Ankle Sprains: Can they be prevented?
Henry Candelaria, BPHE, CSCS, ART®
For those of you who enjoy basketball, volleyball, tennis, squash, soccer, or any activity that involves a high amount of lateral movement, you can appreciate the pain and disability experienced from an ankle sprain. You have either experienced it yourself, or have watched a fellow health enthusiast suffer through the process. Once you have sprained your ankle, you are always at a higher risk for spraining it again. That is, if nothing is done about it. On many occasions, a recreational athlete will suffer an ankle sprain during game play and will continue playing despite swelling and pain.
These are obvious signs of damage to muscles and ligaments that help stabilize the joint. After the game, often times the PRICE protocol is applied:
P – protect the injured area (i.e. STOP PLAYING!)
R – rest the injured area (i.e. STOP PLAYING!)
I – ice is applied at 10-15 minute intervals over an hour period to reduce swelling and pain
C – compression of the involved area is applied via a tensor bandage (the tensor bandage is applied from a relatively distal point to the injury, moving proximal towards the body to reduce swelling and pooling of inflammatory fluids)
E – elevation of the injured joint above the level of the heart is maintained to promote adequate lymphatic drainage
However, this protocol is often times not followed and, when it is implemented, the duration is usually only for the first few days following the injury. As a result, ligament and muscle tissue is not given the proper environment to promote adequate healing, and proprioceptive (the sense of your body position in space) input from that joint remains altered. Depending on the extent of injury, the athlete often experiences only mild pain after a few days, and therefore feels that she/he is ready to return to regular play. But is this really the case? Are they ready to return without adequate rehab, and what I call pre-hab, that is preventative care?
It is thought that ankle sprains often occur partly due to altered proprioceptive input from the ankle joint. There are three main systems that provide you with a sense of your body positioning in space: your eyes, your ears, and the ligaments and muscles that are associated with the various joints of your body, particularly those of your ankle joint. This system lets you know how far to reach for that bottle of water, the degree of incline of the treadmill, and the orientation of your body relative to the ground while your diving for that stray squash ball. These are all things that you do not have to think about, but happen ‘behind the scenes’. If one of these systems is altered due to injury, then the body has to rely on the remaining two systems to ensure proper positioning and correct orientation of your limbs so that you can function optimally. However, when your body is under extra stress and has higher demands from its regulatory systems, as in when you participate in physical activity, the stress may be too much for the handicapped proprioceptive system and as a result, injury occurs, either a new injury, but often a re-aggravation of an old, improperly treated injury.
So how can this be prevented? Well, simply by ensuring that your workout routine has a component to it that stresses the proprioceptive input to your body, you are reducing the risk of injury to this system. ‘Wobble boards®’, ‘dynadiscs®’, and Bosu® balls are all very popular pieces of equipment to use when training balance and proprioception. Recently, a study by McGuine and Keene (2006) showed that the use of this type of equipment, in combination with functional exercises specific to the sport of basketball, reduced the risk of ankle sprains in high school female basketball players by 50%. However, it is important to keep in mind that these exercises are high risk exercises and should not be done without proper introduction, supervision, and progression. Because the surface that you are standing on while performing these exercises is not stabile, the risk of ankle and knee injuries are high. It is not recommended to start this type of program without first consulting a fitness or health professional.
So, if you have a history of ankle sprains, are at risk of experiencing one because of the sport you enjoy, or are just interested in learning more about this type of training, let your trainer know that you would like to incorporate proprioceptive exercises into your workout program, or you can contact me at the email found on my profile link from Yuri’s website, http://www.totalwellnessconsulting.ca/meet_henry_candelaria.htm for more information.
Fu, ASN and Hui-Chan CWY. (2005). Ankle Joint Proprioception and Postural Control in Basketball Players With Bilateral Ankle Sprains. Am J Sports Med. 33(8):1174.
McGuine TA and Keene JS. (2006). The Effect of a Balance Training Program on the Risk of Ankle Sprains in High School Athletes. Am J Sports Med. 34(7):1103.
Copyright © 2006 Henry Candelaria, BPHE, CSCS, ART®