Over the course of training we are bound to encounter plenty of injuries, many of which include Ankle Sprains, Knee Pains, Hamstring Pulls, Tendinopathies etc.
In this article we will briefly explore the multiple stages of Ankle Sprain Rehabilitation from prehab all the way to rehab and then further into improving performance.
Most structures in the body depend on each other and work together to dictate the complexity of movements and functions, the ankle not only makes up part of this structure, it is the base of support for it.
The ankle does not work alone of course; whenever we’re shifting our weight forward, backwards or sideways the ankle is there to initiate the movement or stop it. However this is a multi-structural function, the local structures involved here are the muscles (Calf, Peroneus, Tibialis, etc.), joints, ligaments, tendons, cartilage and fascia.
The most adjacent contributing structures are the knees and hips, their role is to make the job easier for the ankles; that means that if we were to jump and land on our feet we can’t solely rely on the ankle to do the job of take-off and landing. The ankle will solicitate the help of the whole body structures especially if we’re trying to complete an efficient jump.
Following this logic the function consists of multiple structures working together to accomplish complex movements. These are the principles for most rehabilitation programs, educating the players how to solicitate more than one structure is the key to efficient movement. In chronological order this article will describe the different phases of training.
Let’s start with the prehab, short for prehabilitation, which is a form of training that aims to minimize the incidence of injury. The program is usually done throughout the year during training, the same program also includes a set specific daily drills or exercises done during the warm up on the field. It is not only meant to protect the ankle but to also teach the neurological system how to recruit all muscle groups and structures during specific movements such as shifting body weight or position, changing directions, running and the rest of the agility requirements. By recruiting all these structures all the way up to the core the function of the ankle and foot becomes simpler and more efficient.
Ideally, following proper prehab and strength training programs the ankle shouldn’t be injured but we know that injuries are preventable but inevitable.
In such case the first course of action is to determine the extent of the damage if there is any and to decide whether or not the player should continue playing or stay on the sideline.
The second step to take is to rule out serious injuries, such as fractures or dislocation of the joint. Once we determine the severity of the injury we then inform the player or young player’s parents of diagnosis, the treatment course and the prognosis.
Rehabilitation is the next phase in the program, it follows certain principles and protocols based on EBCP (Evidence-Based Clinical Practice), defined as the conscientious, explicit, and judicious use of the best evidence in making decisions about the care of individual patients.
The best evidence suggests that complete or partial immobilisation of the joint (using a cast or a pneumatic ankle brace ‘aircast’) for a long period of time will lead to longer recovery periods, in this matter, based on the doctor’s best judgement, immobilisation should only be applied for the appropriate period of time. After the removal of the aircast the physiotherapist will begin the passive joint mobilization, first with non-weight bearing exercise and then gradually adding weight bearing mobilization exercise. The patient/player has a lot of work to do also, he has to repeat certain exercises as frequently as possible at home in order to progress faster.
Following the passive stage of treatment the patient is then asked to gradually add weight to his workout this is done following certain steps, first is strength training bilateral (on both feet) then unilateral (on one foot), after proper monitoring of the development of the muscles and the movement, the succeeding steps are power training, jump training and agility. It is useful to note that these stages and steps overlap with each other according to the clinician’s best judgement and assessment, they don’t necessarily follow each other in some chronological order.
The take-home messages are efficiency and progression because there is no bad exercise but there is bad progression and non-efficient exercise, the key instruction here is to adhere to the training progression dictated not by the clinician or physiotherapist but by the body’s response to the treatment.