Ankle sprains are a very common injury, yet avoidable, affecting both sedentary individuals and athletes. Ankle sprains tend to affect the lateral (outer) ligaments most, due to the mechanism of injury often tends to be an inward rolling of the ankle.
Many individuals under-estimate the importance of the appropriate rehab for lateral ankle sprains, but acute ankle sprains that aren’t dealt with properly are the major risk factor for re-injury and developing chronic ankle instability. In an athletic population in particular, recurring ankle sprains can mean lots of lost playing time, pain and frustration due to the same injury over and over.
The acute phase of ankle sprains are often well rehabbed, in which we apply the RICE principle of rest, ice, compression and elevation. The greatest missing link leading to chronic instability is the lack of a return-to-function rehabilitation - whatever your 'function' may be.
The biggest and most crucial parts of rehab in preventing recurring injuries is re-gaining the appropriate proprioception and somatosensory awareness in the foot. Proprioceptive exercises teach your body to control the position of a deficient or an injured joint and somatosensory awarness relates to or denoting a sensation (such as pressure, pain, or warmth) that can occur anywhere in the body, in contrast to one localized at a sense organ (such as sight, balance, or taste). These are big words to explain that when the foot is injured, the signal of stability and placement of our foot in space is altered in the receptors of the ankle, and therefore our input to the brain has been altered, which increases our risk of second injury.
Proprioceptive training can start with super simple balance exercises to help re-train the ankle and the brain, such as standing on one foot for up to a minute and then progressing to closing your eyes on one foot. To make it more challenging you can introduce the use of a balance or wobble board after an ankle injury.
For athletes, proprioceptive training should work it’s way up to explosive and stability challenging movements, such as appropriate landing on jumps, cutting motions, or bosu ball single leg work. The type of sport or function the individual needs to get back to would result in altered treatment to help you get back to what you need to.
As a whole, I see too many athletes neglecting their ankles and end up wearing a brace on each foot constantly plagued by injuries, not realizing what they should have done to help themselves in the first place!
Injuries are avoidable with the proper foundation focusing on strength and mobility. Hopefully this blog helps to provide some insight into the key role a physiotherapist can play in rehabbing an ankle injury, and how to prevent further ankle injuries down the line.
Written by Tamar Kideckel, MScPT, BAScKIN, Diploma in Fitness & Health Promotion