Ankle Sprains – Long-term Problems and Rehab
In earlier installment in this series (https://www.syracusechargers.org/therapy/chapt94/) examined a traumatic (as opposed to overuse) injury sometimes suffered by runners – ankle sprains. The aim of that article was to offer some tips to prevent such injuries, as well as to emphasize the importance of seeking medical attention to rule out a fracture if the apparent sprain manifests in severe swelling, bruising, and weight-bearing pain.
What wasn’t covered was the best course of treatment for an ankle sprain, both immediate and long-term. I won’t go into the details of the former, as most people are aware of the standard protocol of Rest, Ice, Compression, and Elevation (RICE), which is still generally advised, though this is now somewhat controversial and subject to questions regarding the first two measures, as I outlined recently. Rather, I’d like to discuss the long-term effects of ankle sprains that are not readily apparent but can adversely affect runners.
There are primarily two problems that can develop after an ankle sprain. The first, and most often encountered, is the development of a chronic instability of the ankle, due to the failure of the ligaments that have been damaged to regain their normal length and strength during the healing process. Additionally, the injured ligaments can lose their ability to provide proprioceptive (position sense) feedback through the nervous system to the supportive muscles. Without these two properties, the ankle is subject to repeated sprains and, the more often you sustain a sprain, the more permanent the damage, which increases the risk for recurrent sprains, which leads to …etc, etc.
Thus, it is critically important that sprains be properly rehabilitated the first time in order to prevent this chronic instability from developing. I strongly recommend seeing a physical therapist for one or two visits minimum, if not ongoing treatment for acute sprains, to get the proper guidance on care and exercises (for strength and balance training primarily) to address this potential complication.
A more subtle aftereffect of an ankle sprain is a loss of mobility in the ankle joint. Specifically, an often-found characteristic of this injury is a long-term reduction in dorsiflexion range of motion of the ankle. (Dorsiflexion is the movement you would see if, when standing or sitting, you lift the ball of the foot and toes upward while keeping your heel on the floor.) This impairment occurs acutely due to swelling in the joint that prevents full motion; it becomes a chronic problem if this movement is not restored during the rehabilitation process, causing the ankle joint ligaments and/or muscles to become shortened and stiff.
A 2009 study that appeared in the Journal of Science and Medicine in Sport confirmed that this is a frequently seen consequence of ankle sprains. Compared to a control group, subjects with chronic ankle instability demonstrated a significant reduction (9-25%) of dorsiflexion range during jogging.
A certain amount of dorsiflexion (most estimates average 10° for walking, 25-30° for running) is necessary for normal gait mechanics. A reduction in range becomes of concern due to the potential for developing abnormal movements at other joints in the lower limb to compensate for this limitation. The most common compensatory patterns are increased foot pronation or a turned-out position of the foot (via external rotation of the hip, usually). Like any abnormal movement pattern, these will often lead to some structure such as muscle or tendon being overstressed by the repetitive activity, leading to tissue breakdown.
Most people – and many clinicians – fail to recognize that there is this loss of mobility at the ankle, since it is often small and subtle. The adverse effects, though, can be large, so anyone who suffers an ankle sprain would do well to be sure to include as part of a rehabilitation program exercises and, if necessary, professional treatment that address this often seen effect of what may seem to be a simple ankle sprain.