Returning to Sport after an Ankle Injury

Ankle injuries are very common, and the main reason ankle injuries occur again is because they aren’t rehabilitated properly the first time.

It isn’t just strength around the ankle that is important, but the ability for the muscles and nervous systems to work together to stabilise the ankle. The ability for the neuromuscular system to work properly is called proprioception. Even when you are pain-free your proprioception after an ankle injury is still likely to be affected leaving you vulnerable to re-injury.

For a quick test- balance on your un-affected leg first. Then compare to your affected leg.

• Is your affected limb working harder to balance?
• Can you hold your balance for as long?
• Are you swaying and moving your other limbs to help you balance?
• Now close your eyes. See what effect this has!

If you are like 99% of people who have had ankle sprains you will notice a significant difference in your ability to balance on the affected limb. This is the inability for the muscles to co-ordinate themselves to stabilise the ankle. If this is not corrected through rehab, then the chances of re-injury on return to sport, are markedly increased.

It is best to take advice from your therapist on how to progress through your rehab program but below you will find a number of activities from early to late rehab that will help you regain your proprioception.

It is important to progress your balance activity so your neuromuscular system adapts and improves. Any activity can be progressed by changing the perturbations, increasing speed or distance, and by taking vision out of the equation.

Eg throwing/catching balls, closing eyes, increasing speed

Balance Exercises

1. Wobble Board
   • Balance two feet
   • Roll rim clockwise and counter-clockwise
   • Balance one foot

2. Balance Bubble/Cushion/
   • Balance one foot
   • Balance one foot throw/catch a ball- in the air/against the wall
   • Lunge step onto bubble
   • Walk on balance pods

3. Mini-tramp
   • Jumping one foot
   • Jumping side/ side
   • Jumping forward/ back
   • Jumping rotations 45deg, 90 deg
   • Jumping and stick landing
   • Jump from ground up onto tramp- stick landing
   • Jump from tramp to ground- stick landing

4. Single leg jumping on ground – AIM is for the affected leg distance= unaffected leg distance
   • Jump forward for distance
   • Jump to left for distance
   • Jump to right for distance
   • 2 jumps for distance

Not only is the distance important, but make note of the quality of your jumping on the affected leg

• Does the affected leg jump feel the same as the unaffected jump?
• Are you pre-loading in the same way on the affected leg?
• Does it sound the same when you land on the affected side?
• Are you landing heavy on the affected side?

Running activities

Before starting a running program you should;

• have 85% of jump for distance forward of the unaffected leg
• be taking equal stride lengths
• be spending the same amount of time on each leg through stance phase.

1.Straight line running

2. Square runs- clockwise and counter clock-wise

3.Diamond runs- clockwise and counter clock-wise

4.Shuttle runs- lead with the left and right foot

You can progress all these activities by adjusting your speed ie 40%, 50%, 75%…full sprint, as well as altering the distance.

Sport Specific

• Add in a ball into any of the activities
• Jumping sports
• Contact sports- tackle practice 1 vs 1
• Dodging and tackle avoidance- 1 vs1

Adaption

The principle of load progression ensures that your neuromuscular system can adapt to the changes imparted onto it so that it can accept new levels of load.

This is easily seen in a simple bench press exercise. You can’t lift 25kg until you have lifted 30kg. You can’t lift 35kg until you have lifted 30kg. You can’t lift 40kg until you can lift 35kg and so on. If you were to try and lift 40kg straight away, you would fail beacuase your body has not adapted to the load.

This stepped up approach (blue line below) is needed in your approach to rehabilitation. It is important to slowly and steadily increase the load and demand placed on the body so that the body will adapt. This allows for the following;

• the physical capability of your body to adapt ie strength and proprioception
• your central nervous system will adapt and develop confidence in the next level of increase which will allow for success. If your brain thinks it is reasonable and logical to achieve the next level of increase, then you are more likely to succeed. If you are weary, unsure and lack confidence at a certain level of increase, you are more likely to fail.
• if you fail a certain level of increase, then you can continue at the previous/lower level of success until the body has fully adapted, to allow you to try the next increase again and succeed, and move forward.

The saw tooth approach (red line below) is a very common approach to rehabilitation and will guarantee failure and prolonged recovery;

• it does not allow for physical and neural adaptation
• it does not allow for central nervous confidence to develop so you are setting yourself up for failure
• when you have a failure your activity reduces to zero and progression ceases.

In rehabilitation typically you can increase load by ja number of variables;

1. weight
2. distance
3. time
4. speed

When increasing a part of the rehab activity it is important not to increase the multiple variables at the same time. So only 1 at a time.

For example on return to Straight Line running activity;

1. Start with 20m straight line run throughs at 50% intensity
2. If this level is achieved, then increase distance to 30m.
3. If this is achieved then increase to 40m.
4. If this level is achieved you may want to increase intensity to 75%, but ensure you drop the distance down to 20m again.
5. then increase distance to 30m, then to 40m.
6. You may now want to increase distance to 60m, but drop the intensity back again down to 50%.

As you can see you can juggle the variable to increase the load requirements of the body and to allow for adptation.

Looking at this example, if there is some failure at a level, lets say 30m at 75%, then you would drop down to the previous level, 20m at 75%, until adaption and confidence has been achieved before trying the level again.

Therapists are experts in diagnosing and prescribing rehab for ankle injuries and we strongly suggest you seek their diagnosis, advice and guidance after an ankle injury.