Chronic Ankle Injuries
Have you ever heard someone complaining of ankle pain and weakness years after they experienced an ankle injury? It is almost expected that if you have sprained your ankle, you will experience weakness forever. Sometimes associated problems may develop in the hip or knee or the other ankle. Well, no need for worry; there are steps you can take to aid your recovery and build up your ankle strength.
The ankle joint sits between the foot and lower leg (the tibia and fibula). It is a large complex joint made up of three bones: the tibia, fibula and the talus. It is capable of moving the foot up and down, in and out. It acts, along with the foot, to propel the body forwards, backwards and sideways, adapt to uneven surfaces, support the body and maintain stability. Because of the need to adapt to movement on different surfaces, and also support the body, it has a network of ligaments running in different directions that increase the ankle’s stability. Ligaments are thick, fibrous, flexible bands of tissue that connect bones and limit excessive movement. Ligaments and the reaction times of our muscles to changes in the position of our foot protect us from injury. However, there are times when this mechanism fails; or is overstretched, resulting in an ankle sprain.
A sprain is a movement that takes the joint beyond its normal range and can be graded depending upon the severity of the injury. Regardless of the severity, ankle sprains are often accompanied by pain, swelling and decreased function.
Grade I – Mild sprain with no tears to the ligament. Responds to rest, ice and a period of exercise to promote quicker return to activity.
Grade II – Moderate sprain where some of the fibres are torn but the ligament remains intact; you may notice light bruising. May require a brace or splint to allow better healing of the ligaments followed by rehabilitation and exercise before full function is restored.
Grade III – Severe sprain where the fibres are completely ruptured. This is usually accompanied by bruising as the torn fibres cause bleeding beneath the skin. These do not always respond to conservative management and may require surgical intervention Healing and return to function depend on the grade of the sprain and although pain and swelling may resolve in a few weeks, it can take several months (sometimes up to a year) for full ligament healing to occur. Not all ankle sprains heal as expected and if symptoms are still present after six months, the condition is then classified as chronic.
Most sprains occur when the ankle twists in an outward motion, stretching all the structures on the outside aspect of the ankle. In severe cases it may cause a complete rupture of the ligament or even a fracture which would require immobilisation.
Why are some people more predisposed to injury than others? Age, poor balance, weakness and previous injuries are all factors that increase the risk of injury. A previous injury that is left to heal without rehabilitation can develop laxity in the lateral supporting ligaments, with tightness and weakness of tendons and muscles which can affect postural control, static and dynamic balance, proprioception (reaction time), biomechanics and gait.
As with any injury, prevention is always better than cure. But we do not always know we have a problem until after the injury occurs. Working on ankle and balance exercises can reduce the risk of injury but if you have already had an ankle injury, or an injury that keeps recurring, a physiotherapist can help identify any weaknesses and altered biomechanics and design a unique exercise programme based on your individual needs. A recent study concluded that lower limb and balance exercises prescribed and supervised by a physiotherapist have a greater success rate on recovery and preventing recurring problems than injections or exercises that just focus on ankle strength.
If you sprain your ankle, the first step is to remember the Protect Optimum Loading Ice Compression Elevation protocol, then speak to a physiotherapist about developing an exercise programme that gradually increases in intensity as your pain and swelling reduce. The most important take-home message is: don’t accept the unacceptable; a weak, unstable ankle can have negative affect on the whole body and create more problems in the future.
Kim Jackson is a UK-trained physiotherapist with over 20 years’ experience. She specialises in musculoskeletal pain and dysfunction including back pain and sciatica, stroke and other neuro conditions plus sports physiotherapy, having worked with local, regional and international athletes and teams treating injuries and analysing biomechanics to improve function and performance. She is registered with the Allied Health Council and is a member of PASL. She currently works at Bayside Therapy Services in Rodney Bay, O: 458 4409 or C: 284 5443; www.baysidetherapyservices.com
The pain from an ankle injury can resurface at any time, especiallly if you’re not careful.