Chronic ankle injury

[ajs166]

I am a 30 year old male currently living in Korea.

About 9 months ago I sprained my ankle after landing from a jump playing basketball. After visiting a clinic my ankle was put in a splint for about 2-3 weeks and I was then prescribed physio.

After two to three weeks of physio I returned to sport (mainly taekwondo) feeling my ankle had sufficiently recovered. At this time my ankle didn't feel 100% (there was no pain but a loose/weak feeling which was more annoying than painful). After two months of training I still had this weak/loose feeling so returned to the clinic.

The doctor said my ankle needed more time to recover and prescribed physio for six weeks. After six weeks of treatment the loose/weak feeling remained and the doctor insisted again to continue with physiotherapy until my ankle recovered completely. It has now been over five months since I restarted the physio for the second time and there hasn't been any great improvement in my ankle.

I want to trust the doctor and physio I am recieving treatment from but given I am not not living in my native country(New Zealand) I am skeptical. My treatment is the same everytime. First a heat pack, second ultrasound, third electronic massage machine. I have not been given any rehab exercises to do. When I questioned the physiotherapists about this they suggested two different exercises 1. balancing on one leg, 2. calf raises, but this was only after I questioned them and there has been no follow up. I have tried other clinics in Korea but the treatment is the same - treatment as above with machines rather than a rehab program.

I have the following questions I would appreciate any answers to.
1. Is the above treatment standard for the injury I have?
2. Are there any exercises I could do myself to help rehabilite my ankle on my own?
3. If I were to stop treatment and return to sport would I cause long term damage to my ankle?
4. Will I require surgury to correct this problem?

Any advice would be so much appreciated. Being unable to train and play sport for such a long time has left me frustrated and depressed. I now feel desperate but being in a foreign country makes it hard to know what to do. With other injuries, I have followed my physio's advice to the letter and always have had good results so it is frustrating when asking for advice just being told "Your ankle still needs more time to recover" without being any rehab program to follow.

Any feedback would be so much appreciated.

Thank you

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[Musculoman]

Hay ajs,
I don't have much time sorry so have to be relatively brief.

1. The above treatment is quite lacking for your curernt injury. Firstly, unless you had a severe sprain / malleolus fracture or something to that degree you should not have been splinted. You shuold have been non/minimal weightbearing with crutches, prolonged spliniting of a sprained ankle will impair your chances of a good recovery. Your therapist should have started focusing more on restoring ankle stability and proprioception by now.

2. There are plenty of exercises depending on what level you are at. If you are fairly pain free and active with only the loose/weak feeling you can try some of the following.
- Single leg stance with eyes closed or on an uneven surface i.e. rolled towel, (make sure you don't re roll your ankle)
- walking lunges / static lunges
- standing on one leg and throwing a ball against a wall, make it harder by standing further from the wall, increasing the height you throw the ball, and adding weight to the ball i.e. medicine ball
- Form a X on the ground with tape and hop from one section to another
- put a ball against the wall (soccer ball) and lie on your back with your foot resting on the ball and your leg @ approx 90 degrees. close your eyes and apply pressure to the ball while slowly rolling it up/down the wall. Increase the amount of pressure you push into the ball to increase difficulty
- Play Hopscotch! (great for ankle stability_

Just some examples, there are a LOT of exercises with varying difficulties , you would have to provide more information on the level you are at for me to give specific and appropriate exercise lists. (please don't do any of the above if they aggravate symptoms.)

3. Following ankle sprains, the incidence of reoccurance is much higher. It is advisable to continue with appropriate exercises to strengthen your ankle while TAPING it or bracing it for the next 3 months during sport etc. so YES you CAN reinjure your ankle and provide long term damage, but if you take proper precautions you can reduce this chance. Hard rule is: If it hurts or feels uncomfortable, stop. Evidence shows taping helps with stability and decreases reinjury in clients with chronic ankle instability, while also IMPROVING the reaction time of some local joint stabilising muscles (again helping prevent reinjury).

4. No idea, would have to look at available investigations/ assess the ankle myself. Sorry Can't give much more advice here just yet. Surgical treatment can be an option if the case requires it, and @ around 5-7 weeks post surgical intervention outcome results are quite similar to that of conservative management,.. (can't remember the exact figures and not sure of the reference, don't have time to look it up now so please dont quoote me on that) but i would suggest conservative management currently

Let me know if you want more info just quickly threw this together. Will improve it later on when I have some time!

