Most of you have either injured your ankle or seen someone who badly rolled their ankle while participating in an athletic event. Usually, the crowd goes silent as you lay almost motionless on the floor for the first agonizing seconds, your brain immediately assesses the damage and calculates the risk of standing up or even running back down the court. By now the personal trainer is by your side, asking you things like “did you feel a pop, can you wiggle your toes, how many fingers am I holding up?”
Your teammates help you to your feet, and the competitive side in you puts your freshly sprained ankle down onto the floor, hoping for minimal feedback. You’re knee buckles, and your healthy leg jolts straight to diminish pressure on the bad limb.
You get back to the bench, and your leg rests on a bag of ice, while the trainer evaluates the ankle. Probably not broken. Now what? Protect. Rest. Ice. Compress. Elevate. The game continues. Halftime.
You balance yourself on your good leg as the trainer takes you back to the locker room. “Let’s tape it up and see how you feel.”
You take the first step on the supported ankle. Still hurts. A lot. Feels unstable. You know you couldn’t run down the floor, much less play defense on someone and risk breaking the other ankle.
What do you do if it is broken? Better make sure, so you get an x-ray. Negative for fracture. The doctor tells you to use crutches or a boot for 2-4 weeks, then go weight-bearing again after that. And call him in 6 weeks if it’s still there. Great! Right? Wrong!
This is the most common thing I hear from athletes following an injury. They were told to do nothing after an injury. In this case—the ankle. I do agree with letting things heal; however, we lose a lot of integrity in the ankle by simply doing nothing.
Treat Your Sprain Sooner Rather than Later
1. First, your brain has millions of neurons that are constantly monitoring every sensation your foot and ankle experiences. From the pressure you put on the ground, to your toes wiggling, to stepping on a Lego. Your brain also controls the muscle function of this ankle, and in turn, relays specific data back to the brain, and the cycle continues. By simply doing nothing for even one week, you risk weakening that neurological connection. This connection is what gives an athlete coordination and stability—very important things if you want to receive a Volleyball serve, or stop a defender from crossing you over and finger rolling the basketball in the net.
2. Second, you lose flexibility. Granted, you are stiff and sore from the injury, but your lack of weight on the calf, Achilles, and plantar fascia to name a few, will certainly cause dysfunction in the way you walk. This commonly leads to new symptoms in the lower back and plantar fascia once the athlete returns to play following doing nothing.
3. Third, Wolff’s Law. Every action has an equal and opposite reaction. If you don’t have any force being put into your muscles, tendons, and bones, you will lose mass. It will not be so severe that you are diagnosed with muscle wasting by a trained professional; however, the phrase “if you don’t use it, you lose it” does apply.
So What Can You Do?
It’s simple. Evaluate what has been damaged in the ankle. The hard work is done, we don’t have a fracture. So we must check the ankle ligaments, tendons, and muscles wrapping around the ankle that may have been damaged. If your ankle is swollen up like a cantaloupe, that’s a good sign you’ve damaged one or many of those soft tissues.
How does this communicate with the brain? It still sends signals to the brain; however, now pain sensation, also called nociception, is getting instilled in the brain with every movement. You’re learning how to walk with this pain. This is important to note, as when the pain is gone, the muscle memory is still there from that limp you had to cover up the pain. Recognizing and treating this is key.
You must then identify several other things:
● What range of motion is comfortable in the ankle
● What ligaments/tendons need time to heal
● What activities can the athlete perform laying down, seated, or standing.
Once we’ve evaluated what the athlete can perform on their own and what needs to be done by the doctor, we decide it is the ankle in a stable position, or is it subluxated from the injury. The most common question by athletic trainers, coaches, and parents is usually, “Did you hear a pop?” A pop can mean many things, and ruling out fracture is great.
In my experience, the pop they are hearing can by the joint releasing pressure between the long bone of the shin which sits on top of the ankle bone, or talus. In this case, the athlete feels very unstable on the ankle. There is no confidence when they take a step, and severe pain will follow. The joint sensory receptors that once had the position and movements of the ankle stored and learned concretely in the brain are now trying to interpret movements like they’re being spoke in Greek! It’s important to examine and treat the integrity of this joint, as proper dorsi- and plantarflexion of the ankle is almost impossible with dysfunction.
If left unaddressed, this injury will also precede many future injuries. Many of them will come later in one’s twenties and thirties, most commonly while walking on an uneven surface without doing anything athletic whatsoever.
Finally, we can begin treatment after deciphering the soft tissues injured, the integrity of the joint, and the amount of strain we can put on those regions. At this time we’ll begin to stimulate the portion of the brain that interprets sensation to keep that neural connection strong. This can be done with vibration, electric stimulation, or pain-free passive movements of the ankle. Also, low-level laser therapy will be applied to help facilitate healing by increasing the function of the mitochondria driving ATP, or energy, to the nucleus of the soft tissue cells.
We then take into consideration the integrity of the joint. It may need a mild manipulation to help realign the joint, thus creating a cascade sensory receptor response in the brain. This will help with proprioception, or the awareness of where your ankle is in space. This will be important when performing weight bearing exercises to improve balance and function, followed by dynamic sport-related movements.
We’ll then begin to address the adhesions developed by the repair phase of healing following the acute inflammation phase. Normally, after being injured, the ligament, tendon, or muscle feels tight during certain ranges of motion. By utilizing instrument-assisted myofascial therapy, we can reduce these adhesions and pain during use. With the rehabbed joint in a certain position, kinesiotape will then be applied to help increase proprioception and joint awareness.
Our method of ankle injury treatment has helped dozens of club-sport athletes, Division 1 athletes, and weekend warriors get back into action quicker. We believe each athlete’s injury should be treated specifically to the athlete, taking into consideration mechanism of injury, daily usage, nutritional intake, genetic factors, and time-frame between sporting events. This allows for quicker healing and lessens the frequency of repetitive injuries.