What Causes Chronic Ankle Instability?
People who have a sprained their ankle may develop chronic (long-lasting) ankle instability. It is considered to be chronic if the ankle joint still gives way too easily six months after the first sprain, or if the ankle is sprained again within six months of the first sprain. One quarter of all sporting injuries are ankle related, and 85% of the time these are lateral ligament complex problems.
This kind of instability can develop if the ankle ligaments are overstretched or torn, and heal too loosely (mechanical instability). The interactions between the bones in the ankle and the surrounding ligaments and muscles may be disrupted too. The body has an unconscious awareness of movement and spatial orientation within the body, known as proprioception. This helps to coordinate the movements of the joints by using unconscious reflexes to stabilize them and keep the body balanced. So if an ankle feels permanently unstable, this might not only be caused by overstretched ligaments, but also by a problem with proprioception or resulting problems with muscle coordination.
Chronic Ankle Instability Treatment Options
There are a few different treatment options for chronic ankle instability. At first “functional treatment” is tried, involving physiotherapy to strengthen the joint, and possibly wearing an ankle brace or rigid tape to stabilize it.
One common approach is called neuromuscular training. The aim is to improve the stability, strength and coordination of the ankle. Studies show that neuromuscular training can speed up the healing process of ankle stability and mobility in the first few weeks. But there is not enough research to be able to say what effects this treatment has in the long term.
If the joint remains unstable despite training because the ligaments are too loose, surgery may be considered. One option is to shorten and tighten the ankle ligaments. This is not a very common approach and is usually utilized when all other avenues have been exhausted.
Chronic Ankle Instability Surgery Recovery & Rehab
Getting back to sport after surgery
Ankle instability often leads to problems with muscle coordination. For this reason, ankle exercises are a very important part of rehabilitation after surgery. Wearing an ankle brace during this time may also help. Braces not only support the joint from the outside – the pressure will also help you develop a good sense of muscle coordination again.
People probably benefit from starting movement, strength and coordination exercises two to three weeks after surgery at the latest. Studies suggest that people who do this become active again sooner than those who wear an ankle brace for six weeks and do not do any exercises during that time. In the studies, the participants who started doing exercises and strength training earlier were able to go back to work about one to two weeks sooner. They were also able to do sports again about three weeks earlier. But after about two years no advantages could be seen anymore: the stability and mobility of the affected ankle were the same in both groups.
Physiotherapy Vs surgery?
There were no studies comparing surgery directly with physiotherapy or other treatments. For this reason, it is not possible to say who might benefit most from surgery or how effective it is compared with non-surgical (conservative) treatment.
It is also not clear how the different surgical procedures compare with one another. There are only few small trials on this, and they do not provide reliable results. More research is needed to be able to answer this question.
Overall, it is currently not clear whether surgery leads to a faster recovery than strength and coordination training does. But if the ankle remains unstable because of loose ligaments, surgery might be an option. Whichever treatment you go for: with a little patience, sprained ankles usually become stable again.
If you are suffering from an ankle injury and are looking for a Sydney CBD physio contact the team at Sydney Physio Solutions who can help you get back on your feet again.