Premiership Physiotherapist Neal Reynolds talks to Sportsinjuryclinic.net about ankle rehab and returning to full fitness.
Neal works more on the muscles on the inside - eccentric inversion, rather than working on the peroneals - the evertors on the outside. To him they are no-where near as important as the eccentric strength of the inversion muscles, to control the over-inversion movement. To do this he will use resistance bands. Balance exercises are also important.
From then on it is all about gradually increasing load. If the ankle swells up this means you are doing too much and need to slow down a bit. After 4 weeks if the ankle is still swelling up then it is likely that something else has happened, such as damage to the surfaces of the ankle joint.
There are other more complicated injuries such as high ankle sprains and syndesmosis injuries which are only now becoming more recognised. Ankle sprains can be very complicated, but in most cases they can be treated effectively.
Most people can go without a ligament at the outer ankle. In many footballers who have sprained their ankle, an MRI scan would show up that there is no ligament there and it doesn't cause a major problem as long as they have the balance around the ankle.
The last stages of rehab for an ankle sprain are very different to a muscle injury. For example when going out to do the last few sessions before returning to sport, Neal looks at what will really test the ligament. Running isn't usually a problem in straight lines. So what he does is spend time working from a larger turning circle to a smaller circle and twisting and turning movements. They may be some pain on kicking a ball, more so if the ankle was injured on the inside, rather than the outside.
Ankle rehab late stage
The last stage of ankle sprain rehab is very different to that of a lot o muscle injuries that you might have. When I go out to do the last couple of sessions for an ankle injury I will be looking at what specifically is going to test the ligaments within the ankle. Now again generally if you are running, you probably won't have that many problems and can probably sprint once the ankle has settled down. The ankle ligaments are not going to be tested that much.
The only way they will be tested is if you twist and turn quite sharply. So with my ankle rehabilitation I would spend the time getting from a larger turning circle to a smaller turning circle with twisting and turning to try and get that element of it. That is going to be the most important element of an ankle sprain along with stopping. You might get a little bit when you have to kick a ball but this will depend on where the ankle is injured. if it is injured on the inside you are more likely to get problems kicking a ball.
Preventing ankle sprains
It is estimated that 30 to 40% of all ankle inversion sprains end in re-injury. To avoid being one of the 30 to 40% it is important not to stop the rehabilitation process but continue with it until full fitness is regained and beyond.
It is a common complaint that once an athlete goes over on the ankle they become prone to doing the same thing again. If the original sprain is a bad one and joint laxity has resulted then it may be for certain sports where fast changes of direction are required that strapping of the ankle or wearing a brace is necessary to prevent re-injury.
If the sprain does not result in joint laxity then a recurrence may be avoided by the following:
Re-establish proprioception. This involves lots of balancing exercises on one leg. Essential to avoid re-injury. If you start to turn the ankle over then you will find you automatically right it without even thinking about it. If the proprioception is damaged then you lose this ability.
Strengthening the ankle. This will provide a far more stable joint. Also, if the ankle does start to turn and the proprioceptors work properly, the ankle starts to right itself, the muscles need to be strong enough to pull the ankle back in a split second.
Susan Findlay of the North London School of Sports Massage explains the use of sports massage when treating ankle sprains.
Often people coming in for treatment of a sprained ankle are suffering with repetitive injuries which are causing weakened ankle ligaments and surrounding muscles and tendons. In this case, light frictions may be used although it is important to consider that the ligaments are already weak and you should be aiming to build up the strength in the muscles surrounding the joint.
Muscle energy techniques can help to re-establish proprioception to prevent future injuries. In the case of a 1st injury, treatment is important to prevent the injury happening again. Sports massage can help with flushing out the swelling in the joint, breaking down adhesions and stretching tight tissues such as the calf muscles.