Ankle sprains are a common injury for the sporting population, and can be a frustrating setback. Sprains are usually caused by an inward ‘rolling’ of the foot, as ankle control is lost while running or changing direction. As the foot twists inwards, the ligaments on the outside of the ankle may be damaged or torn as they are stretched out beyond their maximum length. In severe cases, one or more ligaments may rupture completely. You may hear a ‘pop’, and walking will be painful. Occasionally, the ligaments on the inside of your ankle may be damaged, but this is uncommon as they are much stronger.
Although severe ankle sprains may require several weeks in a surgical boot, treatment will usually involve the following steps:
- Controlling pain and swelling
- Restoring movement
- Restoring strength and power
- Restoring balance and proprioception (what is proprioception? We will explain this in a minute!)
- Sport/activity specific rehabilitation.
The fourth step is often neglected: An injured athlete will reach the stage where they feel pain-free and strong, and prematurely return to play. However, since they have not yet attained pre-injury levels of balance, they have a very high risk of re-injuring. Poor rehabilitation of the ankle is recognised as the primary risk factor for re-injury (Mattacola, 2002), and re-injury can set progress back weeks or even months, and can often develop into a chronically unstable ankle.
What is proprioception?
Proprioception is the often-forgotten sense. Stop reading for a second, close your eyes and try to touch your nose with your pointer finger. How did your body know how to do that? Put simply, proprioception is knowing where a particular body part is in space. Proprioception has a myriad of functions, including allowing us to catch a ball without having to stare at our hands, to kick the right spot on a soccer ball to aim it into the goal, and to realise when our ankle is about to roll so that the body can activate protective mechanisms to avoid injury.
After an ankle sprain, proprioception is greatly diminished, and will not automatically return without training. Ankle proprioception drills may include a balance board or bosu ball, and involve both static and dynamic (movement-based) drills.
A 30 year old man presented with an ankle sprain sustained while playing soccer. Initially, treatment included massage to reduce swelling, gentle range of motion exercises, and advice regarding self management (RICE, selecting appropriate footwear, and how to safely ascend/descend stairs without pain). Once he was able to walk without pain, simple balance drills were introduced, as well as stretches and exercises to restore his regular gait. Further treatment will involve ankle mobilisations to increase ankle mobility, strength exercises, and a variety of balance and proprioceptive drills. Sports-specific movements will gradually be introduced once movement, strength and proprioception are approaching pre-injury levels.
If you would like to find out more about how we could help you with your ankle injury, please call us on (02) 9743 2311 or click here to book online.
By Tim Nesbitt-Hawes, Physiotherapist
Mattacola, C. G., & Dwyer, M. K. (2002). Rehabilitation of the Ankle After Acute Sprain or Chronic Instability. Journal of athletic training, 37(4), 413–429.