Ankle sprains are a fairly common traumatic injury. However, if not treated promptly and correctly, they can lead to motor impairments, or even a limp, in the affected patient. This article will therefore review the definition of an ankle sprain and the various rehabilitation strategies to implement in order to effectively treat a patient who has suffered this type of injury.
What is an ankle sprain?
An external ankle sprain is defined by a twisting of the foot inwards, in a forced inversion movement of the ankle. This type of pathology involves one or more bundles of the lateral collateral ligament or the external collateral ligament.
External ankle sprains account for nearly 90% of this type of twisting injury. However, sprains of the medial collateral ligament or the tibiofibular ligaments also occur. These are less common and are generally caused by different injury mechanisms (ankle eversion, external rotation of the foot, etc.).
What are the different levels of severity of an ankle sprain?
The severity of a sprain is determined according to 3 grades:
- The first grade is defined by the stretching of one of the bundles of the lateral collateral ligament or the external lateral ligament, without it being ruptured or torn. This first grade involves moderate pain and edema, which do not prevent the patient from moving their ankle;
- Grade 2 involves a complete tear of one of the ligament's bundles, while the others may only be stretched or partially ruptured. The patient may then experience sharp pain and their foot is no longer able to function properly. The ankle is swollen and bruising may appear;
- Grade 3 is synonymous with a complete tear of several bundles of the ankle ligament, accompanied by a loud cracking sound. It involves intense, shooting pain and renders the ankle completely unstable, impossible to move.
What are the causes of an ankle sprain?
Ankle sprains are generally accidental. However, certain intrinsic and extrinsic factors can be involved in a patient's condition. These include, but are not limited to:
- the patient's age, sex, and experience;
- the recurrence parameter for ankle sprains;
- the diagnosis of a proprioceptive deficit of the ankle;
- the diagnosis of a deficit in the muscles that move the ankle;
- the difficulty of performing ankle flexion;
- a weakness of the muscles in the hip area;
- the use of shoes unsuitable for practicing a sport.
What are the differences between an ankle sprain and peroneal tendonitis?
Peroneal nerve impingement and ankle sprains are two disorders affecting the ankle region. However, they have important distinct differences that should be understood.
Peroneal nerve inhibition, also known as peroneal dysfunction, affects the peroneal muscles of the leg. These muscles play a crucial role in ankle stability. When they malfunction, other leg muscles are forced to compensate, which can lead to the development of various related pathologies.
Fibular inhibition is primarily characterized by restricted mobility of the fibula, one of the bones in the lower leg, usually caused by excessive muscle contraction or tension on surrounding tissues. This restriction can lead to an abnormal gait and uneven weight-bearing on the ankle, potentially causing pain and postural problems. In cases of fibular inhibition or ankle sprains, patients may experience pain and discomfort that can affect their mobility.
However, for healthcare professionals, it is essential to distinguish between these two disorders in order to establish an accurate diagnosis and develop a treatment plan tailored to each patient. Peroneal nerve inhibitions are often treated with myofascial release techniques and postural rehabilitation, while ankle sprains often require a more specific approach, focused on ligament rehabilitation and restoring joint stability.
The impact of fibular inhibition on ankle stability
When the peroneal muscles are inhibited, the tibialis anterior muscle, responsible for dorsiflexion of the ankle, can become overused. This overload leads to inflammation and pain in the shin (shin splints).
Healthcare professionals play a vital role in managing peroneal nerve inhibition, particularly through specific rehabilitation techniques to strengthen the peroneal muscles and restore ankle muscle balance. These interventions aim to reduce patient pain, improve joint stability, and prevent associated musculoskeletal disorders and tendinopathies.
Why is ankle rehabilitation necessary after a sprain?
The primary risk associated with an ankle sprain (even a mild one, classified as grade 1) remains recurrence. Indeed, in athletes, for example, the recurrence rate can reach 70%, potentially leading to chronic instability and early-onset osteoarthritis. Therefore, the primary objective of ankle rehabilitation is to minimize this risk by addressing all functional deficits associated with the sprain.
The 6 key areas of ankle rehabilitation
Following a sprain, and more generally after trauma or surgery, ankle rehabilitation is essential to help the patient regain their previous mobility. To achieve this, the practitioner will need to work with the patient on six main areas:
- ankle mobility;
- the musculature;
- proprioception;
- edema;
- the pain;
- combating lameness through gait training.
