ANKLE SPRAINS – RECOVERY, REHAB AND RISK REDUCTION
Ankle sprains are one of the most common sports injuries especially in sports such as basketball, netball and football with an incidence rate of 7 per 1,000 exposures.
Unfortunately some people (athletes, coaches, parents, other health professionals) may think an ankle injury is a minor injury and so in many cases appropriate rehab is not performed.
Making sure your ankle injury is managed properly will go a long way to reducing your risk of re-injury and ongoing complications such as chronic ankle instability.
What Happens When You Sprain Your Ankle?
There are multiple different structures that can be injured when you sprain your ankle.
The most common ankle sprain is called a lateral ankle sprain and occurs when you roll over the outside of your foot/ankle. This can occur while changing direction, landing from a jump, or treading on an opponents foot.
When you sprain your ankle, ligaments are stretched and can even completely tear.
*ligaments connect bone to bone and are important for the stability of joints.
There are 3 ligaments that are commonly involved in a lateral ankle sprain. The anterior-talofibular ligament (ATFL), calcaneo-fibular ligament (CFL) and the posterior talofibular ligament (PTFL). See the image below.
You can also sustain injury to the anterior tibiofibular ligament that attaches the two lower leg bones together (the tibia and fibula). This is referred to as a high ankle sprain or syndesmosis injury. It is important that this type of injury is ruled out as it requires a different approach to rehab compared to the common lateral ankle sprain and in some cases surgery is needed.
A less common injury is a medial ankle sprain which causes injury to the ligaments on the inside of the ankle. These injuries typically take longer to recover.
How Long Does It Take To Heal?
Ligaments take about 4-6 weeks to heal. Depending on the grade of ligament injury sustained it can take anywhere from a few weeks to a few months or longer to return to pre-injury activity and sport.
It is important to perform appropriate rehab for your ankle sprain as 20-50% of ankle sprains can lead to chronic ankle instability (pain, swelling & instability).
Chronic ankle instability increases the risk of re-injury or sustaining multiple ankle sprains which can lead to an increased risk of osteoarthritis later in life.
It is not uncommon for me to see someone with an ankle sprain 6-12 weeks after their initial injury, despite the importance of seeking physiotherapy immediately following an ankle sprain.
This makes it more difficult to determine exactly what you have done and the extent of the injury.
The sooner you can be assessed the sooner you can begin your rehab and be back doing what you enjoy.
If you do not perform rehab for your injured ankle, your risk of future injury and complications is significantly increased.
What Does Rehab Involve?
Rehab involves a combination of exercises that will get you back to sport or daily activities pain free. Some examples of the different things you may do are…
Range of motion exercises to restore normal ranges of motion in the ankle joint
Strength exercises to regain strength e.g. calf raises, band resisted ankle movements
Balance exercises to regain proprioception
Plyometrics to get that spring back and be able to run, jump and change direction with confidence
When you see me for ankle rehab we work our way through a series of exercises that tick all these boxes and make sure you and your ankle are ready for whatever you throw at it.
Here are some examples of rehab exercises you might perform.
What Can Increase Your Risk Of An Ankle Sprain?
Research has shown a number of factors that increase the risk of an ankle sprain, they include:
A history of a previous ankle injury
Wearing shoes with air cells in the heel
Not performing an adequate warm up involving static stretching and dynamic movement
Not having normal ankle dorsiflexion range of motion (bending your ankle up)
Not completing a balance or proprioceptive prevention program if there is a history of previous ankle injury
How Can You Reduce Your Risk of Injury or Re-injury?
Firstly, make sure you have completed adequate rehab overseen by a Physiotherapist for any previous ankle injury. There are a number of tests that a Physio can have you perform to determine your readiness to return to sport and check for any underlying deficits. These tests are a combination of strength and movement tests like jumps and hop tests that compare your affected leg to your unaffected leg.
If you can pass these tests before returning to sport your risk of re-injury will be reduced.