Some quick links which might help describe things for you:
http://doeatc.k12.hi.us/pnfankle.pdf Evidence supporting concervative management of chronic ankle instability
http://www.orthogate.org/patient-edu...stability.html General information on ankle sprains

Musculoman out!

[ajs166]

Thank you for your reply Musculoman.

I am very keen to try some of the exercises you have suggested. As far as the level my ankle is at I am confident of attempting all of the exercises you described. My ankle seems to be unaffected by running and walking up and downstairs but the loose feeling seemed to slightly increase after playing a friendly game of indoor soccer and jumping exercises at taekwondo. My ankle certainly doesn't feel like it about to give way when I exercise.

I was just wondering how frequently I should do the exercises (reps/sets, days per week etc). If you have any advice regarding this it would be great.

Thanks again. I already feel better knowing I can actively do something about this injury rather than just sitting and waiting.

ajs166

[Musculoman]

Hay ajs
Glad I can help.

An exercise program you may want to try then may include:

1. Single leg stance approx 2m away from a wall. Use a basketball / larger ball preferably (or a tennis ball if it is all you have) and throw it against the wall about 1m above head height. Repeat 10 times. 4 sets
1. to make it harder (if the above is too easy) Throw the ball so you have to catch it each side, or stand on an uneven surface, or throw the ball higher, or stand further away from the wall, or use a heavier ball.

2. Form a cross on the ground with tape. Hop in a pattern (top left, top right, bottom left, bottom right) or you can change it up. Complete the pattern 5 times in a row. 3 sets. Can make it harder by jumping further away from the centre in each quadrant.

Different version of 2. Place a single line on the ground, hop over it left and right 5 times. Add an object to hop over. i.e. book. Try and find something which will fall over if you hit it, so you do not injure yourself. Start with small objects and build up. If you can hop over something > 20cm 5 times , 3 sets you are doing well Keep practicing.

3. Put a basketball/volley ball or fit ball against the wall if you have one. Lie on your back and put your foot up on the ball so your leg is @ 90 degrees. Close your eyes and roll the ball steadily up and down the wall, trying not to shake best you can. Start just holding the ball against the wall and going up and down 3 times (we will call this 0%), every 3 times increase the pressure by 25% until you are pushing as hard as you can (call this 100%) against the ball and going up and down 3 times. The aim is NOT to shake, don't try and go quickly, the slower the better. This one is all about control. 2 Sets

4. Continue your calf raises, single leg. Try and do them without holding on to something if you can! If you master this, try and do them without holding on and closing your eyes, you will find this quite difficult I assure you. 4 sets 10 reps

5. Sport specific exercise: Try and find an exercise you may do in your martial arts class which may give you the unsteady feeling in your ankle. Practice this in a controlled environment slowing each part down and making sure you are steady and in control of each movement.

The idea of these is to strengthen your ankle, AND increase your body's awareness of what it is doing (proprioception). You use 3 things for balance and ankle stability: Vision, Vestibular system and Proprioception. When you injure a joint, you lose some proprioceptive feedback (body loses the ability to KNOW your ankle is moving to the left or right etc.) therefore your stability muscles take longer to react, which can cause pain, feelings of instability etc.

Here is some information about proprioception! May be an interesting read for you:

Very laymans description:

What Is Proprioception?

Reccomended reading: (try and work your way through it, look up terms you may not know, will help you a lot in the future, especially for your martial arts and any future injuries!)

The Sensorimotor System, Part II: The Role of Proprioception in Motor Control and Functional Joint Stability

Try these exercise sets twice daily each. It won't happen over night, but it should help to give you a full return to sport. If they all get too easy, just send me a message and I can give you some harder / different exercises.

Regards,
Musculoman! (feel like a superhero with this name... didn't think about that when I signed up!)

Edited to remind you: Any pain / aggravation stop the exercise in question and shoot me a post.

[ajs166]

Hi Musculoman

Thank you so much for the comprehensive program. It is exactly what I was looking for. The exercises look interesting and challenging so they will keep me busy and motivated. I can't wait to get started.

Thanks for the links too. I read the first article but haven't had time to read the second one yet. Both look interesting. I'm always interested to know what is going on with an injury but usually don't know where to look for information so I appreciate you posting the links.

I'll let you know how I get on with the exercises.

Thanks so much again. I feel so much better than this time last week now I have a program to follow.

ajs166

[Musculoman]

Glad to help mate Keep us all in the loop as to the outcome of all this, as I am sure people following this post with similar injuries will be keen to know. If you need any more advice you know where to find me.

Take care,
Musculoman.