Rolling in and out through ankle injuries…

Cover Photo Ankle Blog

March 28, 2018

Ankle injury! We’ve all been there right? Or at least you know of someone that has?  That dreaded, instant gut-wrenching pain of an ankle roll during a game of netball, at the school sports or during a harmless jog around the park… Ugh, ankle injuries.

Unfortunately ankle injuries can be an ongoing issue and you may find yourself carrying the recurring and sometimes “old” injury for years to come. You may experience either a frequent ache from time to time or the sporadic and sudden sharp pain when you move into an awkward position. If you’ve suffered an ankle injury I’m sure this sounds TOO familiar!

So where to go from here? First, a little bit of applied science and anatomy – our favourite!

The ankle joint is a synovial hinge joint formed between the tibia (shin bone) and fibular (not so well-known shin bone) and performs a range of movements including:

  • Inversion – pointing the foot in <
  • Eversion – pointing the foot out >
  • Plantarflexion – bending the foot downwards like planting the foot when driving a car, get it?
  • Dorsiflexion – bending the foot upwards, like lifting your foot to tap to the beat of your favourite song
  • Rotation

It is also important to note the specific movements provided by two primary joints within the ankle joint:

  • Talocrural joint- responsible for dorsiflexion and plantarflexion
  • Subtalar joint- responsible for inversion and eversion.

The ankle has many roles, but primarily it acts as a lever for efficient propulsion during movement, accommodates for uneven surfaces – both expected and unexpected – and absorbs shock when in a vertical upright position (Fraser, Fegal and Hertel. 2016).

When comparing ankle injuries, you may notice the injuries discussed can be significantly different. There can be a range of symptoms and pain sites that differ depending on the location of the injury and the mechanism of the injury sustained. The two common areas of injury to be aware of include injury to the lateral compartment of the ankle – meaning the outside of the ankle – and the medial side of the ankle joint – meaning the inside of the ankle. It is also important to mention that a commonly seen ankle injury is a syndesmosis ankle sprain, accounting for 1-11% of ankle injuries. We won’t dive into syndesmosis ankle sprains during this particular blog as it’s a whole new kettle of fish!

Lateral ankle injuries is most common, with Rubin and Sallus (1996) reporting the lateral compartment of the ankle to affect 85% of total ankle injuries. The most common cause of a lateral ankle injury involves the foot moving into a position of inversion and plantarflexion, with the anterior talofibular ligament mostly affected (Rubin and Sallus 1996).

Medial ankle sprains are less common, with a total of 5% of ankle injuries reported to be associated with the medial ankle. The deltoid ligament is most commonly affected with this type of injury, usually as a result of eversion (toes pointing out). It is also common for the foot to be forced into a dorsiflexion position.

Now to the fun stuff…

As mentioned, these types of injuries can reoccur. The ankle may give out during normal active daily living tasks or recurrent sprains while participating in sport.  You may also have noticed there is a psychological impact with ankle injuries. Our mind is good at reminding us of the possibility of the gut-wrenching pain you could experience whilst trying to make it to the bus that you are about to miss,  or maybe mid-way through the next swift dodge you make to intercept a pass for the win of the Netball Championship – one can dream…

That fear we speak of is detrimental to our quality of life as well as our athletic performance.  Not to worry, this is where we can help! Physiotherapists and Exercise Physiologists use scientifically proven methods of exercise rehabilitation incorporating balance, strength and proprioceptive specified exercise to assist in improving the stability and integrity of the ankle joint. Interestingly, it has been demonstrated in a number of studies that balance training is most effective! Read on…

A recent study performed by Wright, Linens and Cain (2017) discussed the benefits of two key rehabilitation protocols involved in ankle instability rehabilitation. The two protocols included specified balance training (wobble-board) and resistance training  with the use of a resistance band. Three supervised sessions over a four week period were completed by the participants of the study. Over the four-week intervention, balance training was the most effective.  Improved participation satisfaction, clinical outcomes and compliance to training reflecting engagement, motivation and enjoyment of the prescribed exercise were established. It is however important to consider the barriers and limitations with this particular study and their impact on the results.

Now into the nitty-gritty to finish off on a high! Exercises that you could incorporate into your weekly exercise regime to assist with the niggling ankle pain are outlines below. But, firstly it’s important to remember that consistency with a regular rehabilitative exercise program is the key in returning the ankle to a state of improved stability and integrity and one that will ultimately prevent recurrent injuries in the future. If you feel your injury is more advanced, come on into Bodyfit NT and engage in a one-on-one rehabilitative session with one of our experienced Exercise Physiologists or Physiotherapists, to assist in long term management protocols and sport-specific recovery.

 

Exercise Prescription for Rehabilitation:

Strengthening:

  • Heel raise: Preferably perform on a step for greater range of motion. Lower your heel toward the floor and push up through your toes and ball of your foot. Aim for maximum height and slowly control the movement back down to starting position. Complete 2 x 15 repetitions.

Heel Raise

Stretching:

  • Gastrocnemius stretch: Seated on the floor wrap a towel around the ball of your foot and slowly bring your toes toward your body with your knee straight. You should feel your calf muscle stretching to a point that is comfortable and not causing any form of pain. Hold the stretch for 30seconds and alternate sides.

Gastroc Stretch

Balance Re-training:

  • Single leg stance: Place a piece of foam or a cushion under your foot, slowly move into a single-leg stance position and aim to hold for 30seconds-1minute. Aim to increase difficulty by scanning the room with your eyes or performing a small hop. Complete on both sides.

Balance- Single Leg Stance