintaining the range of motion at the ankle and forefoot. So if you’re about to start your sporting season (Netballers, Basketballers, footballers – I’m looking at YOU!) Make an appointment to get set up with an ankle ‘PRE’-habilitation program and makethis year the year you don’t sprain an ankle!
If in doubt get it checked out.
Pourkazemi, F., Hiller, C. E., Raymond, J., Black, D., Nightingale, E. J., & Refshauge, K. M. (2018). Predictors of recurrent sprains after an index lateral ankle sprain: a longitudinal study. Physiotherapy, 104(4), 430-437
Gabriella Sophie Schiftan, Lauren Ashleigh Ross, Andrew John Hahne
The effectiveness of proprioceptive training in preventing ankle sprains in sporting populations: A systematic review and meta-analysis
Journal of Science and Medicine in Sport, Volume 18, Issue 3, 2015, pp. 238-244
Doherty, C., Bleakley, C., Hertel, J., Caulfield, B., Ryan, J., & Delahunt, E. (2016). Recovery from a first-time lateral ankle sprain and the predictors of chronic ankle instability: a prospective cohort analysis. The American journal of sports medicine, 44(4), 995-1003.
Smith, B. I., Curtis, D., & Docherty, C. L. (2018). Effects of hip strengthening on neuromuscular control, hip strength, and self-reported functional deficits in individuals with chronic ankle instability. Journal of sport rehabilitation, 27(4), 364-370.
Hubbard, T. J., & Hertel, J. (2006). Mechanical contributions to chronic lateral ankle instability. Sports medicine, 36(3), 263-277.