ANKLE INJURY REHAB
Don’t Dismiss Ankle Sprains: Manual Therapy, Balance, and Beginner to Advanced Exercises The ankle is one of the most common sites of injury in exercise and sports. In a recent study, ankle sprain accounted for 76.7% of injuries in sports (1). While more common in sports, ankle sprains also occur in every-day activities like walking on uneven ground or stepping off a curb. Up to 70% of people who sprain their ankles will continue to have difficulty with them. In fact, once an ankle is sprained, up to 80% of people will suffer recurrent sprains (2), and up to 72% will develop symptoms of chronic ankle instability (CAI) (3). Between 5% and 19% of athletes experience psychological distress following an injury to levels comparable with patients receiving treatment for mental health illness (4). Stress increases the risk of an athletic injury (5). Rehabilitation following injury can be adversely affected by loss of confidence, fear, and anxiety. To safely return to exercise activities, it is crucial to train physical and cognitive demand, as well as sport-specific technical skills (6) in order to establish optimal neuromuscular control, injury reduction, and overall performance capabilities (7). Ankle sprains can be very disabling, as the research shows. These data suggest that it’s important to better care for ankle sprains. The good news is, research also shows that individuals who have sprained their ankles can benefit from a physical therapy program that includes manual therapy and a supervised exercise program. Potential benefits are less pain and improved ability to perform daily activities and return to sport (2). What follows is an evidence-based rehabilitation approach for various ankle injuries including the management of ankle sprains. What we do as Doctors of Physical Therapy at Elevate PT & Fitness always depends on our thorough evaluation of each individual patient. What interventions we choose and when depends on the specifics of the injury, the tissues involved, a patient’s pain and function level, and patient-specific goals. In this article you’ll see a manual therapy intervention; early-stage non weight-bearing exercises for important ankle muscles often weakened in an injured ankle; balance and proprioception exercises; and high level plyometric training. Manual Therapy Joint Mobilization: Manual therapy joint mobilization techniques are used to modulate pain and treat joint dysfunctions that limit range of motion (ROM) by specifically addressing the stiffness and altered mechanics of the joint. The altered joint mechanics may be due to pain and muscle guarding, joint effusion, contractures or adhesions in the joint capsules or supporting ligaments, or malalignment or subluxation of the bony surfaces. Non Weight-bearing Band Resistance: Non weight-bearing exercises allow activation of muscle tissue, low-intensity stress through connective tissue (ie. tendons/ligaments), loading without over stressing tissue or compromising healing process. The following are Theraband exercises for Tibialis Posterior and Peroneus Longus, two muscles often impaired in injured ankles. Population: For individual unable to tolerate full weight-bearing. Weight-bearing: Re-introduction to weight-bearing exercise will increase tolerance to standing and walking, in an attempt to normalize gait pattern and reduce stress on neighboring joints and tissues. Population: For individual several days/weeks after injury, tolerant to full weightbearing on affected limb. Balance/Stability/Proprioception: Challenge balance to restore proprioceptive feedback to neuromuscular system, increase awareness of body position in space and in relation to ground surface. Loss of proprioception is a risk factor for re-injury. What follows are several single leg exercises to challenge balance, proprioception, and nueromuscular control in all planes of ankle movement. Population: For individuals able to weight-bear with minimal pain, ambulate short distances, and who display poor control, strength and stabilization. Power/Plyometric: Plyometric movements are similar to game-time speed and intensity, stress joints and tissue to maximal extent. Agility and control of momentum is often impaired by ankle injuries, and can lead to further injury if not appropriately addressed. Final stage before return to sport-specific activities. The following exercises demonstrate a few ways to introduce higher level, sport-like challenges in the sagittal and frontal planes. Population: For individuals able to run/jump without pain, returning to sport-specific skills training. (A licensed physical therapist can perform a thorough evaluation to help determine if you are a good candidate for this treatment as part of a program designed to help get you back to full activity after an ankle sprain. For more information on the treatment of ankle sprains, contact us at Elevate PT & Fitness, or your physical therapist specializing in musculoskeletal disorders.) _________________________________________ References: (1)Predictors of lower extremity injuries at the community level of Australian football. Gabbe BJ, Finch CF, Wajswelner H, Bennell KL. Clin J Sport Med. 2004 Mar; 14(2):56-63. (2)Journal of Orthopaedic & Sports Physical Therapy, 2013 Volume:43 Issue:7 Pages:456–456 DOI: 10.2519/jospt.2013.0504 (3)The Relationship between Muscle Function and Ankle Stability. Lentell G, Katzman LL, Walters MR. J Orthop Sports Phys Ther. 1990; 11(12):605-11. (4)Considerations for Normalizing Measures of the Star Excursion Balance TestPhillip Gribble-Jay Hertel – Measurement in Physical Education and Exercise Science – 2003 (5)A systematic review on ankle injury and ankle sprain in sports. Fong DT, Hong Y, Chan LK, Yung PS, Chan KM. Sports Med. 2007; 37(1):73-94. (6)The team physician and return-to-play issues consensus statement http://www.amssm.org/MemberFiles/RTP_Cons_State.pdf Published 2002. Accessed September 2011 (7)Initial changes in posterior talar glide and dorsiflexion of the ankle after mobilization with movement in individuals with recurrent ankle sprain.Vicenzino B, Branjerdporn M, Teys P, Jordan K. J Orthop Sports Phys Ther. 2006 Jul; 36(7):464-71.