One simple test is single leg calf raise strength. A good measure of adequate calf strength for the average active person is being able to perform 25-30 single leg calf raises.
Another way to reduce the risk of re-injury and the severity of future injury is by wearing an ankle brace or strapping your ankle with sports tape. Recent evidence supports the use of an ankle brace or taping for at least 6 months following injury. The role of taping or bracing to prevent first time ankle injury is less evident so there is no need to tape or brace an ankle that hasn’t been injured.
Ankle sprains are not a simple injury
Ankle sprains require rehab to help prevent ongoing complications and reduce the risk of re-injury
If your doctor or medical professional does not suggest physiotherapy or rehab you can refer yourself to a physiotherapist for rehab, no referral is needed.
It is very important to have a physiotherapy assessment after sustaining an ankle injury
Taping or bracing can help to reduce the risk of recurrent ankle sprains
If you suffer an ankle sprain book in for an assessment so I can get you back on track and back to doing what you enjoy ASAP.
You can book a physiotherapy appointment with me at Reeves Empowered Performance & Nutrition, located in Burnie by clicking HERE.
There’s a section in the book Atomic Habits where the author (James Clear) talks about our habits shaping our identity. This really resonated with me so I thought I would share it with you.
James talks about beginning the process of changing your habits by focusing on who you want to become (your identity) rather than what you want to achieve (outcome based). There is an example given of 2 people who are offered a cigarette.
One person says “No thanks I’m trying to quit” which sounds fine but this person still identifies themselves as a smoker who is trying to be something else.
The other person says “No thanks I’m not a smoker”. A small difference that signifies a shift in identity. They no longer identify themselves as someone who smokes.
A habit becoming part of your identity is a strong form of intrinsic motivation.
Rather than being someone who says they ‘want’ this become a person who ‘is’ this.
The more pride attached to a certain aspect of your identity the more motivated you will be to continue habits that reflect this identity e.g. if you take pride in being physically strong you won’t want to miss a training session as that would not support your self-identity.
You could be training for a marathon but the goal is not just to run 42km, the real goal is to become a runner.
The goal is not to lose fat and maintain a healthy weight, the real goal is to become someone that eats nutritious foods and controls their calorie intake.
People who use this identity approach can find it easier to continue with their newly formed habit/s.
“A person who incorporates exercise into their identity doesn’t have to convince themselves to train.” They are simply acting like the person they already believe themselves to be.
Along these same lines is the story of a woman who was trying to lose weight. She succeeded at losing weight just by thinking to herself “what would a healthy person do?”. For example, when deciding what to eat or when faced with taking the stairs or the elevator she would ask herself this question and act as a ‘healthy’ person would. She started identifying herself as a healthy person, her actions followed suit and she lost weight.
On to how this resonated with me…
Over the years I’ve had a few people tell me that I “must be really motivated” or ask me how I am “so motivated”, in regards to being a self-coached athlete in an individual sport that trains by himself.
My reply would be along the lines of “I am intrinsically motivated to do my best and training is just something I do now, a non-negotiable, it’s part of being a runner.” Without knowing it I was using this self-identity principle.
I don’t have any more motivation than the next person. I am focused on running as best I can and making sure I don’t retire thinking I never reached my potential.
I Identify myself as someone who is committed, disciplined and dedicated. Not someone who is overly motivated. If I wake up early to go to the gym or go for a run I struggle to get out of bed just like anyone else. It’s not motivation that gets me out of bed, it’s the fact that I identify myself as an athlete who is dedicated, disciplined etc and to live up to that identity I need to go and train.
I finish work for the day drained and tired and the last thing I feel like doing is trying to sprint around an athletics track but if I don’t do it then I can’t call myself a dedicated athlete.
Another example of how self-identity can help habits is if you’re really needing to give up a specific food or bad habit. Rather than saying “I’m not allowed to eat that” you could change your inner dialogue to something like “I don’t eat that food anymore”. Similar to the cigarette example above.
