There is no such thing as a simple ankle sprain

 Ankle sprains are a very common ailment in the active population, whether it’s netball, football or playing with your kids at the local playground. However, the unfortunate thing is that up to 33% of the population report ongoing symptoms following an ankle sprain, and up to 64% report they never fully recover (Doherty et al, 2018). 20% of the population between 18-65 years report chronic and ongoing disorders at the ankle that they attribute to an old injury. As a result, we must consider the notion that there is no such thing as a simple ankle sprain

Following the acute stage, it is important to restore common factors that are often shown in poor outcomes for lateral ankle sprains, which are reduced ankle range of motion, poor proprioceptive & balance, and poor strength of the peroneal and calf muscles (Cho, Park, Choi, Kang, & SooHoo, 2019; Thompson et al., 2018). The main thing we will consider today is the range of motion of the ankle. There are two common movements that remain impaired following an ankle sprain, dorsiflexion & plantarflexion. In particular, the restoration of weight-bearing dorsiflexion is particularly important as it’s been shown to negatively influence hip and knee biomechanics, as well as increase risk of recurrent ankle sprains and other lower limb injuries (Somers, Aune, Horten, Kim & Rogers, 2020). We look at dorsiflexion using the knee-to-wall test, as shown in the image above. Asymmetry of 1-1.5cm is normal, but anything outside this could be related to your ankle sprain. This is an important movement in the ankle as it influences the biomechanics of how someone walks, squats and runs. In other words, it can affect everything we do in an active capacity. 

Although the evidence is not quite as strong for plantarflexion, it’s important to consider as it can increase the likelihood of secondary injuries to the calf muscle and posterior impingement episodes in the ankle.

What to do next? 

If you’ve sustained an ankle sprain, you might be wondering what is next. Restoring these movements above are attainable via dynamic exercise, but particularly for dorsiflexion, manual mobilisation from your physiotherapist (Weerasekara et al, 2020). As for the recurrence rates noted earlier, exercise interventions have been shown to significantly decrease the risk of sustaining a recurrent ankle sprain (Doherty  et al, 2017). 

References

Doherty, C., Bleakley, C., Delahunt, E., & Holden, S. (2017). Treatment and prevention of acute and recurrent ankle sprain: an overview of systematic reviews with meta-analysis. British Journal of Sports Medicine, 51(2), 113-125. doi:10.1136/bjsports-2016-096178

Somers, K., Aune, D., Horten, A., Kim, J., & Rogers, J. (2020). Acute Effects of Gastrocnemius/Soleus Self-Myofascial Release Versus Dynamic Stretching on Closed-Chain Dorsiflexion. Journal of Sport Rehabilitation, 29(3), 287-293. doi:10.1123/jsr.2018-0199

Weerasekara, I., Deam, H., Bamborough, N., Brown, S., Donnelly, J., Thorp, N., & Rivett, D. A. (2020). Effect of Mobilisation with Movement (MWM) on clinical outcomes in lateral ankle sprains: A systematic review and meta-analysis. The Foot, 43, 101657. doi:10.1016/j.foot.2019.101657

Weerasekara, I., Osmotherly, P., Snodgrass, S., Marquez, J., De Zoete, R., & Rivett, D. A. (2018). Clinical Benefits of Joint Mobilization on Ankle Sprains: A Systematic Review and Meta-Analysis. Archives of Physical Medicine and Rehabilitation, 99(7), 1395-1412.e1395. doi:10.1016/j.apmr.2017.07.019

Background / Diagnosis 

  1. Anterior impingement – tibia and talar neck TOP
    1. ? Exclude OCD
    2. Persistent stiffness, KTW
  2. Anterolateral (5/6 findings) – commonly occurs upon synovial thickening following repetitive or severe injuries, meniscoid lesions
    1. Chronicity
    2. TOP anterolateral joint line
    3. Recurrent thickening/swelling
    4. Anterolateral pain with DF/Ever
    5. Pain SL Squat
    6. Mechanically stable
  3. Posterior Impingement – os trigonum?
    1. Natural variant – becomes tender and symptomatic post-ankle sprain due to loss of ROM or irritant (oedema)

Components of Rehabilitation

  1. Mobility & Flexibility – Talocrural
    1. Dorsiflexion – KTW
    2. Plantarflexion
  2. Strength
    1. Calf – Soleus and Gastrocnemius
    2. Inv / Ever
  3. Proprioception & Balance
    1. Static and Dynamic
  4. Plyometric (e.g. hopping) 

 

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