Recurring Ankle Sprains – Chronic Ankle Instability

by Ashlea Otto

Ankle sprains are a common musculoskeletal injury which affect those participating in sport and within the general community (1,2). People experience pain, swelling and poor function, which requires rehabilitation to heal and return to normal activities such as sport, work or exercise.

It has been reported that up to 55% of people who sustain an ankle sprain do not seek evaluation or treatment from a healthcare professional and only 11% receive a supervised rehabilitation program following diagnosis (2,3,4).

Because of their common presentation and often-quick resolution of pain and swelling, ankle sprains are considered by many to be minor injuries that resolve over time. While this may be true for some, a large number can lead to persistent problems including pain and chronic ankle instability (CAI) as a result of inadequate healing or lack of proper rehabilitation post initial injury (3,6).

Chronic ankle instability (CAI) is a condition which arises from subsequent or recurring ankle sprains and includes a combination of symptoms including persistent discomfort, pain, swelling, avoidance or adjustment of usual sporting or daily activities, and the perception of the ankle feeling wobbly, unstable or giving way. Those with CAI have been shown to report decreased function, physical activity levels and quality of life (4,5).

So how can CAI or subsequent ankle sprains be prevented? Let's begin with basic ankle anatomy to understand where ankle stability originates.

Although the ankle joint is complex, it is comprised of four main structures: bones, ligaments, muscles and nerves. Two leg bones (the tibia and fibula) and one foot bone (the talus) form the skeleton of the ankle. These bones are supported by two major groups of ligaments. The ligaments situated on the inside of the ankle are called the medial or deltoid ligament. Whereas the ones the outside of the ankle are called the lateral ligaments. The term ankle "sprain" represents damage or stretch to one or more of these ligaments.







When the ligaments are injured, there is increased joint laxity or readiness for the ankle to roll or give way. To compensate for this, the muscles and the nerves that control the movements of the ankle joint are required to provide extra stability. This is where an effective rehabilitation program becomes very important.

When muscles contract, they help to create stiffness around the joint. The stronger the muscles are the greater stability they provide. The nerves and nervous system also stimulate the muscles and protective reflexes around the ankle. Following ankle sprains individuals have been found to have deficits in ankle strength, balance and proprioception (the body's ability to sense where and how the ankle is positioned in space without having to look at it) (5,6). This highlights the importance of completing and effective strength and proprioception rehabilitation program following a sprain. The quicker your muscles are able to detect and react to unexpected ankle movements, the more likely they are able to prevent the chance of another sprain. .

Physiotherapy rehabilitation programs have been shown to significantly reduce the risk of future ankle sprains, improve function and perceived confidence in ankle function (7,8,9). If you have a history of rolling your ankles or feel like your ankles give way regularly, contact Physiohealth and we can assist you with your own comprehensive assessment and tailored rehab program.




References:
1. Hiller, C. E, et al. (2012). Prevalence and Impact of Chronic Musculoskeletal Ankle Disorders in the Community. Physical Medicine & Rehabilitation, 93(10), 1801-1807. 2. Fong, D. T., Hong, Y., Chan, L., Yung, P., & Chan, K. (2007). A systematic review on ankle injury and ankle sprain in sports. Sports Medicine, 37(1), 73-94. 3. Van Rijn, M., et al., (2008). What is the clinical course of acute ankle sprains? A systematic literature review. The American Journal of Medicine, 121(4), 324-331. 4. Gribble, P. A., et al. (2016). 2016 consensus statement of the International Ankle Consortium: prevalence, impact and long-term consequences of lateral ankle sprains. British Journal Of Sports Medicine, 50(24), 1493-1495. 5. Hiller, C., Nightingdale, E, & Raymond, J. (2015). The impact of chronic ankle instability: a systematic review. British Journal of Sports Medicine, 49(3), 47-52. 6. Hiller, C., Nightingale, E., Lin, C., Coughlan, G., Caulfield, B., Delahunt E. (2011). Characteristics of people with recurrent ankle sprains: a systematic review with meta-analysis. British Journal of Sports Medicine, 45(8), 660–672. 7. Ferger, M. A., Herb, C. C., Fraser, J. J., Glaviano, N., & Hertel, J. (2015). Supervised rehabilitation versus home exercises in the treatment of acute ankle sprains: a systematic review. Clinics in Sports Medicine, 34(2), 329-346. 8. Wright, C. J., & Linens, S. W. (2017). Patient-Reported Efficacy 6 Months After a 4-Week Rehabilitation Intervention in Individuals With Chronic Ankle Instability. Journal Of Sport Rehabilitation, 26(4), 250-256. 9. Powden, C. J., Hoch, J. M., & Hoch, M. C. (2017). Rehabilitation and Improvement of Health-Related Quality-of-Life Detriments in Individuals With Chronic Ankle Instability: A Meta-Analysis. Journal Of Athletic Training, 52(8), 753-765.
This entry was posted in Articles, Athletics, Common Injuries, Football Ankle & Feet, General Ankle & Feet, General Exercises, Gymnastics Ankle & Feet, Gymnastics/Dancing, Running, Soccer, Tennis, Tennis Ankle & Feet, Triathlon, Triathlon Ankle & Feet. Bookmark the permalink.