Get back in the game after an ankle injury

By Daniela Ginta

Ankle injuries are some of the most common types of injuries that may seem easy to recover from —unless you’ve had one, that is. From sprained ankles to torn ligaments and broken bones, ankle injuries happen to recreational and seasoned athletes alike. Contrary to what people may think, it has nothing to do with one’s fitness level. What makes it, or breaks it (no pun intended) is allowing proper time for rehabilitation, which could take anywhere from six to 12 weeks for moderate ankle sprains and up to six months for more serious injuries such as fractures and torn ligaments, says Alex Fell, a Vancouver physiotherapist at Gastown Physio and a high performance coach with the Canadian Ski Coaches Federation.

The whole body connection
Each of the leg articulations taken separately is as delicate as it is intricate, but all of them together make for a strong stable mechanism. The secret behind the magic of stability and locomotion lies in synchronicity and constant use. An injured ankle can trigger knee, hip and even lower back pain if not properly managed during rehabilitation. “If a joint is immobilized, the other joints will be affected due to altered joint mechanics,” says Fell.

Muscle atrophy, a normal occurrence with immobilized legs, adds to the challenge. After removing the cast or walking boot you will most likely experience stiffness and a change in the mechanical pattern that affects stability and typical range of movement. It is safe to assume that lack of pain is a positive sign, but recovery from an injured ankle also involves regaining stability, balance and ability to perform all the functional tasks. Without proper rehabilitation there is a high risk of developing a functional ankle instability, says Fell, which may lead to reinjury in approximately 40 to 70 per cent of people.

Safe return to sports
A slow reintroduction to movement involves starting with passive range of motion such as having someone move your foot for you, to ankle circles and figure-8 exercises — all depending on what is appropriate in each case, says Fell. Appropriate transition to the next stage, resisted and weight-bearing exercises, should ideally be assessed by a physiotherapist. As eager as you are to return to sports after temporary immobilization, go with safe, low impact activities such as cycling, swimming and water running, advises Fell.

Fell advises using the stationary bike during the first couple of weeks to avoid the risk of accidents or having to put sudden weight on the recovering foot.
While walking is low impact and definitely beneficial, keep in mind that something as innocuous as barefoot walking could be challenging with a stiff foot and partially atrophied muscles.

Once your foot has gained back its full mobility and is stable enough to sustain running, start with 1:3 or 1:4 run/walk program that gradually builds up running minutes. It is important that the ankle joint is stable by then, because the first point of contact with the ground is through that foot/ankle complex and the way the whole load of that impact is attenuated will affect the joint stacking above it, explains Fell.

To brace or not to brace
A brace can help and also hinder recovery. An ankle brace may affect the change of the joint mechanics in a way that might increase the stress on the other joints, explains Fell. Ideally, he adds, recommendations for using a brace should be done by a professional, whether a physiotherapist or a brace specialist, based on the athlete’s level of competition, severity of injury and the urgency of a competitive schedule.

Bottom line
While not all injuries require casts, walking boots or physiotherapy, the golden rule is that if you cannot put weight on your injured foot or the pain persists for more then 48 hours, you need to see a doctor. During recovery it is essential to perform correct movements and not persist in limping as you may be tempted to, advises Fell, even if that means moving slower than expected. The more you use your joints correctly the faster the recovery. 

Daniela Ginta, MSc, is a freelance writer in Vancouver B.C. She runs and cycles and has recovered successfully from more than one ankle injury.

May/June 2012

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