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The Importance of Treating Ankle Sprains to Prevent Further Injury

Did you know that an ankle sprain can increase your risk for other injuries, including injuries of the knee, hip, and low back? A recent study published in the American College of Sports Medicine (ASCM) journal Medicine & Science Sport & Exercise showed that one in five individuals that sought care for an ankle sprain experienced an injury to the knee, hip, or lower back within the following year. The study found that targeted therapeutic exercises for the initial ankle sprain reduced the likelihood of an additional injury and should be considered for all individuals after ankle sprain as they return to work or sport. Ankle sprains are one of the most common sports injuries sustained in active individuals and studies have found that they can initially seem like a minor or self-limited injury, but only 60% of people will have resolution of their ankle instability in the first year. The remaining 40% of individuals go on to develop chronic ankle instability. That’s a condition characterized by persistent or perceived giving way in the ankle that can limit function beyond the year after the injury.  Ankle instability is a complex condition in that it results in both mechanical and sometimes neurophysiologic impairments. Specifically, an ankle sprain injury can lead to increased ankle and midfoot instability and decreased sensation to the ankle and foot affecting both sensation and balance. Ankle sprains can also result in altered foot position during walking, running, and jumping landing activity.  All these impairments can result in vulnerabilities to the lower half of the body that make it more susceptible to injury.  Individuals with chronic ankle instability have been found to have mechanical and physiological impairments that affect sport specific activities, like running, jumping, cutting, twisting, and turning. Most patients who had an ankle sprain are not provided with supervised rehabilitation afterwards, despite evidence that rehabilitation has been shown to improve short and long-term symptoms and function. 


            This study published in the ACSM journal looked at military health system and individuals who sought care for ankle sprains.  They looked at over 30,000 individuals who met the study criteria and of that group just over 20% were diagnosed with an injury affecting the knee, hip, or lower back within the first year after their ankle sprain. These individuals were more likely to experience a knee or low back injury over a hip injury. Approximately 25% of the study group received therapeutic exercises after their ankle sprain, which resulted in a much lower likelihood for secondary injuries. Immediately after an ankle sprain, individuals typically have limited ankle mobility, decreased muscle strength, slower walking speeds, and altered landing strategies.  Long-term after an ankle sprain individuals continue to have altered movement capabilities. These altered neuromuscular and movement strategies can lead to a secondary knee or low back injury. While knee and low back injuries are common in military settings, therapeutic exercise can be an effective intervention to restore adequate ankle function and re-balance any alterations and gait and balance mechanics after an ankle injury.


            What all this means is that if you have sustained an ankle sprain, it is important to see your sports medicine physician because while many ankle sprains are considered minor or self-limiting, there is a high enough percentage of individuals who will go on to injure their knee, hip, or lower back after the ankle sprain within a short period of time. These secondary injuries could be prevented with accurate diagnosis and treatment recommendations, including therapeutic exercises. These therapeutic exercises may have a protective effect on sustaining additional injuries. Additionally, associated fractures with the initial ankle sprain increased the odds of sustaining a subsequent hip or low back injury. Females also had a higher risk of sustaining a subsequent injury to the hip or low back, whereas males are more likely to sustain a subsequent knee injury. When an individual received appropriate therapeutic exercises after the ankle sprain, their likelihood of a subsequent proximal injury, decreased significantly.


            If you have sustained an ankle sprain injury, schedule an appointment to discuss treatment options to speed along your recovery and help reduce additional injury.  At Sports Health Northwest, we want to help you recover from that injury, and reduce your risk of any additional injuries. We are here to help you get back to your sports, school, and work activity as safely and quickly as possible. 


Dr Westerdahl David Westerdahl MD FAAFP RMSK Sports Medicine Physician and owner Sports Health Northwest, Inc.

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