With the news that Rory McIlroy tore his Anterior Talo-Fibular ligament (ATFL) of his left foot, the golf world is wondering when he will be able to compete again. The injury, described as a Grade 3 complete tear, suggests he suffered the typical inversion ankle sprain. According to one expert, the ankle has to be held immobile in a cast for six weeks. Golf is certainly a sport built on tradition, but that “old school” immobilization should have been buried long ago. In released photos, Rory is using crutches with a removable boot, and he posted, “rehab already started”.

Function-driven AFTL therapy

Unfortunately, starting rehab doesn’t mean the same thing to all movement professionals. The specific protocol should be driven by knowledge of the function of the AFTL in weight-bearing, walking, and golf. The ligament must go through the normal healing cascade, which includes:

  • 1-2 days of inflammation control
  • 3-14 days of tissue reparation
  • Followed by tissue maturation under controlled stress

Normal weight-bearing and walking create forces that produce joint motions opposite of those that caused the injury. If there is no associated damage to the ligaments that hold the tibia and fibula together or the joint surfaces, then full weight-bearing “as tolerated” should be encouraged (with appropriate edema control).

Full weight-bearing benefits

Full weight-bearing has a multitude of benefits with no detriment to the healing ligament.

  • First, the critical motions of pronation of the subtalar joint and dorsiflexion of the ankle are restored.
  • Second, muscle action pumps the edema out of the region.
  • Third, normal motion provides the proper signal to the fibroblasts to “knit” the injured ligament back together without allowing unwanted adhesions.

If this injury had occurred to an athlete in another profession, they might return to play even though the ligament isn’t healed, with the understanding that the healing could be disrupted by a similar incident.

Potential challenges and solutions

The return to golf for a right-handed golfer with a left ankle sprain is challenged by the biomechanics of the follow-through. The ankle and subtalar joints go through the same motion that caused the injury. The post-injury paradox is that the motions that caused the injury must be utilized to restore function and prevent another injury. Gary Gray would call this the causative cure. Avoiding these joint motions is similar to immobilization; adhesions form and return to function is delayed.

Therefore, in the maturation stage, the ligament must be put under tension. Gradual, controlled application of forces is essential to proper healing. The muscles must be re-trained to decelerate these movements during the finish of the swing. Control of the mass and momentum of the entire body, considering the violence of the finish of the golf swing, must be achieved before return to golf. Any hesitation to complete the full swing will alter impact and put other tissues at risk.

So what about the speculation on the timing of his return?

If there are no associated injuries as mentioned above, then an accelerated program can begin. If there were no tournament schedule to consider, then two weeks to heal the ligament and 3-4 weeks to provide the maturation stress, as well as maximize deceleration control, would be optimal. Being a great athlete in excellent condition, Rory might be able to attempt to play sooner. The longer the period of immobilization and limited weight-bearing (in the misguided name of protection), the longer the rehabilitation. Playing in the Open seems very unlikely.

About Gray Institute

The Gray Institute was established by Dr. Gary Gray as the international hub for Applied Functional Science. For more than 30 years, Gary Gray has shared his expertise through speaking engagements and education in the movement industry. Today, the Gray Institute offers courses, events, a comprehensive video library, products, and more to aid physical therapists, athletic trainers, and other professionals in the treatment of their clients.

Connect with Gray Institute on Social Media to stay up-to-date on the latest new, products, industry insights, and more!

Facebook | Twitter | Google+