Chronic recurring ankle injuries are one of the most common complaints at chartered physiotherapy clinics. Athletes commonly complain of an initial incident of “twisting” or “rolling over” of the ankle which is followed by season after season of similar less severe incidents necessitating further periods of absence from sport. This is inevitably a source of frustration for athletes who just want to get on with their season. So why does it happen? The answer is that your initial ankle injury was probably never correctly rehabilitated.
The most commonly injured structures when you twist your ankle are the ligaments which support the outside of your ankle joint. This type of injury is what doctors and physios call an inversion injury of the ankle. There are three major ligaments supporting the outside of the ankle – the anterior talo-fibular ligament (ATFL), the posterior talo-fibular ligament (PTFL) and the calcaneo-fibular ligament. Of these the vast majority of injuries occur to the anterior talo-fibular ligament (ATFL).
The integrity of the ankle joint depends on fully functional ligaments to support it. The ligaments, muscles and tendons surrounding the ankle, more so than any other joint play a vital role in maintaining a neutral joint position and in providing internal feedback on the position of the joint. Your ability to sense the position of your ankle joint in space, known as proprioception, is therefore hampered when the ankle ligaments are injured. Without adequate awareness of the position of our joints in space you become more susceptible to injury. Combine this increased susceptibility to injury based on poorer awareness of our joint position in space, with an already injured ankle ligament and the likelihood of re-injury is significant.
So what can be done? Once the initial ligament injury has been effectively rehabilitated, it’s essential that the athlete progresses through a phased proprioception training programme. Ankle proprioception programmes aim to increase our awareness of the position of our joints in space. They include various balance drills initially such as single leg hopping or balancing on one foot and can progress to more challenging drills including wobble boards once the proprioception improves.
The chronic ankle injury will not fully resolve and become functional in dynamic activities until a comprehensive rehabilitation programme has been completed and athletes risk season after season of recurring problems and frustration until the problem is effectively remedied.