Joint mobility in the context of ankle rehabilitation
To help the patient regain good ankle mobility, ankle mobilization is essential. This must be performed gently, manually, and always respecting the patient's pain level. This step allows for a slight recovery of mobility before progressing to weight-bearing exercises that utilize gravity, effectively combating ankle stiffness. After an ankle sprain, it is beneficial to consult an osteopath who can release certain joint restrictions and expedite recovery.
Ankle rehabilitation and muscle strengthening
Muscle strengthening exercises can begin as soon as the first stage is completed (i.e., as soon as the ankle has regained sufficient mobility). This stage should be approached progressively, initially by applying pressure to the foot against the practitioner's hand, then by... ankle rehabilitation exercises using weights or elastic bands.
Proprioceptive work
Proprioceptive training begins a few weeks after the start of ankle rehabilitation. Proprioception is the sense that allows us to be aware of our body's position in space, thanks to information transmitted to the brain about the location of our limbs. This step focuses on improving the body's ability to maintain balance. It is therefore crucial to minimize the risk of recurrence or imbalance. To facilitate this phase, the practitioner may suggest that the patient use various equipment, such as a trampoline, a ball, or foam pads. Furthermore, this step remains essential for ensuring proper ankle stabilization and successful rehabilitation.
Treatment of edema
Edema, or swelling of the ankle, is an inevitable consequence of an ankle sprain. It is not serious, although it can sometimes be painful for the patient. To help reduce it, manual lymphatic drainage and the use of herbal pain-relieving creams can be beneficial. Edema can also be treated with cryotherapy, laser therapy, ultrasound, or magnetotherapy, for example.
Pain relief and ankle rehabilitation
Generally, the pain experienced by patients during rehabilitation is related to ankle stiffness. Therefore, it is essential to prioritize improving ankle mobility to minimize pain. TENS (Transcutaneous Electrical Nerve Stimulation) remains a valuable tool for relieving pain if it persists despite a good return of ankle mobility.
The walking pattern in ankle rehabilitation
By definition, gait pattern determines how a patient moves while walking. When it is altered, a limp with hip sway or external rotation of the foot can develop. The onset of a limp may indicate that the ankle has been immobilized for too long and that the patient may still be apprehensive about walking, resulting in poor foot placement. To address this gait disturbance, it is advisable, for example, to work on the gait pattern by walking in front of a mirror with the patient, in order to guide them through the necessary adjustments to regain smoother mobility.
The importance of the Allyane method in ankle rehabilitation
The Allyane neuromotor reprogramming method is based on mental imagery, proprioception, and listening to low-frequency sounds emitted by a patented medical device. In the context of an ankle sprain, it accelerates patient recovery by allowing them to quickly regain optimal contraction of the peroneal muscles.
The Allyane method also plays a role in lifting motor inhibitions put in place by our brain to protect the joint. It helps accelerate recovery and overcome any plateaus that may appear during the rehabilitation phase.
It also offers the possibility of optimizing functional movements, which can prove essential, particularly for professional athletes. It also provides a solution for patients still suffering from chronic ankle instability, whose condition has not improved after a year.
After an ankle sprain, the peroneal muscles sometimes exhibit motor inhibition at two levels: a strength deficit, notably with an excessively long and insufficient response time, or an alteration in the sequences of muscle contractions with the other ankle stabilizers (anterior and posterior tibialis anterior). When the foot strikes the ground, the peroneal muscles must pre-contract before heel-to-ground contact. This pre-contraction ensures external ankle stability, and in cases of motor inhibition, it can be significantly delayed in addition to reduced contraction quality. It is therefore important to reprogram the ankle using the Allyane procedure, which will, on the one hand, re-afferent the peroneal muscles, improving both strength and function, and on the other hand, reprogram the sequences of muscle activity between the different stabilizers. The result of Allyane neuromotor reprogramming on chronic ankle instability is often dramatic and immediate. Upon leaving the session, the patient feels their ankle is stable and functional, and in the very short term, chronic pain decreases or even disappears.
It will be enough to maintain the strength of the peroneal muscles in their concentric and eccentric values and to continue to improve the proprioception of our ankle on unstable surfaces and when landing jumps.
Interested in learning more about the Allyane neuromotor reprogramming method and becoming a certified practitioner? Don't hesitate to contact us!