Physiotherapy for Recurrent Ankle Sprains (Chronic Ankle Instability - CAI)
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Recurrent Ankle Sprains, Are They a Given?
Some people view ankle sprains as a part of sport that they have to accept, especially after rolling the same (or both) ankles more times than they can remember.
While it can be common to have repeated ankle sprains, it doesn't have to be a given that your ankle will continue to roll.
Many people may have accepted this to be true, and aren't aware that there are options they can undertake to reduce their likelihood of future injuries.
The Problem
With each ankle sprain, your risk of subsequent injury can increase, here's why.
Dynamic, Recursive Model of Aetiology of Sports Injuries - Meeuwisse et al., 2007
The model above represents a useful model of injury risk. If we use this model to explain the cyle of recurrent ankle sprains it goes something like this:
Previous ankle sprain occurs, increases risk of subsequent injury
+/- appropriate rehab (NB: just waiting to be pain free isn't rehab enough), if no appropriate rehabilitation/injury risk reduction strategy = increases risk of subsequent injury
Return to sport/continue playing sport despite sub-optimal function or prevention strategy
Exposure to subsequent mechanism (uneven surface, land on opponents foot, etc)
Repeat ankle injury, increases risk of subsequent injury
Repeat cycle
Without identifying and addressing the underlying risk factors (Intrinsic – relevant to you, Extrinsic – occurring outside of you) and completing appropriate rehabilitation (including regaining strength, balance, power), this cycle may not be addressed.
Breaking the Cycle of Sprains
The process of getting ahead of subsequent ankle sprains looks like this
1. Engage an appropriately experienced/qualified rehabilitation specialist (Exercise Physiologist, Strength and Conditioning Coach, etc) to identify your specific underlying risk factors and conduct a thorough physical assessment.
To be sufficiently comprehensive, the assessment should include:
Identification of Extrinsic Risk Factors (Equipment, Environment, Sport Played, etc)
Ankle Range of Motion
Tolerance of Weightbearing
Strength and Endurance (ideally of the whole lower limb, but most essentially the calf)
Power (Hop testing, single and repeated, both linearly and in multiple directions)
Lower limb biomechanics during gait/sports activities – if appropriate
2. Complete a comprehensive rehabilitation program post initial, and/or subsequent sprain(s), and continue a risk-reduction/strength and conditioning program for (ideally) the next 12 months
The program should include roughly 5-10 exercises at any one time, and address all of the factors outlined above in the assessment. This could include strength/endurance exercises like calf raises, ankle inversion/eversion, power exercises including pogo hops and bounds, and dynamic balance exercises such as kettlebell passes, star excursion, and dual tasking on one leg. Most importantly, and please note: single leg calf raises alone are likely NOT sufficient rehab.
3. Engage in other strategies to reduce risk such as taping, which is said to reduce the risk of subsequent injuries by as much as 50%. These strategies can be tailored to you based on the identification of risk factors during your initial assessment.
In order to address recurrent ankle sprains, it is beneficial to identify the relevant risk factors and deficits in physical performance, and consistently implement a risk-reduction strategy and rehabilitation program.