So next time you’re attempting to implement a new habit or kick a bad one, try focusing your habits and actions on the type of person you want to become not the end result that you want to achieve.
I’m about halfway through Atomic Habits and it’s one of the best books I’ve read, highly recommended.
If you are a non-strength sport athlete (field/court-based sport, track & field etc) your approach to resistance training should be different to that of a bodybuilder or strength sport athlete (e.g. weightlifter, powerlifter).
Training for bigger muscles like a bodybuilder or focusing solely on moving heavy weight slowly is an inefficient way to train. Bigger muscles, being shredded and being strong as an ox DO NOT equal performance. ⠀⠀⠀⠀⠀⠀⠀⠀⠀ There’s nothing wrong with wanting to gain muscle mass and improve strength. In fact, there are many athletes who would benefit from adding a bit of muscle mass and even more that would benefit from improving their strength. BUT, there is are effective and less effective ways to go about it.
Athletes use their whole body and as such the focus should be on training movements AND muscles not just muscles. With this in mind, the typical bodybuilding split with a focus on training specific muscles to improve muscle mass / training for aesthetics is a poor use of an athlete’s time in the gym.
Athletes also require more than just strength to perform their best. Therefore, training purely to lift heavy stuff slowly is also inefficient and has its limitations.
WHAT IS THE PRIMARY GOAL OF RESISTANCE TRAINING FOR AN ATHLETE?
The full spectrum of the force-velocity curve (FVC) should be trained with a focus on the individual’s areas that will yield the greatest improvement in those performance parameters.
Athletes need to be strong, fast and powerful so training each part of the force-velocity curve is vital. You’ll only limit yourself & your athletes by only training one part of the FVC e.g. never doing explosive movements like plyometrics and only doing heavy ass lifts that produce a lot of force but very slowly.
Power = Force x Velocity
You could be the strongest person in the world, but if you don’t bring velocity you’ll be as powerful as a wet paper towel.
CHARACTERISTICS OF ATHLETE PERFORMANCE TRAINING PROGRAMS
We can take parts of bodybuilding, powerlifting & olympic lifting training and apply them in a well-rounded program that ticks the boxes necessary to improve important athletic qualities.
The major movements that should be trained are variations of a Squat (knee dominant), Hinge (hip dominant), Single Leg Variations, Horizontal Push, Horizontal Pull, Vertical Push, Vertical Pull and Carries. These movements should make up ~80-90% of your program with isolation exercises making up around 10-20%. ⠀ Manipulating tempo, lifting with intent, dynamic effort, max effort, accumulation, intensification, performing explosive and powerful movements (jumps, throws, sprints) are all common components in athlete specific programs.
YOU WILL STILL BUILD A GOOD LOOKING PHYSIQUE
Increases in muscle mass & strength will still occur through correctly implemented and programmed resistance training, supported with adequate nutritional habits (adequate protein + calories) ⠀⠀⠀⠀⠀⠀⠀⠀⠀ Athletes should be training for performance not to look good in front of the mirror. Looking good in front of the mirror will be a by-product of adequate nutrition and being a fast, strong, powerful & athletic athlete.
There are many ways to organise your resistance training split and your program should change depending on your goals and what time of season it is (e.g. off-season vs pre-season vs in-season).
Two of my favourite training splits for an athlete are below
If you are an athlete make sure your training is specific to what you need to improve. Don’t just try to build muscle and don’t just lift heavy weight slowly. There will come a point where becoming stronger will not translate into any further benefits for performance or athleticism.
The force-velocity curve (FVC) is important for both coaches and athletes to understand for correct exercise prescription in terms of exercise selection & loading parameters. Having an understanding of the FVC and how to use it to program & train effectively will also ensure that training is maximising performance improvements.
Force can be thought of as muscle contractile force, or the amount of ground reaction force (GRF) produced. Ground reaction force is the force exerted by the ground on the body. Force is usually expressed in the unit Newtons (N).
