Rehabilitation of the Ankle After Acute Sprain or Chronic Instability

ankle sprain

Rehabilitation of athletic injuries requires the prescription of sport-specific exercise and activities that challenge the recovering tendons, ligaments, bones, and muscle fibers without overstressing them. The goal of rehabilitation is to return an athlete to the same or higher level of competition as before the injury. Rehabilitation must take into consideration normal tissue size, flexibility, muscular strength, power, and endurance. Control of swelling and effusion must be accomplished with frequent application of external pressure, modalities such as cryotherapy, and active range of motion (ROM). The effectiveness of the rehabilitation program after injury or surgery often determines the success of future function and athletic performance. An understanding of the body’s response to injury is paramount to designing a rehabilitation approach. Ligamentous and soft tissue injury results in biochemical changes similar to those seen after an injury.

Injury results in bleeding and damage to tissue, which produces pain. After the initial insult, the inflammatory response is initiated, followed by the proliferative phase and the maturation phase.

Stress to collagen fibers results in fiber orientation along these specific lines of stress. Specifically, rehabilitation during days 1 through 5 should focus on protection of the injured tissue, then supervised and protected stress may be applied from days 6 to 42. The goal of athletic rehabilitation is to return the athlete to participation as quickly as possible, while allowing the injured tissue to heal without compromising it by further injury. The following goals are important for any rehabilitation program: decreased swelling, pain, and initial inflammatory response and protection of the joint so that a secondary inflammatory response does not develop from overly aggressive rehabilitation. Similarly, ROM, muscular strength, power, and endurance must be returned to preinjury levels so that full, asymptomatic functional activities may be performed to the preinjury level and beyond.

The application of specific functional exercises is important to stress the healing tissue. The specific adaptation to imposed demand (SAID) principle is helpful when designing functional progression. The activities and stresses placed on the tissue must be specific to those of the activities at hand. Nonetheless, development of the higher levels of the rehabilitation spectrum must incorporate a working knowledge of the specific activity. If the athletic trainer’s knowledge of the specific activity is vague, incorporating the aid of a member of the coaching staff often results in a welcome collaboration and improved therapy. Chronic instability (CAI) is thought to be the result of neural (proprioception, reflexes, muscular reaction time), muscular (strength, power, and endurance), and mechanical mechanisms (ligamentous laxity).

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