ANKLE SPRAINS: The Good, The Bad, and The Ugly
by
Will H. Stewart II CMT, FAFS
The Scene: 1996 Summer Olympics in Atlanta, Georgia USA
The Event: Womens Gymnastics
The Apparatus: The Vault
The Athlete: Kerri Strug
This should start ringing a few bells. The US team needed a score of 9.493 to win the gold medal for the US. Her first attempt received a score of 9.162. It was erroneously thought not to be enough. To make matters worse, she had under-rotated her first fault and injured her ankle, and because of the miscalculations, her coach told her she needed to do it again. On an injured ankle, Kerri Strug sprinted down the runway and nailed her vault receiving a 9.712. Gold! This was truly what Olympic moments are made of. Ms. Strug was later taken to the hospital and treated for a third-degree lateral ankle sprain. This was, of course, after she had stood on the podium to receive her gold medal with Team USA Gymnastics.
Most of our ankle sprains are not as dramatic as Kerri Strug’s; however, they can be just as bad and ugly. The foot/ankle complex is an amazingly beautiful and complicated system of many bones, muscles and connective tissue that give 3-D support. However, this complex system is prone to injury. Eighty-five percent of ankle injuries are sprains and out of those, 85% are lateral ankle sprains. Unfortunately, ankle sprains that are not rehabilitated functionally can cause dysfunction not only at the foot/ankle, but also up the kinetic chain.
Functionally, as we look at the foot and ankle, we know that as the foot hits the ground, it causes a chain reaction that takes the calcaneus into eversion. There are numerous muscles, in particular the peroneus longus, which decelerates the eversion along with assistance from the medial deltoid ligaments of the ankle. However, as stated before, most of our ankle sprains are inversion sprains. While we have muscles that decelerate inversion of the foot, along with the three lateral ligaments, it unfortunately is, as in Kerri Strug’s case, not enough.
After the ankle is evaluated and diagnosed by a qualified health care provider, functional rehabilitation can commence. Traditionally, depending on the grade of the sprain, the R.I.C.E. method was recommended to control inflammation and ensure no further damage. Guided by Applied Functional Science, we know that there are 12 multi-joint muscles that send their tendons across the ankle and subtalar joints of the foot. We also know that ice reduces swelling. Therefore, one of the many strategies for rehabilitating a lateral ankle sprain (right foot, in this case) would be to mobilize the affected region by performing a 3-D lunge progression in cold whirlpool (as well as out of the whirlpool) that will elicit the proper sequence of joint motion and stress the tissues from least to greatest. This will effectively provide an authentic swelling control to “pump out” inflammation, as well as proprioceptively stimulate the ankle/foot complex.
A lunge matrix progression for a right stable lateral ankle sprain that goes from least amount of stress to greatest could look like this:
Right Foot Left Lateral Lunge (Least Stress)
Right Foot Anterior Lunge
Right Foot Posterior Lunge
Right Foot Left Rotation Lunge
Right Foot Right Lateral Lunge (Most Stress)
The Right Foot Right Lateral Lunge is the last lunge in the progression since it will stimulate lateral ankle ligaments more than the others listed above it. Discretion for the lunge progression is paramount so that motion is introduced at the right time and right direction without overstressing the damaged tissues. Gary Gray explains and demonstrates other powerful techniques in the “Ankle Sprains: Chain Reaction Rehab” edition of the Functional Video Digest Series that observe proper biomechanics to facilitate proper joint motion, soft tissue healing and proprioception. Some ankle sprains are bad, some even look pretty ugly; however, if we understand Chain Reaction Biomechanics, we are able to assist the body in healing and returning to GOOD function.