Mousa Dembélé is a professional midfield footballer who plays for Belgian and Tottenham Hotspur Football Club. On 3rd November playing against Wolverhampton Wanders Dembélé sustained a lateral ankle sprain.
What is a lateral ankle sprain?
The outside of the ankle is comprised of three ligaments which are strong connective tissue that stabilises the ankle joint. Lateral ankle sprain is one of the most common sporting injuries and is frequently re-injured. Lateral ankle sprains commonly occur when the ankle rolls inwards under body weight, which can stretch or in worst cases rupture the ligaments to the outside of the ankle. With lateral ankle sprains the surrounding tendons, muscles and nerves may also be damaged.
What are the symptoms of a lateral ankle sprain?
When suffering with a lateral ankle sprain there will be a lot of pain around the outside of the ankle joint and there may be pain when walking. There may also be swelling or bruising to the ankle, which can present immediately or up to 48 hours post injury; the amount depends on how severe the sprain is, with some cases not having any swelling/bruising at all.
What is the healing process?
The ligament healing process follows a specific order of events, this is the same for any ligament in the body. It starts with the acute inflammatory phase, then regeneration phase and finally the tissue remodelling phase. Depending on injury severity the process can take anywhere from weeks to many months. It is also important to note; the ligament may not reach its previous level of tensile strength.
How can this be treated at Mike Varney Physiotherapy?
Your therapist will take a detailed history of your symptoms then perform a physical examination, which will determine the severity and grade of the ankle sprain. Severity can range anywhere from minimal tearing of the ligament’s collagen fibres (grade 1), moderate-significant tearing of ligament fibres (grade 2) or complete rupture of ligament fibres (grade 3). These grading’s will also determine the amount of sessions that will be needed for treatment. In some cases, imaging may be necessary to determine the grade of the sprain.
At the clinic we provide a comprehensive treatment program for lateral ankle sprain. This includes advice, activity modification and treatments including POLICE (Protect, Optimal Loading (maintaining as much joint strength and range of motion without further damage), Ice, Compression and Elevation), deep tissue massage, acupuncture, electrotherapy and Kinesio taping. Your therapist will also prescribe a home exercise programme to complete in between sessions which can aid in recovery and returning to elite sport. The treatment plan for a lateral ankle sprain is:
Stage 1: initial care
Immediately following injury the primary focus is to reducing pain and swelling at the ankle, which can be done with the POLICE protocol.
Depending on the player’s ability to put weight through the ankle they will either off-load the ankle completely using crutches (non-weight bearing), partially weight bear to help reduce the pain and swelling or they may be able to completely weight bear.
Stage 2: range of motion (ROM)
When pain allows, ROM exercises can begin without load. These movements will address all directions available at the ankle to make sure the injured ankle regains full movement and is equal to the good side.
Important stretching exercises and joint mobilisations can be provided by a therapists in session to decrease pain and increase ROM.
Stage 3: strength
Early strengthening exercises can begin with isometrics, which is muscle activation without moving the joint through its range of motion. Progressions can be made to the same exercise or with increasingly demanding exercises.
A specialised form of exercises known as proprioceptive exercises are required after an injury in order to activate muscles involved in joint stability. These exercises help to reduce the demand on the ligaments and the risk of the injury reoccurring. Simple examples of proprioceptive exercises include balancing on one leg.
Endurance activities can begin in this stage including exercise bike, swimming and walking to maintain levels of fitness.
Stage 4: functional – re-introducing sports specific activities
This is slowly re-introducing the player to sports specific training through a graduated return to play program. For Dembélé, this will include passing drills, agility work and slowly working back into game environments first without, then with contact from other players. It is important the player passes these tests before going back into a full game situation.
We also carry out regular testing with recognised outcome measures to assess how the recovery is going and whether the player is ready to progress.
If you are suffering with a lateral ankle sprain give us a call on 01279 414 959 to book an appointment today!