I was 15 years old when I went up for a rebound during a basketball game and came down with my foot on another player’s shoe – twisting my right ankle hard to the side and falling to the ground. I didn’t play the rest of that game. Or the next few. I didn’t get treatment…and I rolled that ankle another 200 times over the next 10 years.
That injury and the instability that followed has been the foundation for many others that arose higher up in my body through the years as my it compensated for the lack of stability and control I had in my ankle while continuing to participate in competitive sport.
In over 20 years of physiotherapy practice, I’ve seen many clients with the same picture of disability and lack of adequate treatment – resulting in unnecessary suffering and progression to chronic ankle instability.
When we roll our ankle, there are a number of tissues of the body that are affected but the most common are:
a. Ligaments – these are the connective tissues in the body that run from bone to bone and act to stabilize joints and are the most common tissue that we significantly injure when we sprain an ankle, especially for the first time. The degree of injury depends on the type of sprain and whether the ligament has been fully torn or not.
b. Muscles – the muscles that run down through the ankle help to both stabilize and propel us during movement. They can become torn, impinged or bruised with ankle sprains.
c. Bones – fractures (breaks) to the bones of both the foot and ankle can occur and may not show up on xrays if they are taken too early.
d. Nerves – the nerves that run down the leg into the foot have a crucial role of innervating (bringing signals to) the muscles of the foot and ankle. When stretched, nerves can sustain injury that affects their ability to transfer those signals as well as affecting health to the nerve higher up in the chain of the body and can turn into issues closer to the spine if the nerve root that creates that nerve becomes affected as well.
The attitude that these issues will “just work themselves out” is unfortunately common, even among the physicians and surgeons that advise clients after their initial injuries in the hospitals and walk-in clinics.
Here’s a few reasons that I believe ALL ankle sprains should see an orthopaedic Physiotherapist post-injury:
1. Hands-on therapy can help with minimizing scar tissue development and joint stiffness. As the tissues of the ankle heal post-injury, hands-on (manual) therapy can help to minimize the scar tissue that develops in these soft-tissues. Even if you are immobilized in a walking boot, there is often a number of safe treatments that can be done to ensure that your tissues don’t heal unnecessarily tight and limit your movement and function down the road.
2. The “little world” in your joint needs to be taught how to work again. There are receptors within your ankle joint that are responsible for sensing where it is in space. These receptors become disorientated post-injury and need to be retrained. A suscinct set of balance and strength exercises from a Physiotherapist can help immensely with developing your joint position sense (called proprioception) and preventing chronic re-injury.
3. Education on when it’s safe to return to sport and activity is NOT just common sense. I would say the most common strategy post-ankle sprain is the “wait it out and rest” approach and then return to sport when pain has resolved. Unfortunately, the ankle most people return to sport with is left with stiffness, scar tissue and altered muscle and joint performance, which sets the stage for re-injury. A Physiotherapist can help you with figuring out when it is safe to return by performing functional tests and measurements to determine when the right timing for return to sport will be.
So, if you or someone you know has sustained an ankle sprain and is planning on just waiting it out, please share this post with them. Early treatment really is key to the best results possible after these very common and potentially chronically dibilitating injuries.
If you are in need of treatment, our team of Physiotherapists would be happy to help. Book an initial assessment with them HERE.
Katrina Sovio, Registered Physiotherapist & Clinic Director.
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- Gaddi D, Mosca A, Piatti M, Munegato D, Catalano M, Di Lorenzo G, Turati M, Zanchi N, Piscitelli D, Chui K, Zatti G, Bigoni M. Acute Ankle Sprain Management: An Umbrella Review of Systematic Reviews. Front Med (Lausanne). 2022 Jul 7;9:868474. doi: 10.3389/fmed.2022.868474.
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