Ankle Sprain 101

Ankle sprains are common in athletes and non-athletes, affecting 1 in 10,000 people every day. 60-70% of ankle sprains involve the anterior talofibular ligament and are considered a lateral ankle sprain. I’m sure a lot of you have experienced an ankle injury, whether you rolled it running, playing beach volleyaball, landing on a box jump, or during a dance off at Fenners. But you won the dance off so it was worth it right?!?

Mechanism of injury

However it happened, the mechanism of injury is usually the same. Most lateral ankle injures are caused by rolling onto the outside of the ankle while the foot is pointed down (inversion and platarflexion). This is a very unstable position for the ankle, which is why the ligaments become overstretched (sprained) or may even tear. In more severe cases, some people can have a high ankle sprain, which involves the lower leg and takes longer to rehab. Medial ankle sprains can also occur, but are not as common because the ligaments on this side are so much stronger. Medial ankle sprains are also less common because of the awkward angle your ankle has to be in to  sprain these ligaments.

Grades of Sprain: ¹

• Grade I – 11.7 days before full athletic activity
• Grade II – 2 to 6 weeks before full athletic activity
• Grade III – > 6 weeks for full recovery

What do you do if lateral ankle sprain occurs? PRICE!  ¹

• P – Protection – Splint, tape or brace ankle in as much dorsiflexion as tolerable
• R – Rest – refrain from all activities that cause pain and use crutches if necessary
• I – Ice – Place on ankle for 20-30 minutes 3-4x/day to decrease inflammation
• C – Compression – Wrap ankle with tape or ace bandage to prevent swelling
• E – Elevation – Elevate ankle above heart level to prevent swelling

Single leg balance to improve stability/proprioception

The goals of rehabilitation following an ankle sprain  includes the following: ¹

• Reduce pain and swelling
• Improve ankle range of motion
• Strengthen muscles of the ankle and foot. Start in a non-weight bearing position (resistive band) and working up to weight bearing (toe raises).
• Static and dynamic balance training to help stabilize the ankle
• Incorporate sport specific tasks (running, jumping, cutting, etc.)

* A major focus for rehab is improving proprioception, which involves the joint’s ability to communicate with the body’s movement. When you do things like run, skip and jump, your joints must communicate with your muscles and the rest of the body to know when and what to do. Ligaments contain cells called proprioceptors that help the joint communicate with the body, and when the ligament is injured proprioception is affected as well. This means decreased communication, so when you land on your foot the correct muscles may not turn on a the right time…..leading to instability and possibly re-injury. ¹

Star jumps!

* Bracing/taping can be a good temporary fix following an ankle sprain, as well as help ease an athlete back into their sport. However, you eventually want to be able to build up strength and balance on your own without relying on the brace.

If any of the above goals are not reached, a person is at risk for another sprain. Most of the time physical therapy is recommended because specific techniques can be used to normalize the joint and speed up rehabilitation.  This injury takes dedication to heal. 72% of people with a lateral ankle sprain have residual symptoms/instability up to 18 months after the initial injury. This time frame can be reduced with proper rehabilitation, as well as help reduce the risk for re-injury. Chronic ankle instability can be a result of multiple ankle sprains and/or incomplete rehabilitation. The rehab for this is even longer, but strength and stability can still be gained with an appropriate protocol. ²

Additional problems that occur with not meeting the above goals include compensations from the joints above (knee, hip, back). Take a squat for example. Those with limited ankle flexibility tend to turn their toes out, allow their foot arch to collapse and can’t seem to keep their knees from collapsing in. So if you’ve had multiple ankle sprains and are struggling with your squat form (me, myself and I) maybe it’s time to work on your ankle flexibility.

I’m ending this post with 2 good thoughts for the weekend:

Happy Halloween:) Don’t forget to join us for the Halloween WOD tomorrow!

and GO CARDINALS!!!!!!! #33  Daniel Descalso is a superstar!! Awesome game last night….ready to take it home tonight. I should have been a cheerleader…

References:

1. Dutton, Mark. Orthopaedic Examination, Evaluation, and Intervention. Second edition. The McGraw-Hill Companies, Inc, 2008.

2. Holmes A, Eamonn D. Treatment of Common Deficits Associated with Chronic Ankle Instability. Sports Medicine. 2009;39(3):207-224.

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Workout of the Day 10/28/2011

A. Power Clean 1-1-1

B. 3 Rounds for time:

5 Power Cleans (135/85)

15 Box Jumps

300m Run

* If you havent done your Back Squat 5-5-5-5-5 from Monday, do it instead of the workout

FUNdamentals

A. Hang Power Clean 10-10-10

B. B…tch Better have my Money (modified)
2 rounds
Run 200m
10 Pull-ups
10 Push-ups
10 Burpees
10 Squats
10 Walking lunge steps, each leg

Firebreather WOD (6pm only)

Linda 10,9,8…1

Deadlift 1.5 BW

Bench BW

Clean .75 BW