Did you know that ankle sprain is the most common sports-related injury, reflecting approximately 10% to 25% of all sports injuries?
The lateral ankle ligaments are affected 80% to 90% of the time. These injuries can cause damage to the ligaments, muscles, nerves and mechanoreceptors that cross the lateral ankle. Up to 73% of athletes who sustain ankle sprains experience recurrent ankle sprains and 59% report functional loss and residual symptoms that have affected athletic performance. Those residual symptoms resulting from the ankle sprains are often associated with a condition known as chronic ankle instability (CAI).
What is chronic ankle instability?
This condition is characterized by repetitive ankle- sprain injuries, frequent episodes of the ankle “giving way”, and decreased self- reported function stemming from an acute ankle sprain. Research has found that people with CAI have reported diminished health- related quality of life and are at great risk for developing post- traumatic ankle osteoarthritis.
The development of CAI is characterized by structural changes, sensorimotor deficits and altered movement patterns. It can present with joint restrictions, laxity of ligaments, joint degeneration and loss of strength. As you can tell the ankle sprain in not as an innocuous injury as you might have thought.
Patients with CAI exhibit deficits in:
- Functional performance
- Proprioception
- Strength
Many researchers have found discrepancies in gait patterns of patients with CAI, as well as running and landing procedures due to modifications that took place and which may be related to an altered connection between the central nervous system and the injured muscle or nerves (or both) surrounding the ankle. For example, reduced ankle dorsiflexion (the ability to bring toes up) may predispose to re injury of the ankle and several future lower limb injuries including plantar fasciopathy, iliotibial band syndrome, patellofemoral pain syndrome, patellar tendinopathy and medial tibial stress syndrome.
The role of physiotherapy is important in cases of chronic ankle instability. The therapist will assess and recognize the impairments, the functional limitations and possible deficits and will help you develop the goals of the treatment and organize the treatment plan. Clinicians perform several therapeutic interventions, such as stretching, manual therapy/ mobilization techniques, electrotherapy, ultrasound and exercise to improve those limitations and promote better function.
It has been suggested by research that therapeutic exercises seem to improve functional components of the ankle joint while mobilization techniques mechanical components.
Some of the most commonly used therapeutic exercises are:
- Closed or open kinetic chain exercise
- Resistive training with elastic bands
- Balance exercise
Therapeutic exercises contribute to improving, repairing or maintaining:
- Strength
- Cardio- respiratory function
- Mobility
- Elasticity
- Stability
- Proprioception
The combination of therapeutic exercise and manual mobilization techniques contribute to:
- Decrease of pain
- Self- reported function
- Dynamic and static balance
Residual symptoms such as pain, persistent swelling, feelings of ankle joint instability and respraining can be decreased with an appropriate rehabilitation program and consequently improve the self- reported function.
Why balance?
Balance is a motor skill of clinical relevance, as balance deficits may result in multiple episodes or recurrent sprains and diminished lower extremity function. In order to maintain postural control, the body is in a state of continuous movement, adjusting to keep the center of gravity over the base of support.
If you need more information regarding ankle sprains please book in with one of our therapists.
Call us on Dunstable – 01582 608400 or Leighton Buzzard on 01525 372 447 to book an appointment.
Let’s exercise 🙂
1. Stand with the affected leg in the center of a room with your hands close to your hips
2. Try to reach with the free leg as far as you can in a posterior- lateral direction
3. Try not to put the whole weight of your free leg on the floor but merely touch the surface of it
4. Return the free leg near the affected
5. Repeat the same for the posterior- medial direction
6. And the anterior direction
7. Repeat the sequence for each direction 3 times and complete 3 sets.
8. Three times per week please.
References:
Hall E., MS, Docherty C., Simon J., Kingma J., Klossner J., (2015) Strength-training protocols to improve deficits in participants with chronic ankle instability: A Randomized Controlled Trial. J. of Athl. Train.; 50(1): 36–44.
Hertel J. (2000)Functional instability following lateral ankle sprain. Sports Med. 2000 May;29(5):361-71. Review.
Hoch M. C., Farwell K. E., Gaven S. L., Weinhandl J. T. (2015) Weight-Bearing Dorsiflexion Range of Motion and Landing Biomechanics in Individuals With Chronic Ankle Instability. J. Athl. Train.; 50(8): 833–839.
Kosik KB, McCann RS, Terada M, Gribble PA. (2017) Therapeutic interventions for improving self-reported function in patients with chronic ankle instability: a systematic review. Br J Sports Med. 2017 Jan;51(2):105-112. doi: 10.1136/bjsports-2016-096534. Epub 2016 Nov 2.
Olmsted LC, Carcia CR, Hertel J, Shultz SJ. (2002) Efficacy of the Star Excursion Balance Tests in Detecting Reach Deficits in Subjects With Chronic Ankle Instability. J Athl Train. 2002 Dec;37(4):501-506.
Terada M., Pietrosimone B.G., Gribble P.A. (2013) Therapeutic interventions for increasing ankle dorsiflexion after ankle sprain: a systematic review. J. Athl. Train.;48(5):696-709