Velocity can be thought of as muscle contraction velocity (speed) or velocity (speed) of movement (meters per second).
Power = Force x Velocity
You could be the strongest person in the world, but if you don’t bring velocity you’ll be as powerful as a wet paper towel.
WHAT DOES THE FVC SHOW?
The FVC shows the relationship between force (F) and velocity (V). The relationship between force and velocity is inverse. What this means is that if force increases, the velocity of movement will decrease and if velocity increases the amount of force produced will decrease.
There is a trade-off between force and velocity. When an exercise produces a high level of force it will also produce a slow movement velocity.
An example would be a 1RM deadlift vs a box jump. The 1RM deadlift would produce a large amount of force but the weight would be lifted at a slow velocity. Whereas, a box jump would produce a high movement velocity (moving fast) but a low amount of force.
This means that different exercises and intensities can be categorised into various parts on the force-velocity curve. These parts and example exercises can be seen below.
WHY IS IT IMPORTANT TO UNDERSTAND THE FVC AND HOW WILL IT AFFECT TRAINING/PERFORMANCE?
For athletes, the goal of resistance training is to become stronger, faster and more powerful. Through correct training, the FVC will shift to the right indicating that the person can apply a larger force at a faster velocity or move at a faster velocity while producing larger levels of force.
By shifting the force-velocity curve/profile to the right there will be an increase in power and rate of force development (RFD) which is critical for athletic success in many sports.
RFD can be thought of simply as how fast an athlete can develop/produce force.
An athlete with a larger RFD will be more explosive as they will be able to develop larger forces in a shorter amount of time.
If you want to run faster, change direction quicker, jump higher and throw further you need to be training to increase RFD and power/explosiveness.
The most effective way to improve RFD is through training methods that will developboth the force and velocity ends of the spectrum. So it is vital to train all parts of the force-velocity curve.
By training only one part of the FVC an athlete will only improve their performance at that section of the curve. For example, if an athlete only trains maximum strength, that athlete will only improve their performance at the maximum strength section of the curve. So, while they may improve maximum force production, it may also cause a decrease in muscle contraction velocity…not great if your goal is to become fast, powerful and explosive.
Therefore, it is important that strength training is combined with training to improve power i.e. train all parts of the Force-Velocity Curve for best results.
The time dedicated to training each part of the FVC will depend on a number of factors such as the individual’s strengths and weaknesses (their own unique force-velocity profile), sport, position, training age and time of the year e.g. pre-season, competition or off-season.
The FVC shows an inverse relationship. When an exercise produces a high level of force it will also produce a slow movement velocity.When an exercise produces a high velocity it will also produce a low amount of force.
For athletes wanting to maximise their performance it is vital to train all parts of the force-velocity curve
Credit to the guys at Science For Sport for some of this blog content and graphs
WHY IS ATHLETE DEVELOPMENT / STRENGTH AND CONDITIONING IMPORTANT?
A combination of technical & tactical skill, psychological & emotional strength and PHYSICAL capacities are required to become a successful athlete. We enhance these physical capacities through strength and conditioning training.
Aims of athlete development / strength and conditioning
⠀ 1. Develop an athlete’s physical capacities e.g. rate of force development, strength, speed, power & vertical jump etc. to be able to perform sport related tasks like sprinting, jumping, skills etc.to a higher level, while withstanding affects of fatigue or performance-drop longer than their opponents.
2. Build robustness to withstand the technical and physical demands of sport and training without getting injured.
3. Develop athleticism to support technical skills: enable athletes to tolerate training loads to maximise exposure to technical or tactical practice. Without a physical base the ability to tolerate training loads required for technical proficiency is reduced.
Strength is the foundation from which all other physical qualities of performance like POWER, SPEED & AGILITY are developed. Without proper strength development, these qualities cannot be optimized.
If you are wanting to get the most out of yourself and reach your potential, strength and conditioning is vital. If you don’t you are leaving gains & improved performance on the table.