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.2002 Dec;37(4):413-429.

Rehabilitation of the Ankle After Acute Sprain or Chronic Instability

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Rehabilitation of the Ankle After Acute Sprain or Chronic Instability

Carl G Mattacola et al. J Athl Train.2002 Dec.

Abstract

OBJECTIVE: To outline rehabilitation concepts that are applicable to acute and chronic injury of the ankle, to provide evidence for current techniques used in the rehabilitation of the ankle, and to describe a functional rehabilitation program that progresses from basic to advanced, while taking into consideration empirical data from the literature and clinical practice. BACKGROUND: Important considerations in the rehabilitation of ankle injuries include controlling the acute inflammatory process, regaining full ankle range of motion, increasing muscle strength and power, and improving proprioceptive abilities. These goals can be achieved through various modalities, flexibility exercises, and progressive strength- and balance-training exercises. In this article, we discuss the deleterious effects of ankle injury on ankle-joint proprioception and muscular strength and how these variables can be quantifiably measured to follow progress through a rehabilitation program. Evidence to support the effectiveness of applying orthotics and ankle braces during the acute and subacute phases of ankle rehabilitation is provided, along with recommendations for functional rehabilitation of ankle injuries, including a structured progression of exercises. RECOMMENDATIONS: Early functional rehabilitation of the ankle should include range-of-motion exercises and isometric and isotonic strength-training exercises. In the intermediate stage of rehabilitation, a progression of proprioception-training exercises should be incorporated. Advanced rehabilitation should focus on sport-specific activities to prepare the athlete for return to competition. Although it is important to individualize each rehabilitation program, this well-structured template for ankle rehabilitation can be adapted as needed.

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Figures

Figure 1
Figure 1
Three grades of an ankle injury. A, The grade I sprain is characterized by stretching of the anterior talofibular and calcaneofibular ligaments. B, In the grade II sprain, the anterior talofibular ligament tears partially, and the calcaneofibular ligament stretches. C, The grade III sprain is characterized by rupture of the anterior talofibular and calcaneofibular ligaments, with partial tearing of the posterior talofibular and tibiofibular ligaments.
Figure 2
Figure 2
Phases of wound healing. Reprinted with permission.
Figure 3
Figure 3
Use of external ankle support to provide stability and sensorimotor feedback during exercise (DJ Orthopaedics, Vista, CA).
Figure 4
Figure 4
Achilles stretching, A, weight bearing, and B, nonweight bearing.
Figure 5
Figure 5
Clinician-assisted manual resistance performed in pain-free range of motion. A, plantar flexion and dorsiflexion, B, eversion, and C, inversion.
Figure 6
Figure 6
Manually applied perturbation into inversion and plantar flexion. Athlete is asked to quickly and forcefully resist the perturbation, and move the ankle into dorsiflexion and eversion.
Figure 7
Figure 7
Walking on the heel, A, and toes, B, for assessment of ability to bear weight and maintain balance. This can be used as a gross measure of functional status and as an intermediate rehabilitation exercise.
Figure 8
Figure 8
Balance exercises can be performed on different surfaces, A and B, and with eyes open or closed, C, and can be progressed to active movements that invoke perturbations while maintaining balance, D, and perturbations invoked externally, E.
Figure 9
Figure 9
A and B, Advanced balance and functional exercise with internal provoked perturbations while performing dynamic activities.
Figure 10
Figure 10
Exercise in water reduces compressive forces and supports injured tissue. A and B, Exercises can be initiated without resistance and then progressed, C, to resistance until D, functional exercises can be performed.
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References

    1. Andrews J R, Harrelson G L, Wilk K E. 2nd ed WB Saunders; Philadelphia, PA: 1998. Physical Rehabilitation of the Injured Athlete.
    1. Andriacchi T, Sabiston P, DeHaven K, et al. Ligament: injury and repair. In: Woo S L, Buckwalter J A, editors. Injury and Repair of the Musculoskeletal Soft Tissues. American Academy of Orthopaedic Surgeons; Park Ridge, IL: 1987. pp. 103–128.
    1. Martinez-Hernandez A, Amenta P S. Basic concepts in wound healing: clinical and basic science concepts. In: Leadbetter W B, Buckwalter J A, Gordon S L, editors. Sports-Induced Inflammation. American Academy of Orthopaedic Surgeons; Park Ridge, IL: 1990. pp. 55–102.
    1. Kegerreis S. The construction and implementation of functional progression as a component of athletic rehabilitation. J Orthop Sports Phys Ther. 1983;5:14–19. - PubMed
    1. Konradsen L, Olesen S, Hansen H M. Ankle sensorimotor control and eversion strength after acute ankle inversion injuries. Am J Sports Med. 1998;26:72–77. - PubMed

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