Ankle Sprains: Not So Simple.

Lateral ankle sprains (LAS) are one of the most common sports injuries, especially in indoor/outdoor court sports such as Basketball, Netball and Tennis (Fong et al., 2007). As a result they have a high economic burden with direct and indirect costs associated with the injury. Some researchers claim that the burden of LAS in the US alone during the 90s/2000s was in excessive of US$2 billion per year (Dallinga et al., 2012). The concerning thing is that this figure may be under appreciated as it has been found in the literature that less than half of all people who experience a LAS will actually seek medical attention (McKay et al., 2001).

From a clinical point of view, the problem with LAS is that there is a very high recurrence rate and 20% of the general population and 30-50% of the athletic population will go on to suffer from chronic ankle symptoms (pain, swelling and instability); also known as chronic ankle instability (Gribble et al., 2016, Attenborough et al., 2015 & Tanen et al., 2014). It is believed that contributing factors to the development of chronic ankle instability are: 

1) Very few will seek medical attention for primary LAS and 

2) Most people prematurely return to sport; when their pain is absent.

The good news is that a recent systematic review and meta-anaylsis showed that there are 2 very simple things that can be done to reduce the chances of a primary LAS developing into chronic ankle instability (Doherty et al., 2016). These are:

1) Exercise Therapy: Exercise therapy when performed in high doses (>900mins) significantly reduced the chances of recurrent LAS by 42%. Furthermore, exercise therapy significantly improved function following primary LAS. 

- 900mins sounds like a lot, but when broken down is very achievable:

- 5x30mins per week = 150mins per week

- 150mins per week x 6 weeks = 900mins

2) Bracing/Taping: Significantly reduced the risk of recurrent LAS by 62%. It is currently recommended that a brace be worn on the injured ankle, or that it is taped for every game or training session for at least 6 months following the initial LAS.

Take home messages:

1) Ankle sprains are not so simple, and they need to be respected.

2) The absence of pain does not mean that you're ready to return to sport. The subtle losses of strength, ROM, proprioception and balance do not magically re-appear once your pain has gone.

3) Make sure you see a physiotherapist and COMPLETE your rehab; 6 weeks of regular strength, balance, stretching, plyometrics and agility should be considered a non-negotiable part of the rehab plan.

4) Ensure that you brace or tape your ankle for training and games for at least 6 months following your sprain.

5) Like every injury, the decision to return to sport following a LAS should be based on performance criteria such as strength, balance and hop tests rather than time-alone or the absence of pain.

For more information on this topic, feel free to contact me here, or via www.mickhughes.physio