Physiotherapy   [back to the Category]

Chronic ankle sprain   [read the french version]

Author :   Errol Toran, D.C

This case en pointe concerns and Asian dance and fashion design student who presented with chronic ankle sprain. The most recent injury occurred while she was inline skating. When she presented to the office a month later, the swelling had diminished and there was no longer any obvious bruising. There was still significant pain when the outside of the ankle was pressed. The most severe problem was a 40% reduction in the range of motion. The reduced range of motion caused her to limp. The limp aggravated her lower back and neck. When we examined the neck we found that the orientation of the neck bones was distorted. Apparently the once stable neck, was destabilized after a month of limping. Her neck presented with moderate pain while she studied.

We put her on a plan of mobilization and electric muscle stimulation. The muscular stimulation was needed for relaxing the musculature of the neck and reducing the pain in her foot. The mobilization was needed to both re orient the neck bones and un lock the ankle joint. The first time we worked on the ankle, it released with a loud pop and instantly regained much of the lost mobility. We worked on the neck and ankle for about two weeks and then started her on a program of rehabilitation.

We used a specific ankle strengthening program. We isolated the ankle motion into the six basic component movements. These movements isolate and strengthen the weakened muscles. As is common in these types of injuries, the movements that control winging of the foot on the injured side were the weakest. This weakness is the cause of the chronic injury because the weakness allows the foot to roll over the outside of the foot. The goal of the therapy was to strengthen all the muscles around the ankle, and so re stabilize the ankle.

We find that dancers often injure their feet in this manner. The demands of jumping and the increased flexibility of the dancer's ankle leave the ankle vulnerable these jamming type injuries. Landing hard or on hard floors can jam the heel into the shin bones. Dancers on pointe tend to jam the bones just above the toe box. They are also more prone to sheering the joint where the ankle and foot meet.

The best treatment is prevention. The stronger the muscles of the ankle, the less likely the joints are to disorient. A simple program of strengthening can mean the difference between chronic injury and high performance.