The Residual Effects of Acute Ankle Sprain
Introduction
An ankle sprain is often considered one of the most common injuries seen in sports. An ankle sprain is an injury to one or more ligaments around the ankle joint. The ligaments around the ankle play an important role in maintaining the passive stability of the joint and delivering accurate information to the nervous system about the position of the joint in space. Ligaments are considered to have limited blood supply, and their ability to recover following an injury may be limited, as this depends on the extent of the injury.
The severity of an ankle sprain can vary depending on the extent of the injury and associated tissues. Ankle sprains can present differently between individuals; some can tolerate weight-bearing with minimal limitations and signs and symptoms, while others may not be able to tolerate any weight-bearing, and other signs and symptoms, such as bruising and swelling, may be present.
Following an acute injury, we expect to see the normal physiological healing process, which involves inflammation, repair, and remodeling of the injured and new tissue. The initial inflammatory phase is often when most pain and swelling are present, and depending on numerous factors such as the extent of injury, age, healthy lifestyle, etc., the duration of this phase can vary.
Nonetheless, as expected from an acute injury, as time goes on, pain will often decrease and the injury will become more comfortable. At this point, many people will return to their previous activities and sports. However, studies indicate that residual symptoms and limitations persist in 40%-70% of people who have sprained their ankle. These residual symptoms can often be seen months to years following an acute ankle sprain, and they have been shown to impact the quality of life and be associated with recurrent ankle sprains.
Chronic Ankle Instability
Chronic ankle instability (CAI) - is a condition characterized by repetitive episodes or perceptions of the ankle giving way, ongoing symptoms such as pain, weakness, or reduced ankle range of motion (ROM), diminished self-reported function, and recurrent ankle sprains that persist for more than one year after the initial injury.
Effects Associated with Long-term Signs and Symptoms Following an Ankle Sprain:
Mechanical
Changes in joint mobility: Depending on the severity of the injured tissue, we may see an increase in laxity of the joint. This increase is often presented by hypermobility during certain movements, specifically internal rotation of the rearfoot on the tibia. On the other hand, it is also common to see limited joint mobility in the sagittal plane of movement, specifically dorsiflexion. This can be a result of both joint kinematic alterations and/or soft tissue-related restrictions.
Sensory-Perceptual Changes:
Deficits have been reported in both the active and passive joint position sense of frontal and sagittal-plane ankle motion in CAI groups, which rely more on visual information.Pain and Instability:
People with CAI most commonly report episodes of ankle pain and instability during activities such as walking, jumping, and pivoting.Muscular Weakness:
Weakness of certain muscles, specifically the evertors and plantar flexors, has been observed in people with CAI.
Motor-Behavioral
Motor-behavioral impairments among patients with CAI involve deficiencies and alterations in muscle contractility, movement patterns, and the physical activities they choose to engage in or avoid.
Reflexes:
Due to the aforementioned nerve system-related changes, there are also alterations in the responsiveness and reaction time of muscle activation around the ankle. Some studies have indicated delayed reactions in the fibularis longus and brevis in response to inversion movements of the ankle.Neuromuscular Inhibition:
Decreased muscular activity due to nervous system-related changes following an ankle sprain has been observed in the fibularis longus, soleus, and other proximal muscles such as the quadriceps, hamstrings, and posterolateral hip musculature.Balance:
Decreased performance in balance-related tests has been observed, along with increased rotational movements by the torso compared to the lower extremity during rotational movements.Movement Patterns:
Changes in movement patterns have been indicated, such as increased plantar flexion and inversion during walking, along with a lateral shift in the center of pressure. Additionally, people who experience CAI have been found to have less variability in their movement patterns, which is often associated with the degree of freedom of a joint and appropriate coordination between parts of the body. Lastly, during cutting movements, increased involvement of the knee and hip musculature has been observed, which may be a compensatory response to decreased ankle function.Reduced Physical Activity:
Due to all the reasons described above, people with CAI tend to participate in less physical activity, which may lead to other long-term health complications in the future.
Conclusion
Not all people who experience CAI will present with all of the symptoms described above! However, the symptoms and effects described are commonly seen months or years after an acute ankle sprain. This can interfere with a person’s quality of life, as their level of physical activity decreases and participation in sports is either interrupted or accompanied by other psychological limitations, such as fear of movement. It is highly advisable to see a physical therapist following an acute ankle sprain to:
Help you overcome the initial stage of injury.
Reduce the risk of developing long-term limitations.
Safely and confidently return to your activity.
Rule out other red flags or anything that may require further medical assessment or intervention.
Book a free consultation to learn more and help you go back to the activities you enjoy
References:
Anandacoomarasamy A, Barnsley L. Long term outcomes of inversion ankle injuries. Br J Sports Med. 2005;39(3):e14. doi:10.1136/bjsm.2004.011676
Hertel J, Corbett RO. An Updated Model of Chronic Ankle Instability. J Athl Train. 2019;54(6):572-588. doi:10.4085/1062-6050-344-18
