Treating those Chronic Ankle Injuries
One of the most common sports injuries that I encounter with both GAA and rugby teams is the chronic ankle sprain. They will feel a sudden sharp pain on the outside of their ankle joint followed by swelling, bruising and an inability to take a full step over the following days and week. Very often they are back playing within a couple of weeks with the ankle being strapped by the Physio before matches. The question is what is causing this repeated ankle sprain and what should be done to prevent it from re-occurring. The following 3 factors help answer this Chronic Ankle question.
Overly tight ankle ligaments
Over tightening of the repair tissue on the healing ligament to the surrounding soft tissue ankle structure leads to a restriction on full movement in the joint. Hence when the athlete twists and turns or lands from a jumping position the overly taut outside ankle ligament (Anterior Talofibular ligament) is unable to withstand the forceful stress of this movement causing a repeated rupture of the ligament. This problem can be diagnosed by the Physical therapist by looking for pain in bending the foot downwards and turning it inwards at the same time. Friction massage concentred on the restricted ligaments coupled with mobilisations to the surrounding joints to help reduce restriction in movement can eliminate this problem.
Poor Proprioception Control
A weakness in an athlete’s balance or protective reflex muscle stabilisation in the ankle joint can lead to re-injury. Commonly there is a lack of proprioception or balance exercises in the exercise rehabilitation program after an ankle sprain injury. Hence the muscles and tendons of the ankle fail to give a strong reflex response to stabilise the ankle joint during a sudden landing or twisting movement. Single leg standing with progressions to eyes closed followed by wobble board, trampoline and jumping exercises are all required to alleviate poor ankle proprioception.
Excessive instability in the ankle Joint
Structural Lateral Ankle Instability
In certain cases there may be a tear to two out of the three lateral ankle ligaments namely the Anterior Talofibular ligament and the Calcaneofibular ligament. The tendons that surround the outside of the ankle are often not sufficiently strong enough to reduce this excessive movement in the ankle joint. This can lead to re-injury. An intensive strengthening program needs to be enacted. If there is a further injury relapse following this rehabilitation then surgery should be considered.
Tomás Ryan is a Registered Physical Therapist with The Irish Association of Physical Therapy and is based in Thurles.
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