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Ankle Sprains and Re-Injury

Ankle sprains are very common, ranking as one the most injured regions in active and non-active individuals. The figure below highlights the common nature of the injury in sporting populations (1, 2).



Scarily, after an ankle sprain, up to 34% of individuals report re-spraining their ankle at least once (and often more) (3). Furthermore, up to 45% of athletes and individuals report an incomplete recovery at 3 years following the injury (3).


Does this sound like you? And what can you do? Many of those that follow my social media channel (see here) will know that most individuals often either delay seeking treatment and rehabilitation, or don’t see a physiotherapist at all. This significantly increases the risk of injury. Apart from going to see a physiotherapist (the earlier the better), how can you reduce the risk of re-injury or progression to chronic ankle instability? The figure below displays visually the factors the may help reduce injury risk.




  • Ankle Taping or Bracing: Use of taping and bracing has been shown to reduce injury and re-injury risk (4). The proposed mechanism behind the reduced injury risk is likely through increased joint position sense and proprioception (5). Proprioception refers to the perception and awareness of the body position and movement.

  • Injury Prevention Programs: ankle injury prevention programs have been shown to have a significant protective effect for ankle injuries (6). Programs including education, balance, and technical skill training can reduce ankle sprain incidence by up to 47% (7, 8). The programs are more efficient in players with a history of previous ankle sprain (8).

  • Hip Abduction/Glute Strengthening: individuals with chronic ankle sprains have been found to have weaker hip abductor muscles (glutes) on the injured side (9). While unsure of causative or adaptive from the injury (likely the latter), it is important to include hip abduction strengthening (glutes!!) into your rehab/recovery program.

  • Balance and Proprioceptive Training: Balance, postural stability, and proprioceptive training is effective in reducing ankle injury and re-injury (4, 5, 6, 10).

  • Technical Training: Coaching specific jump and land technique reduces injury risk, especially in high risk sports (e.g. volleyball) (4, 5).

  • Education: Knowledge regarding the best injury prevention strategies (e.g. taping/bracing), what to do post injury, benefits of early management, and the value of high-quality progressive rehabilitation assists with reducing injury (5).

  • Address Risk Factors: There are a number of factors linked with increased risk of ankle injuries, including but not limited to reduced ankle ROM, poor balance and poor proprioception (11). The figure below further highlights these risk factors.


My advice: Don’t continually roll your ankle and do nothing. Get an injury prevention and rehab program sooner rather than later!



References:

1. Fong, D. T. P., Hong, Y., Chan, L. K., Yung, P. S. H., & Chan, K. M. (2007). A systematic review on ankle injury and ankle sprain in sports. Sports medicine, 37(1), 73-94.

2. Swenson, D. M., Yard, E. E., Fields, S. K., & Dawn Comstock, R. (2009). Patterns of recurrent injuries among US high school athletes, 2005-2008. The American journal of sports medicine, 37(8), 1586-1593.

3. van Rijn, R. M., Van Os, A. G., Bernsen, R. M., Luijsterburg, P. A., Koes, B. W., & Bierma-Zeinstra, S. M. (2008). What is the clinical course of acute ankle sprains? A systematic literature review. The American journal of medicine, 121(4), 324-331.

4. Martin, R. L., Davenport, T. E., Paulseth, S., Wukich, D. K., Godges, J. J., Altman, R. D., & MacDermid, J. (2013). Ankle stability and movement coordination impairments: ankle ligament sprains: clinical practice guidelines linked to the international classification of functioning, disability and health from the orthopaedic section of the American Physical Therapy Association. Journal of Orthopaedic & Sports Physical Therapy, 43(9), A1-A40.

5. Fong, D. T., Chan, Y. Y., Mok, K. M., Yung, P. S., & Chan, K. M. (2009). Understanding acute ankle ligamentous sprain injury in sports. BMC Sports Science, Medicine and Rehabilitation, 1(1), 14.

6. Grimm, N. L., Jacobs Jr, J. C., Kim, J., Amendola, A., & Shea, K. G. (2016). Ankle injury prevention programs for soccer athletes are protective: a level-I meta-analysis. JBJS, 98(17), 1436-1443.

7. Bahr, R., Lian, Ø., & Bahr, I. A. (1997). A twofold reduction in the incidence of acute ankle sprains in volleyball after the introduction of an injury prevention program: a prospective cohort study. Scandinavian journal of medicine & science in sports, 7(3), 172-177.

8. Verhagen, E., Van der Beek, A., Twisk, J., Bouter, L., Bahr, R., & Van Mechelen, W. (2004). The effect of a proprioceptive balance board training program for the prevention of ankle sprains: a prospective controlled trial. The American journal of sports medicine, 32(6), 1385-1393.

9. Friel, K., McLean, N., Myers, C., & Caceres, M. (2006). Ipsilateral hip abductor weakness after inversion ankle sprain. Journal of Athletic Training, 41(1), 74.

10. Dingenen, B., Malfait, B., Nijs, S., Peers, K. H., Vereecken, S., Verschueren, S. M., ... & Staes, F. F. (2016). Postural stability during single-leg stance: a preliminary evaluation of noncontact lower extremity injury risk. Journal of Orthopaedic & Sports Physical Therapy, 46(8), 650-657.

11. Vuurberg, G., Hoorntje, A., Wink, L. M., van der Doelen, B. F., van den Bekerom, M. P., Dekker, R., & Smithuis, F. F. (2018). Diagnosis, treatment and prevention of ankle sprains: update of an evidence-based clinical guideline. BJSM, bjsports-2017.


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