Why Rest for Ankle Sprains Can Lead to Chronic Instability
Ankle sprains are extremely common in almost every sport. The common thought process is, “it’s just a sprain, I’ll be fine in a few days.” Unfortunately, up to 40% of people develop chronic ankle instability after their first ankle sprain. Chronic ankle instability is a condition that presents with repeated “giving way,” weakness, repeat ankle sprains, and pain (Mugno & Constant, 2023). This post will dive into why some sprains don’t just “go away.” Unfortunately, the answer is complex.
So, what causes chronic ankle instability?
It’s usually not the first ankle sprain! Chronic ankle instability comes into play with repeat ankle sprains. Things in life happen, we can’t prevent every single ankle sprain. However, it is crucial to work to address the sprain appropriately in order to prevent repeat injury or decline in function.
Proprioception - Where You Are In Space
Ligaments connect one bone to another and provide stability. When you sprain your ankle laterally, you stretch the ligaments on the outside of your ankle. In particular, the anterior talofibular ligament (ATFL) is the most commonly injured ligament for lateral ankle sprains. Most people aren’t tearing their ATFL on the first ankle sprain. However, when the ligament and joint capsule are overstretched, it has a massive effect on proprioception.
Proprioception is your body’s ability to know where you are in space. Think about it like your body’s internal GPS system gets altered, which impacts your ability to react quickly with unpredictable terrain or load. Studies show that those with chronic ankle instability consistently present with proprioception deficits (Mugno & Constant, 2023). A lack of proprioception predisposes someone to balance impairments and increased likelihood of repeat ankle sprains.
How to help?
Work on some proprioception exercises such as single leg balance, balance on a foam pad, or single leg strength exercises. There is more to it than this, but it’s a good start!
Ankle Range of Motion
After an ankle sprain, swelling and pain can often limit movement and range of motion. While this may not seem like a big deal, a lack of range of motion can become a big problem if it persists after swelling decreases. Research shows that a large predictor of ankle sprains and repeat ankle sprains is a lack of dorsiflexion range of motion, “flexing your foot upward” (Almansoof et al., 2023).
It’s crucial to be able to move your knee over your toes for walking, running, jumping, etc. When the ankle cannot do that, it’s going to find other ways to compensate. You may find yourself using your hip or knee to “get by.” Unfortunately, this is going to place the ankle to vulnerable positions and increase your likelihood of rolling it again. Additionally, a limited range of motion changes how we absorb force. The stress can be transferred into ligaments that are already trying to heal.
How to help?
Unfortunately, this isn’t always a simple fix. Stretching of the ankle and calf are a GREAT place to start. However, the talocrural joint itself often becomes stiff after an ankle sprain and requires a bit more of a hands on approach in order to help the joint glide more. If you find that your basic stretches aren’t working or you are experiencing pain at the front of the ankle joint, it’s important to reach out to a trusted physical therapist.
Strength
When things hurt, our first reaction is often to rest. While active and modified rest is often appropriate, problems begin when we do this for too long and start to lose strength. No strength = big problems, fast. This can lead to repeat ankle sprains, pain, and issues elsewhere.
How to help?
Find ways to still do strength! Seated calf raises and banded ankle strength aren't going to fix chronic ankle instability, but can be a great starting place if you just rolled your ankle and pain is a big factor.
