One of the most common sports injuries is tearing of the lateral ligaments of the ankle. This is often referred to as an inversion sprain because the foot goes through an excessive amount of inversion. In many cases, the ankle also goes through plantarflexion. Usually, the ankle joint rolls “out” with the foot fixed on the ground, creating the damaging inversion. If the tension limits of the ligaments are exceeded, a tear occurs, and this is accompanied by a substantial amount of bleeding.
Ligaments need to heal without excessive stretch during the first two weeks. Then controlled and gradual stress is applied through movement in order to allow the tissue to mature. The unique thing about lateral ankle sprains is that the normal weight-bearing motions that are created by gravity and ground reaction force do NOT stretch the ligaments. Weight-bearing activities such as squatting and walking create dorsiflexion and eversion. These are the exact opposite of the motions that create a lateral ankle sprain. Therefore, weight-bearing is NOT contra-indicated. The conventional advice to walk with crutches holding the foot off the ground is not helpful, and in fact, will delay recovery substantially.
Before describing a functional approach to rehab, one cautionary note: the strategies involved, including full weight-bearing as tolerated, do not apply to medial eversion sprains, or injuries to the distal ankle syndesmosis (high ankle sprain). With these injuries, motion should be promoted, but full weight-bearing avoided initially.
Besides the pain and swelling that are part of the lateral (inversion) ankle sprain, there is often a loss of motion. This is counter-intuitive because ligament injuries lead to abnormal joint motion and instability. The ankle will lose dorsiflexion and the subtalar joint will lose eversion in all patients, but especially those that have their weight-bearing restricted. This becomes the initial focus of early functional rehabilitation: restore dorsiflexion and eversion using weight-bearing activities while controlling edema. Movements that create dorsiflexion and eversion put the lateral ligaments on slack avoiding any deleterious tension that could delay the healing process. On the positive side weight-bearing movements use the muscular pump to reduce post-injury edema and promote the restoration of proprioceptive muscle activation.
As long as inversion and extreme plantar flexion are avoided, the functional program can progress while the ligaments heal. Using the Strategies embedded in the P-S-T process of Applied Functional Science, movements are designed using the arms, the opposite leg, and even the injured foot in order to create a “motion environment” that accelerates healing and restores function. The individual will gain confidence in his/her abilities as the rehab program progresses. Many athletes can return to sports activities after 1-2 weeks even though the healing and maturation process is not yet complete. Global movements like those in 3DMAPS are used to determine readiness to participate, instead of arbitrary time frames. The injured client needs to demonstrate good motion and sub-conscious activation of muscles to control all motions. Whether it takes 2 weeks or 4 + weeks to return to activities, a functional approach to training and testing will allow each individual to demonstrate their capabilities.