Ankle Sprains: how can they be prevented?

The term lateral ankle sprain refers to a lateral ligament injury which occurs when the ankle rolls outward resulting in a tear or rupture. Lateral ankle sprains have been identified940-bryant-kobe as the most common structural injury amongst athletes. Here is Kobe Bryant doing a serious ankle sprain in the NBA finals of 2013 –>

There have been a number of predictive factors flagged throughout the research identifying both intrinsic and extrinsic influences which have the potential to cause lateral ankle sprains. One of the most positively linked intrinsic factors associated with lateral ankle sprains, is in fact a previous history of a sprain. The initial injury is believed to render the ankle unstable biomechanically as a result of ligament compromise. Taking into consideration that an athlete changes their centre of gravity multiple times within seconds of play, inadequacies in postural sway have also been shown to influence an athlete’s risk of ankle sprain. This is a key finding when it comes to rehabilitation as it is influenced by both the central and peripheral nervous system. Other intrinsic predictive influences which have been flagged but to date have not been individually proven include; gender, height, weight, limb dominance, anatomical foot type, foot size, hyper-mobility and muscle strength although clinically these finding may help in developing an overall reasoning for the injury.

Extrinsic risk factors influencing ankle sprains have primarily been observed through prospective studies inclusive of bracing, taping, shoe type and the duration and intensity of competition. There have been a number of studies looking at the use of ankle braces and rigid taping in the prevention of ankle sprains, many of which have shown nil association in the prevention of an initial ligamentous injury; however consensus amongst researchers appears to be that the use of an ankle brace or taping has a positive influence in reducing the re-occurrence of injury. Given these findings contradict each other from a biomechanical standing, it is reasonable to deduce that the presence of a compressive force such as that previously mentioned provides sensory feedback to the athlete. Shoe type has been found to have no decrease in the incidence of ankle sprain injury. In two well-controlled studies comparing high top basketball shoes to light weight infantry boots and high top basketball shoes vs low top basketball shoes during military training exercises it was shown there was no difference in the incidence of ankle sprains. Additionally, when addressing duration of time played on field, field position and intensity of competition, no difference was found over one thousands hours of basketball game play. However, it should be noted that injury was more likely to take place during game time play rather than practice. What we can glean from all this is that the risk factors for ankle injuries are multi-factorial and it is impossible to completely remove the risk of ankle injuries occurring.

Therefore how do we prevent such an injury which can leave an athlete out of action from anywhere from seven days to twelve weeks? The answer unfortunately is not a straight forward one, in fact, in terms of developing a prevention program for ankle sprains it is suggested clubs establish more specific technical training based on landing, take off and lateral cutting movements. As mentioned previously, tape has only been found to have a positive preventative effect on athletes who have already sustained an injury, the same can be said for the use of custom orthoses which are recommended for at least twelve months following a serious ankle sprain due to duration it takes for ligaments to reach full repair and regain proprioceptive ability. In short, research shows the preventative strategies were most effective in participants who had previously suffered an ankle sprain and not necessarily in limiting the possibility of initial instance. In conclusion, rehabilitation of an athlete whether; weekend warrior or Olympic representative requires the inclusion of more than just a “stretch and strengthen” approach which was once looked upon favorably by many allied health clinicians. It is key to take in to consideration the structures involved, their mechanism of action and the role of the supporting structures, as well as the need for neuromuscular retraining for proprioceptive sense enhancement.