Ankle sprains account for up to 40% of injuries each year and are particularly common in basketball. Even though this injury is common, conventional wisdom and treatment methods often do more harm than good. In this blog, the team at explains how movement science professionals who understand the truths of the human body can help their clients, patients, and athletes heal more effectively.
1. Don’t Ignore the Complexity of Acute Lateral Ankle Sprains
Acute lateral ankle sprains occur when individuals experience sudden inversion stress to the ankle, causing injury to their lateral ligaments. What you may not realize, however, is that during an injuring event, the ankle often goes through plantar flexion as well.
The most common causes of these inversion/plantar flexion injuries are:
- Coming down on someone else’s foot
If the ligaments exceed their tension limits, a tear occurs and the ankle begins to swell.
We now know that ligaments need to heal with the right amount of stress at the right time, without abnormal stress from the motions that originally caused the injury. But you first must properly assess the sprain and rule out a grade 3 injury, an acute eversion sprain involving the medial part of the ankle, and distal ankle syndesmosis (a high ankle sprain).
Once you understand your athlete’s condition, you can build a personalized rehabilitation plan. We’ve discovered that the ankle and the entire body benefit from gradual, controlled stress through normalized movement. This approach allows the tissues to naturally mature, and individuals can heal effectively and progressively. We cannot emphasize this process’s importance enough; improperly rehabbed ankle sprains predispose individuals to future sprains and other chain reaction problems of the knee, hip, and low back.
2. Weight-Bearing Movements Can Help a Lateral Ankle Sprain Heal Quickly
In 1978, Dr. Gary Gray wrote an article in The Physicians Sports Medicine, revealing that early functional proprioceptive exercises facilitating weight-bearing activities to restore healing motions were the key to ankle rehabilitation. We know that movement promotes proprioception, proprioceptors turn on muscles, and it is the muscles that will ultimately protect the ankle and allow it to become fully healed.
When athletes suffer a lateral ankle sprain, they often experience pain, swelling, and a loss of motion. They can lose dorsiflexion and subtalar joint eversion, especially if the individuals have their weight-bearing restricted and do not progress through a proper chain reaction rehabilitation program as directed by Applied Functional Science®.
Through 3DMAPS® training, a movement professional can develop their understanding and skills to create an environment that facilitates the right motions, at the right time, for the right reason. For example, a 3DMAPS certification teaches you that the Anterior Chain Reaction® and the Same Side Rotational Chain Reaction® could encourage the stance leg’s progression into ankle dorsiflexion and eversion. Accessing the performance system, 3DMAPS would direct the practitioner towards proper hybrid exercises and progressive, yet safe, exercises that would ultimately facilitate normalized inversion and plantar flexion as the rehabilitative process continues.
3. How to Initiate Proper Weight-bearing With a Lateral Ankle Sprain
The RICE (Rest, Ice, Compression, and Elevation) method is still valid for athletes’ lateral ankle sprains. However, controlled motion, exercise, and ambulation that encourage the opposite motions of inversion and plantar flexion – eversion and dorsiflexion – are also essential. This should be done initially in a partial weight-bearing status, then progressing to full weight-bearing as tolerated.
We suggest using appropriate compression, ambulation, weight-bearing as tolerated, and usage of crutches. When the individual can ambulate without a limp, you can discontinue the crutches. For most people, this progression from partial weight-bearing to full weight-bearing takes approximately three-to-five days. Ambulation creates eversion and dorsiflexion, the two motions that will facilitate a decrease in pain and a decrease in swelling.
Properly controlled and calibrated exercises are the best modality for reducing swelling, in conjunction with compression. We’d recommend:
- Starting with bilateral squats and progressing to single-leg balance squats, facilitating ankle dorsiflexion and eversion
The ability to do single-leg squats usually corresponds with the time when the individual can ambulate full weight-bearing without a limp.
The Biomechanical Ankle Platform System (BAPS), invented and developed by Dr. Gary Gray of Gray Institute, is a staple in ankle rehabilitation. Because of the unique design of the BAPS, the foot can be positioned on the BAPS to encourage ankle dorsiflexion and eversion, with gradual progression into a very small percentage of inversion and plantar flexion as evaluated.
Avoid weight-bearing activities with other types of ankle sprains. The functional rehabilitation strategies we review in this blog, including full weight-bearing as tolerated, should not be applied to medial eversion sprains, injuries to the distal ankle syndesmosis (high ankle sprain), or obviously with fractures. Instead, seek an orthopedic physician’s consultation for these types of injuries.
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4. Full-Body Movement Progressions Help the Ankle Heal
Progressing with full-body movements, as described above, utilizing squatting, lunging, single-leg balance opposite foot reaches, and hand reaches, progressing to lunges with balance, leaps, jumps, jops, to hops, allow a logical progression back to normalcy. The key is understanding Chain Reaction® biomechanics and facilitating such reactions to protect and then progress based on the success of the individual.
For example, when squatting for an involved right ankle sprain, it is important to protect the ankle while facilitating proper motions through the movements selected. You can do this by putting the right foot slightly in front of the left foot, in a wider stance, with both feet externally rotated. This position, while squatting, allows the right ankle to go through more dorsiflexion and the subtalar joint to go through more eversion, not allowing the ankle to get in a plantar flexed position nor allowing the subtalar joint to get in an inverted position. You can see, then, that you would progress the positions in the opposite directions (left foot in front of right foot, a narrower stance, and feet internally rotated) slowly and surely to progress the ankle.
Gray Institute: Real-World Healing for Over 40 Years
At Gray Institute, our priority is getting injured patients, clients, and athletes back on their feet and back in the game. If you’re interested in learning more about using Applied Functional Science to improve your physical therapy, personal training, or occupational therapy practice, don’t hesitate to reach out! Feel free to fill out our simple online contact form. We look forward to hearing from you!
References
Dubin, J., Comeau, D., McClelland, R., Dubin, R., Ferrel, E. (2011, September 10). Lateral and syndesmotic ankle sprain injuries: a narrative literature review. US National Library of Medicine, National Institute of Health. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3259913/ Tiemstra, J. (2012, June 15). Update on Acute Ankle Sprains. American Family Physician. Retrieved from https://www.aafp.org/afp/2012/0615/p1170.html