Recurring Lateral Ankle Sprains

Lateral ligament injuries represent approximately 85% of all ankle sprains. The incidence of ankle sprain is highest in sports populations. It has the highest recurrence rate of lower limb injuries.

What is a lateral ankle sprain?

An ankle sprain is where one or more of the ligaments on the outside of the ankle are partially or completely torn. They occur when the ankle rolls outward, whilst the foot turns inward causing the lateral ligament to tear and stretch. When a ligament tears or is overstretched its previous elasticity and resilience rarely returns.

Anatomy of the ankle:

Of the lateral ankle ligament complex the most frequently damaged one is the anterior talofibular ligament (ATFL). Their anatomical location and the mechanism of sprain injury mean that the calcaneo-fibular (CFL) and posterior talofibular ligaments (PTFL) are less likely to sustain damaging loads.

Classification of Grades:

The traditional grading system for ligament injuries focuses on a single ligament.

  • Grade I represents a microscopic injury without stretching of the ligament on a macroscopic level.

  • Grade II has macroscopic stretching, but the ligament remains intact.

  • Grade III is a complete rupture of the ligament.

As there are multiple ligaments that cross the ankle joint, it might not be straight forward to use a grading system that is designed for describing the state of a single ligament unless it is certain that only a single ligament is injured.

Why do ankle sprains recur?

Poor rehabilitation after an initial sprain increases the chances of this injury recurrence. This is often due to insufficient rehab. Often times rehab programmes are not specific to the individual or sports person. Most times a person who just wants to return to daily living pain-free will have the same programme as someone who wants to return to high level activity. Often times most sports people try to return to sport prematurely.

Key Components of Rehab Program:

– Strength
– Range of motion
– Functional movement e.g. hopping, jumping & landing
– Running program e.g. straight line & multidirectional
– Being tested under fatigue

Ankle Strength Work
Video 1

After an acute or recurrent lateral ankle sprain the effected ligaments become lax. For that reason it is really important to strengthen all of the muscles that surround and cross over the ankle joint.
This video goes through strength work that can be used from early to late stage rehab.

Dosage:
– Do 3/4 sets to fatigue
– Twice a day
– Feel the area working
– Depending on current strength you might need to adjust sets and times a day and resistance appropriately
– Day on, day off or hard day, easy day
– Start off slow and build

What you should feel 24hrs after exercise:
– No ache= do more
– Slight ache= perfect
– Sore for 2/3 days after= too much

Ankle Strength Work
Video 2

As previously discussed in our last video, after an ankle sprain the effected ligaments become lax. For that reason it is really important to strengthen all of the muscles that surround and cross over the ankle joint.
This video goes through calf strength work that can be used from early to late stage rehab.

Dosage:
– Do 3/4 sets to fatigue
– Twice a day
– Feel the area working
– Depending on current strength you might need to adjust sets and times a day and resistance appropriately
– Day on, day off or hard day, easy day
– Start off slow and build
– Follow the instructions in the video

Ankle Strength Work
Video 3

Following on from our strength work this video moves onto jumping. Jumping work is really important in the lead up to running and it prepares you for multidirectional movements.

Dosage:
– Do 2/3 sets to fatigue
– Twice a day
– If double leg jumps are ok, you can move straight onto single leg
-Keep pain below a 4 out of 10 throughtout
– Day on, day off
– Start off slow and build
– Follow the instructions in the video

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