High Ankle Sprain Rehabilitation
A high ankle sprain is an injury to the ligaments connecting the tibia and fibula. These ligaments include: the anterior-inferior tibiofibular ligament (AITFL), the interosseous membrane, and the posterior-inferior tibiofibular ligament (PITFL). Of all the ligaments in the tibiofibular joint, the AITFL is the most commonly injured.
High Ankle Sprain Injury
The mechanism of injury for a high ankle sprain is forced dorsiflexion and external rotation of the ankle. This type of injury is more common in contact sports, such as football, basketball, soccer, or hockey, but can occur in any population. The athlete usually has their foot planted when there is a valgus strain on the knee or a quick pivot on a planted foot causing dorsiflexion and external rotation of the ankle. This forceful movement wedges the talus bone between the tibia and fibula bone leading to injury of the tibiofibular ligaments.
The concern with high ankle sprains is the risk of fracture or instability. Since the ligaments of the tibiofibular joint are very strong, the force needed to damage these ligaments may have also caused a fracture to the tibia or fibula. Injury to the tibiofibular ligaments can also lead to instability of the tibiofibular joint.
Currently there are no established rehabilitation programs published for the treatment of high ankle sprains. Initially treatment of a high ankle sprain is similar to an inversion sprain, but eventually the emphasis of treatment is on strengthening the plantarflexors and internal rotators of the ankle.
Rehabilitation for high ankle sprains can begin with isometric contractions of the muscles around the ankle. Dorsiflexion and plantarflexion isometric in neutral are often better tolerated initially compared to inversion and eversion. These isometric exercises can then gradually be progressed to the standard banded strengthening exercises (dorsiflexion, plantarflexion, inversion, and eversion).
Once tolerated, the exercises can be progressed to those specifically involved with high ankle sprains. These exercises are focused on strengthening the plantarflexors and internal rotators of the ankle. Another way of thinking of this would be to strengthen the muscles that control dorsiflexion and external rotation of the ankle.
Exercises for a High Ankle Sprain
Initial exercises can use an exercise band around the ankle to resist dorsiflexion and external rotation of the ankle. An exercise progression can begin with a quadruped hip rotation with the band around the foot. Next a leg swing and then a toe tap exercise, both with an exercise band anchored around the ankle. The movements should begin slow and gradually increase the speed of movement.
These movements can then progress to more dynamic and functional movements. Chops and lifts with the injured ankle on a slant board can be used to strengthen the ankle in a similar position. A resisted lateral shuffle with an exercise band anchored around the foot can also strengthen the ankle in positions that will likely be experienced on field.
High ankle sprains are a common injury in contact sports. The ankle is forced into dorsiflexion and lateral rotation which causes an injury to the ligaments of the tibiofibular joint. The rehabilitation program should focus on strengthening the muscles around the ankle, especially the muscles that control dorsiflexion and external rotation of the ankle.
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