Ankle sprains account for a large number of sporting injuries and can lead to chronic instability without appropriate rehabilitation. Most ankle sprains occur to the lateral (outside) ligaments and range from small tears to a complete rupture. There are three ligaments in the lateral aspect of the ankle – Anterior Talofibular (ATFL), Calcaneo-Fibular (CFL), and Posterior Talofibular (PTFL). These ligaments may be damaged during an inversion movement when the ankle rolls outward, whilst the foot turns inward. There is a high incidence of lateral ankle sprains in sports that require rapid changes in direction and body contact such as soccer, AFL, basketball, netball, and rugby. Several risk factors may predispose an individual to an ankle sprain, including lower limb strength and stability, foot anatomy, playing surface, the intensity of activity, fatigue, and footwear. The primary risk factor is a previous ankle sprain.
As with any injury, a thorough exercise rehabilitation programme is essential to facilitating a return to pre-injury function and reducing the risk of a recurrent sprain. Early intervention and adherence to the programme are key determinants of a successful outcome and it is important that gait/walking pattern is restored at an early stage.
The early stages of the programme will focus on restoring the ankle’s range of motion, strength, and stability. It is also important to maintain aerobic fitness (i.e. cycling) and upper body conditioning.
Balancing on one leg is a simple way to improve ankle stability and proprioception. The level of difficulty is increased by incorporating unstable surfaces such as wobble boards and Bosu balls.
Exercises will progress from static to dynamic to increase ankle proprioception. Progressions will be made as loading tolerance improves and should include multi-tasking exercises tailored to the individual’s sport (i.e. balancing on the affected leg whilst kicking a ball with the opposite foot). During this time, it is important to commence a graduated return to jogging. This may consist of several 100 metre runs at a light pace, depending on the severity of the injury.
Single leg star excursion – an effective exercise to improve multi-directional ankle stability and proprioception.
The complexity of the exercises will depend on the level of function the individual is required to return to. The type of activity, playing surface and intensity are three key factors to consider. Exercises can include box jumps, depth jumps, bosu jumps and single leg hopping.
Bosu jumps – improves landing and jumping capacity, and dynamic stability. Progressions can be made by increasing the intensity and adding a reactive component.
Once ankle strength and stability have reached an appropriate level, the next phase is to commence a gradual return to sport. It is important the return is progressive to ensure the connective tissue has sufficient time to adapt to the physical demands imposed. Following a return to sport, a maintenance programme should be commenced to reduce the risk of injury recurrence. If you would like more information on ankle sprains or other rehabilitation programmes that Absolute Balance can provide, please don’t hesitate to contact us at firstname.lastname@example.org
Daniel D’Avoine (B.Sc.Ex.Phys)
Senior Exercise Physiologist (AEP, AES) (ESSAM)
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Doherty, C., Bleakley, C.J., Hertel, J., Caulfield, B., Ryan, J., & Delahunt, E. (2016). Recovery from a first-time lateral ankle sprain and the predictors of chronic ankle instability: a prospective cohort analysis. American Journal of Sports Medicine, 44(4), 995-1003.
Kerkhoffs, G.M.M.J., Kennedy, J.G., Calder, J.D.F., & Karlsson, J. (2016). There is no simple lateral ankle sprain. Knee surgery, sports traumatology, arthroscopy, 24(4), 941-943.
Schiftan, G.S., Ross, L., & Hahne, A.J. (2015). The effectiveness of proprioceptive training in preventing ankle sprains in the sporting populations: a systematic review and meta-analysis. Journal of Science and Medicine in Sport, 18(3), 23-244.