The following article was written for Medbridge- an online, video based continuing education based company.
The inversion ankle sprain is one of the most common musculoskeletal injuries, with an incidence of 7.2/1000 people age 15 to 19.1 People participating in basketball, football, and soccer are at particularly high risk for an ankle sprain. The ankle sprain has been reported to account for up to 34% of all sport-related injuries.2
Ankle Instability
Likely due to the common nature of these injuries, the common vernacular in response to this injury is, “you’re fine; just walk it off.” Because of the common “laissez-faire” attitude related to lateral ankle sprains, they have been likened to the common cold which is the most prominent example of a self-limiting medical condition. Despite this popular belief, ankle sprains can potentially lead to serious long-term disability and dysfunction. Chronic ankle instability and injury are common sequelae following just one sprain.
In fact, people who do not perform ankle proprioceptive/balance exercises after a sprain are more likely to develop ankle instability.3 The reinjury rate following the first-time sprain ranges from 17-73%.3 High-risk sports like basketball report the highest rates of reinjury. Up to 33% of patients have pain or instability at one year and 25% are still experiencing problems at three years post sprain.4
Effective Interventions
As therapists, we have an opportunity to make sure this population receives the care they need to maximize return to prior activity/sport and prevent long-term disability and instability.
Clinicians should address impairments in strength, joint mobility, and proprioception to reduce chronic instability. Specifically, balance/proprioceptive training with sport-specific activity training should be a focus in order to limit recurrence of ankle sprains. Therapists should recognize that patients who fail to use external lace-up supports (especially in high-risk sports) are at higher risk for a lateral ankle sprain.5,6 Therapists should maximize optimal dorsiflexion to decrease ankle sprain and chronic instability.3
Here’s an example of a dynamic proprioceptive activity from the MedBridge Home Exercise library:
And, here is an example of a self talocrural mobilization to increase dorsiflexion:
Advocates for Proper Care
There is a common perception among the public and many medical providers that sprains are self limiting. Ankle reinjury and disability rates suggest this is not the case. Therapists are positioned to advocate for proper intervention like balance/proprioception training to limit recurrence and disability related to lateral ankle sprain.
References
Waterman, Brian R., et al. "Epidemiology of ankle sprain at the United States Military Academy." The American journal of sports medicine 38.4 (2010): 797-803.
Fong, Daniel Tik-Pui, et al. "A systematic review on ankle injury and ankle sprain in sports." Sports medicine 37.1 (2007): 73-94.
Martin, Robroy L., et al. "Ankle stability and movement coordination impairments: ankle ligament sprains." Journal of Orthopaedic & Sports Physical Therapy (2013).
van Rijn, Rogier M., et al. "What is the clinical course of acute ankle sprains? A systematic literature review." The American journal of medicine 121.4 (2008): 324-331.
Aaltonen, Sari, et al. "Prevention of sports injuries: systematic review of randomized controlled trials." Archives of internal medicine 167.15 (2007): 1585-1592.
Dizon, Janine Margarita R., and Josephine Joy B. Reyes. "A systematic review on the effectiveness of external ankle supports in the prevention of inversion ankle sprains among elite and recreational players." Journal of science and medicine in sport 13.3 (2010): 309-317.