by Mitch Hauschildt, MA, ATC, CSCS
I often tell people that in my role as the rehab coordinator for the Division I university athletic program that I never get to work on an ankle sprain. I joke that I don’t get easy stuff like ankle sprains. I tend to get complicated low back pain, sports hernias, thoracic outlet syndrome, and other difficult cases. My coworkers tend to keep more common injuries to themselves and send me the cases that they can’t seem to get figured out. Honestly, I love that role and embrace the tricky cases. But I will also say that every now and then, I would like to get a simple rehab.
Recently, I did actually get an ankle sprain handed off to me and really enjoyed the opportunity to work on something different. It did get me thinking a little bit about how I tend to minimize things like ankle sprains and the importance of giving them proper rehab attention.
The reality is that even though ankle sprains are common, an ankle sprain is never just an ankle sprain. Our foot and ankle are our only contact with the ground while upright, so maximizing the performance in the ankle is essential for long term health. I’ve learned over the years that if someone (especially a young person) sprains their ankle and it isn’t approached with high quality, focused rehabilitation, we are setting them up for failure in the future. Here are a few of those reasons:
- There are a number of different studies that show that our #1 predictor of future injuries is previous injuries. This appears to be true of ankle injuries, as well as other lower extremity injuries. If someone has been injured in the past, even with a minor injury, their risks for a future injury are a lot higher. Thus, if we don’t take the time to rehab an ankle sprain properly, we are setting them up for failure down the road. Rest and ice is not enough. We have to restore proprioceptive feedback from that area of the body into the system.
- Speaking of proprioceptive feedback, if an ankle injury is properly rehabbed, a person’s neurological control will be reduced. Some research suggests that after an injury, the brain starts to rely more heavily on visual feedback instead of proprioceptive feedback. That causes a feedback loop that isn’t authentic, leading to other issues. Proper feedback needs to be facilitated to ensure high quality movement patterns in the future.
- There is also some research out there that shows there is a direct connection between lateral ankle sprains and glute medius function. They suggest that when an individual sustains a lateral ankle sprain, that their glute med tends to shut down. This furthers my argument that an ankle sprain causes a lot of issues neurologically throughout the rest of the kinetic chain.
- When an ankle sprain is left alone, the likelihood of chronic instability rise. This typically happens when someone has sustained multiple sprains (which is more likely when an ankle isn’t handled properly as discussed above). With recurrent or chronic sprains, long term instability will occur, leading to an ankle that is unstable, painful and problematic long term.
- We typically see range of motion issues following an ankle sprain. This is due to the brain’s protective barrier, as well as a change in walking mechanics. Usually, people loose ankle dorsiflexion, which then can lead to further foot and ankle injuries, as well as anterior knee pain, low back pain, hip issues and so on. Range of motion must be restored after an ankle sprain.
I’m sure there are a number of other reasons that we should take the time to properly address ankle sprains, but these are a good place to start. Don’t minimize the need for high quality care for ankle sprains. An ankle sprain isn’t just an ankle sprain. There’s always a lot more to it.
Reading point 3 above has changed my life (physically).
Background: I went to a therapist because of hip, back, and shoulder pain that wouldn’t go away. Through a bunch of diagnostics the only thing he found was bad dorsiflexion in my left ankle and gave me a bunch of stretching exercises. The stretching helped a lot, but once I got to a point I hit a wall like the ankle bone wouldn’t let me go any further. A couple years later trying to manage but still getting nagging pains from training hard with a bad ankle, I tried a chiropractor. He was able to adjust to where I got passed that sticking bone point, but it didn’t last, and the sticking point would return. At that point though I discovered I had an ankle valgus. The internet showed me a bunch of exercises for a valgus. I did those consistently with marginal success and sore foot and ankles all the time by trying to walk with my foot and ankle muscles keeping me from a valgus.
Enter point 3 of this article. Since the short time of reading it, my valgus seems to have cleared up just by trying to walk with “activated” hips and glutes. And this is the most progress I have made on the dorsiflexion in a while. It’s almost like the ankle sprain didn’t cause bad dorsiflexion, the valgus did. And the valgus was caused by lax hips.
Having reflected on the feelings of the leg, it seems to me that anything that would cause a limp would cause those muscles to become deactivated. In my case I had an acl strain that caused me to be on crutches for a while in middle school. After that point the left leg was always susceptible to injury. The two ankle sprains I had after that point happened when both legs were planted at the same time but only the left got injured. Now the left is feeling like the right, which is incredible.
This is great feedback! Thanks for sharing and keep moving forward!