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1st May

2011

Chronic Symptoms after Ankle Sprains

Several studies have shown that up to 50% of people who suffer ankle inversion sprains, i.e. where the ankle rolls over, suffer long lasting pain and functional impairments afterwards, sometimes for several years. It has also been shown that these people often have sprained multiple ankle and foot ligaments, often not recognized at first, and even suffered impact injury to the cartilage in the ankle joint. Even long after the acute symptoms have subsided, this may make it difficult to tolerate prolonged walking, running and jumping, and quick stops or side to side movements. Athletes may also be up to five times more likely to re-injure their ankles.

Although studies have shown that structured rehabilitation significantly reduces the risk of re-injury, other studies have pointed out that physical therapy is often under utilized, or incomplete. Research has shown that people who have had repeated ankle sprains in the past, often have reduced proprioception, or position sense, in their ankles, making key muscle groups slow to react when the ankle rolls in and out. This is believed to result primarily from damage to nerve receptors embedded in the ankle joint capsule.

If there was much swelling after the sprain, and the ankle initially was immobilized, there may later be residual loss of motion in the subtalar joint, the joint between the ankle bone and the heel bone, adding to strain and instability to the often lax ankle joint.

An effective rehabilitation program should be designed to initially enhance tissue healing, and subsequently to restore all functional qualities. Gentle active ankle and foot movements in pain free directions can be started within the first day of injury, and be performed with many repetitions, several times per day, with the leg elevated. Once the bleeding has stopped right after the injury, ice and compression can be continued, but only intermittently for short five minute periods. Ankle movement is the primary means of reducing swelling, pain and muscle guarding, and to stimulate tissue repair. Weightbearing is initially reduced, and the ankle is protected in a brace when up.

Rehabilitation exercises continue with pain free coordination and endurance training with lightly resisted movements without weightbearing on the foot. This is progressed to partial weightbearing exercise with the injured ligaments protected. The opposite leg and the knee and hip can be exercised, to enhance recovery of muscle function. The physical therapist can apply manual techniques, to help reduce pain and muscle guarding and restore mobility.

Full weightbearing is gradually restored, and exercises are progressed in weightbearing and with increasing resistance to increase also strength, and improve key muscles’ reflex ability to contract quicker and stabilize the joint. Pain and swelling are to be avoided with exercise. Balance training is incorporated and made more difficult. The injured joint is progressively more challenged. Finally, power training and plyometric exercise, such as controlled jumping, may be added, before returning to sports activities. Exercise progressions are based on the severity of the injury, and each person’s health, age and goals.

Best wishes for continued good health,

Gunnar

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