Previous ankle sprain treatment has focused mainly on strengthening the joints in the ankle region.  The University of Georgia study suggests that certain repetitive motions in the hip and knee joints may also impact the likelihood of re-injury.

“If you have ankle sprains, you may have a problem with the way you move, and we think we can change movement through rehabilitation,” said Cathleen Brown, assistant professor in the department of kinesiology and head researcher of the study.

Brown’s study looked at the different ways people recovered from an ankle sprain.  She looked at individuals who often participated in physical activity, and noted that some athletes were able to recover without a problem while others tended to suffer setbacks during rehabilitation.

“One theory for explaining those divergent paths is that a person comes up with good strategies to move, land, balance and not get re-injured,” she said.

In the study, 88 participants were divided in three groups:

• Active individuals who still experienced ankle weakness after an ankle sprain (aka copers)
• People who had been injured but no longer suffered from ankle problems
• An uninjured control group

The participants wore a body suit that monitored the exact position of the ankle, hip, and knee joints, and were asked to jump at a target above their head, then land on one foot without assistance.

The study found that of the three groups, the uninjured control group bent their knees and moved their hips from side-to-side more often than the other two groups.  The study also found that “copers” showed variances in their joints upon jumping and landing.  They were unable to use their hip and knee joints as effectively when landing on one leg.

“Maybe the injured people don’t use the same landing strategies, or their strategies aren’t as effective,” Brown said, acknowledging that the study had only been able to examine the results in the short-term. “We don’t know if they are this way because of the injury, or if they got this injury because they land this way.”

Researchers used the study to examine how ankle, hip and knee joints work in isolation, but they hope to synthesize their data with further experiments that examine the joints in combination.  The future studies may be able to determine helpful or harmful movement patterns, which could directly affect rehabilitation techniques across the country.

Brown said she developed her study after looking at similar research that examined whether athletes changed their running technique after an ankle injury.  While future studies may change the way people rehab from an ankle injury, Brown said it’s important to seek a professional opinion if you suffer from chronic ankle weakness.

“I always try to encourage people who are having a lot of problems with their ankle to see a health care professional who would be able to help them,” Brown said. “There are negative long-term consequences to ankle instability, such as ankle osteoarthritis, that may be preventable with treatment.”

Dr. Silverman comments

After an ankle sprain, the ligaments are functionally lengthened. Some people have clinical instability (symptomatic), and some have asymptomatic instability (copers but, I call them Accommodated).

Without a stable ankle to prevent the feeling of instability, the natural reaction is to externally rotate the hip to keep the ankle from ever rolling. This prevents knee and hip mobility described in the article.  The lack of motion doesn’t come from the sprain, the lack of motion comes from the accommodation of the instability.

If you go and try to fix the coping mechanism, you’ll screw up the ankle and people will become more symptomatic.

Although I think the article is great in the fact that it identifies the abnormality, I cannot stress enough the importance of fixing the cause of the problem, not the symptoms.  People should visit a specialist if they have weak or unstable ankles, as doing something like changing your running stride doesn’t address the problem at hand.

Related source:  UGA.edu

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In the interest of getting the medical terminology correct, here are the varying grades of ankle sprains and high ankle sprains.

Ankle Sprains

An ankle sprain involves injury to the stabilizing lateral ligaments of the ankle joint. It occurs when the foot is pointed downward and the ankle rolls inward (the classic ankle roll). Ankle sprains vary based upon how severely these ligaments are disrupted. Everyone heals tissue at different rates, thus return to activity is different for each patient. There are 3 grades of ankle sprains:

• Grade I – A mild sprain that involves no permanent damage to the ankle. It resolves in a few days to 2 weeks and almost never results in problems.
• Grade II – One or more of the major ankle ligaments have been disrupted (Anterior talofibular and calcaneofibular). Major symptoms resolve in 2-4 weeks or more. Long term problems of instability are common, but many muscular athletes can play through the instability for years. Accommodation using braces and strengthening different muscle groups can permit return to sports. But players often develop ankle spurs after 5-10 years.
• Grade III – A complete dislocation of the ankle joint. All the lateral ligaments are ruptured, more than 10% of the time bones are bruised, cartilage can be damaged, other tissues and tendons may be partially torn and nerves may be partially stretched. Some of these injuries cannot be seen on the MRI either. Often patients have gone to the hospital ER and been told nothing is broken.  This is confusing as this injury can hurt more than some ankle fractures.  Healing can take several weeks to months.

High Ankle Sprains

A high ankle sprain involves injury to a joint above the ankle, the syndesmosis, a tight tissue that holds the two bones of the leg (the tibia and the fibula) together. When the foot is at 90 degrees to the leg and twisted outwards, the two bones of the leg are stretched apart. Like ankle sprains, syndesmosis injuries are similarly graded.

• Grade I – Mild partial disruptions of one of the ligaments connecting the tibia to the fibula (usually only the anterior tibiofibular ligament). The joint is stable to a stress test and heals well within a few weeks.
• Grade II – Greater tissue disruption involving two of the three ligaments connecting the bones together. A stress test, weight bearing on the ankle, and checking for widening is unlikely to help since it is too painful in the acute setting. A stress test under anesthesia will demonstrate the injury. These injuries can also be diagnosed by MRI and in many cases are best treated with surgical stabilization. Regardless of treatment it can take 2 months or longer to return to sport.
• Grade III – Obvious dislocation of the tibiofibular joint. Surgery is indicated and return to sport is delayed 2-3 months.

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