Ankle instability : what evidence say?

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Ankle sprain is a frequent injury among professional athletes and recreational players. Out of them 30% to 85% of patients develop chronic ankle instability.

Chronic ankle instability occurs due to,
Structural issues which are

What are the functional issue?

  • Improperly healed ligaments
  • Weak proprioception
  • Poor postural control
  • Nerve-muscle control
  • Reduced dorsiflexion

If not treated properly patient will complain of pain, swelling, stiffness, instability and repeated injury, it may last upto years after injury.Chronic ankle instability may cause secondary issues if not rehabilitated.

For e.g.:
• Peroneal muscle tendon strain
• Impingement of soft tissues
• Osteochondral loose bodies
Balance is maintained by three systems,
• Mechanoceptors from limb ( activated first and most precise)
• Visual feedback from eyes (activated later)
• Vestibular system of middle ear ( activated last)

Weak proprioception impairs ability to maintain the correct postural strategy which in turn affects upper body functions and in long term alignment.

How will you approach an ankle during rehab phases ?

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Rehabilitation of ankle should be tailor made and structured.

Acute phase:

• Rest
• Taping or bracing
• Controlling inflammation
• Establishing full ROM- Study by Kasser and colleagues shows that strengthening of dorsi flexors shows better improvement in ankle ROM than stretching calf muscles.
• Maintain strength in pain free range.

Sub acute phase:

• Once the pain-free ROM and weight bearing has been established.

• Balance training should be established to regain neuromuscular control.

• Propioception training using wobble board, walking on different surfaces (hard floor uneven carpet, different foam pads). Eyes open and later with eyes closed.

Advance training :

• Wobble board exercises with tubing resistance
• Functional exercises on different surfaces and with resistance
• Walk-jog
• Jog-run
• Sports specific training

Tomasz Pointek and colleagues found that patients with lateral ankle instability after 16 weeks of rehabilitation have similar or even better postural control in the case of the injured leg, both in static and in dynamic conditions compare to healthy leg and healthy individuals.

Reference :

•  Cisowski P., Piontek T.,Ciemniewska-Gorzela Assessment of postural strategies and subjective sensations of patients with lateral ankle instability after rehabilitation.Issue Rehabil. Orthop. Neurophysiol. Sport Promot. 2015; 13: 49–68.

• Rehabilitation of the Ankle After Acute Sprain or Chronic Instability; Carl G. Mattacola; Maureen K. Dwyer

• Comparison of Stretching Versus Strengthening for Increasing Active Ankle Dorsiflexion Range of Motion; Richard J. Kasser ,Kevin Pridmore, Karen Hoctor, Leah Loyd, F. Auston III Wortman

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