Recurrent Ankle Sprains and Ligament Laxity

My approach to treating ankle sprains has changed dramatically since I began working with athletes in the late 1990s.  The PRICE (protection, rest, ice, compression, and elevation) approach has been replaced with a clinically superior movement approach designed to reduce pain and facilitate a return to an exercise program.  The PRICE approach was effective to control the inflammatory and pain processes but did little to reduce the recurrence of ankle injuries.  Research reports up to 70% of individuals who sustain an ankle sprain will have limited function and symptoms up to 6 months after their injury.  When these athletes would return to clinic with a subsequent ankle sprain the trend was to blame this recurrence on the loss of ligament strength secondary to the initial sprain.  This commonly held belief is being challenged by the most recent research on individuals with recurrent ankle sprains.

A recent article on 200 division I collegiate athletes examined the relationship between ligament laxity in the athlete's ankle and a history of ankle sprains (Liu et al. Clin J Sp Med. 2013).  The authors measured ankle displacement and movement to passive forces on an ankle arthrometer.  They reported no relationship between ligament laxity and the number of ankle sprains the athletes sustained.   Although some studies have linked laxity with recurrent sprains (Brown et al. 2015) this study and others indicate more factors are at play in these athletes other than ligament laxity.  

Our body regions gain stability through three areas:

1: Passive structures: joint anatomy, ligaments and other passive supports

2: Active structures: muscles and tendons

3: Neuromuscular structures: communication between the nervous system and the muscles noted in balance and proprioception

Depending on the severity of the injury, an injured ankle likely has an initial reduction in all 3 areas of stability.  An athlete who can "cope" with an ankle sprain and return to full sport activity likely is able to compensate when one of area of stability is compromised.  Unfortunately, many of these athletes with chronic complains demonstrate continued to loss of strength and balance in the lower quarter.  Interestingly, it is common to find bilateral balance impairments among individuals who have sustained a one sided ankle injury (Evans et al. 2004).  Impairments on the non involved side indicate impairments may have a central component due to changes the ability of the central nervous system to control posture on unstable or unpredictable surfaces.   It is currently not known if these changes were a cause or effect of the ankle sprain, but not rehabilitating the muscular and neuromuscular systems likely places the athletes at greater risk.

To reduce your risk of future injury after an ankle sprain work with a Physical Therapist to reduce lower quarter impairments and rehabilitate your proprioceptive control.