Ankle sprains always heal, right?
There’s not much mystery about ankle sprains, as many, many people have personal experience with the injury. So why do so many people have persistent pain issues or complaints of instability months, even years after they sprain an ankle? And why does it even matter?
We really don’t treat too many ankle sprains unless the injury is severe and slow to heal.
Occasionally, while taking a history from a client, we learn that our client has stopped running or other recreational sports because they can’t trust their ankle; or they notice their balance is poor; or they have poor stamina for long periods of standing, etc. Most times, these clients are presenting with other complaints, such as back, knee or hip pain. As is the case in a good physio assessment, it is often possible to link the present injury to an old ankle injury; and the ankle function must be restored to get a lasting fix for the present injury.
There are three really significant factors to consider in old ankle injuries:
- The biomechanics, with respect to the foot arches and lower limb alignment. Misalignment can be associated with just the previously injured foot, or both feet, or may also be seen in either or both knees and hips. Any and all of these misalignments can complicate present recovery.
- The integrity of the ligament systems, especially the tib-fib ligament which runs between the lower aspects of the tibia and fibula to hold the two bones together and protect the ankle mortice. Injury to this ligament is referred to as a high ankle sprain, and is often missed, especially when the other ligaments have also been damaged.
- The sensory neural network, just as sensitive as that of the hand, is responsible for mind muscle communication, knowing where your feet are when you can’t see them, and the integrity of foot movement. When injury prevents normal function, your body will come up with a work-around, so that you can still hobble to get around. Very often this work-around persists and alters normal function. It also strongly influences your ability to balance on one foot; and to have confidence that you won’t fall.
When we identify these effects of old ankle injury, the main focus of physiotherapy is exercise: to restore strength, alignment and normal gait. Very often this is the extent of a treatment plan. We will use laser if pain is present or there is evidence of residual scarring; and we may refer out to a pedorthist if the foot mechanics are really poor.
We would like to see most ankle sprains when they occur, even if they seem very minor. The advantage of early treatment is to check the integrity of all the ligament systems and advise of appropriate exercise to preserve balance and restore strength and normal gait. If tissues are moderately or severely sprained or strained, adding laser to the treatment plan will speed healing by 40% or more, provide pain relief and minimize the development of problematic scars.