Wobbly Ankles

Ankle injury is arguably the most common acute sporting injury. For women's gymnastics, it's the most frequently injured area of the body.

Ankle injuries include, but are not limited to 'ankle sprains'. This is the most common cause of ankle injury and will be the topic of today's blog.

An 'ankle sprain' or 'rolled ankle' occurs when the foot is forcefully turned inwards ('inverted' - lateral ankle sprain) or outwards ('everted' - medial ankle sprain) causing stretching or tearing of the supporting ligaments around the ankle. This often occurs during activities where rapid changes of directions are required, especially if these take place on uneven surfaces. The most common ankle sprain we see is a lateral ankle sprain cause by an inversion type injury (see below).

(Example of an inversion ankle sprain)

Ankle sprain may be accompanied by an audible pop or crack which, although often of great concern to the athlete and onlookers, has no particular diagnostic significance. Swelling and bruising often appears rapidly, although occasionally can be delayed some hours.

If the injury is severe enough, ankle fractures are possible. Physiotherapists use clinical assessments which can alert us to the possibility of a fracture. If there is clinical suspicion, plain X-rays can be used to rule this out.

The most common structure injured are the ligaments of the ankle. Ligaments are aligned to resist excessive movements of joints and if overstretched, are susceptible to injury. As shown below, there are many different ligaments around the ankle and depending on the positions of the foot during the sprain, different ligaments are more likely to be injured.

Physiotherapists initial assessment is important to rule out fractures but the grade of ligament damage is only accurately tested after 5-7 days. Bony bruising on the opposite side to the injured ligaments can also occur as the heel bone contacts the ankle bone. This is known as a "kissing injury". An initial period of immobilisation may be necessary, but getting the ankle moving is the first goal in the treatment of ankle sprains.

TREATMENT:

1. Reduce swelling: This can be done via compression, elevation and ensuring relative rest to the injured area.

2. Returning normal range of motion: Impaired movement of the ankle is common post trauma, particularly the motion of our foot bending backwards towards our shin bone (dorsiflexion). This motion is particularly important for helping us to squat deeply and go down stairs. Gentle stretches and mobilisations from early in the rehabilitation can help to normalise this movement.

3. Rebuilding strength: Adequate strength of the muscles in the calf and feet are protective of re-injury. It is also likely that you will lose some strength in the first few weeks after the injury due to immobilisation or activity modification. The most common exercise after an ankle sprain to nail are calf raises (see photo below). The calf muscles perform more work to the ankle joint as we walk and run, than both the hip and knee muscles do to their respective joints. The rest of the chain should be considered in rehabilitation so strengthening of other lower limb muscles and even trunk stabilisers is important, especially for athletes.

4. Proprioception: Proprioception is our bodies ability to sense the position of our joints in space. Much of our proprioceptive system relies on the stretching of ligaments for feedback to the central nervous system. Inevitably following ankle sprains, this mechanism is impaired. In the real world, impaired proprioception presents as difficulty with balance and stability. Proprioceptive retraining is vital following ankle sprain to return normal balance to the ankle and help to prevent re-injury.

5. Sport specific rehabilitation: This is dependent on the sport of choice but late stage rehab needs to replicate the demands of the chosen sport. Often for gymnasts, we ask them to perform more exercises in point or 'releve', jumping, landing, rebounding, leaping and sprinting.

FINAL NOTE: It's important to remember that everyone's different, and each injury requires an individualised treatment plan. So make sure you check in for a review with one of our physios if you've recently suffered this injury!

For bookings, please call 0499 037 569 or book online through our website - www.warringahphysio.com.au/book-now