Here is our latest podcast on the lessons learned from Dr. Eamonn Delahunt’s seminar on lateral ankle sprains and chronic ankle instability.
Physiotherapy for Ankle Injuries
Ankle injuries are one of the leading causes of absence from sport. Many top GAA, soccer and even pro golfer Rory McIlroy have suffered from ankle injuires througout careers. The ATFL ligament, on the outside of your ankle is one of a number of main stabilisers for the joint. Ankle injuries can be divided into three types depending on severity: grade one, two or three.
The ankle plays a crucial part in generating power during jumping, running, cutting and even a golf swing. In the case of a grade three tear, surgery may be considered. However a strong physiotherapy rehab programme has been shown to have equally good, if not better outcomes for grade three ankle injuries.
Initially, I would help the player to reduce pain around the ankle joint, swelling and restore movement. The PRICE principal can be helpful here: Protect, Rest, Ice, Compress and Elevate.
The key to returning to play and preventing further ankle injuries is a dynamic and progressive rehab programme. This mainly involves strengthening the ankle, balance training and sports specific exercise.
The key aspects of my rehab programme are regaining full range of motion, improvement of balance and agility. This depends on the players sport of choice. Basic ways to achieve these are lunges, single leg work and plyometrics.
Ankle movement can be restored with mobilisations and by reducing swelling in the first week post injury. Balance reeducation can be initiated with jumping and landing exercises aswell as basic hopping. Agility is the final stage of physiotherapy. Here the physiotherapist must try replicate and train all movements the athlete is expected to perform when competing in their individual sport so return to top level performance is as easy as possible.
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Chronic Ankle Instability
Chronic ankle instability is an encompassing term used to classify an individual who presents with both mechanical and functional instability of the ankle joint following an initial lateral ankle sprain injury.
Mechanical Instability refers to measurable laxity of the ligaments, i.e. ligaments that are less stiff following injury, with some joint restrictions and synovial changes. Functional Instability is the lingering feeling of giving way or unsteady feeling which is generally attributed to neuromuscular and proprioceptive deficits.
Research has identified a number of potential reasons for long term issues with ankle instability after a sprain. One theory is that the ankle proprioception, where the joint is in space, is impaired creating an impaired reflex arc of the muscles that help stabilise the ankle joint. Swelling of the joint can cause the feedback system of the ankle joint to also alter and cause long term neuromuscular deficits.
So clinically, what can we do to help and reduce this occurring?
- Reduce pain and swelling of the joint
- Loading in functional tasks as soon as possible e.g. walking, running, cutting
- Establish baseline strength and power
- Improve proprioception of the ankle joint
- Practice tasks that are important to your need
- Landing/jumping mechanics