Recurrent Ankle Injury - Lateral Ligament Sprain
Please see my post titled CUBOID SYNDROME as this pattern is very relevant to recurrent ankle injuries. After restoring normal accessory motions, of the foot and ankle as described in CUBOID SYNDROME, it is necessary to reevaluate the integrity of the foot and ankle ligaments. These tests are described in the literature. Prior to moving the client into weight-bearing exercise, I would screen the hip in all directions and then screen the pelvis. I believe that pelvic side-glide restriction is a common compensation for an ankle injury, in which the client reduces weight-bearing on the symptomatic side. Please for example pelvic side-glide fixation . I am not aware of any research that addresses this, but maybe by posting the idea here it can be encouraged. There are some nice studies in the literature addressing hip abductor weakness in response to ankle injuries. I submit that a pelvic side-glide fixation would perpetuate hip abductor weakness and inhibit muscle function. If present, resolving thepelvic side-glide fixation would be a reasonable first step towards restoring hip abductor stength, endurance, firing sequence, etc. As the client moves beyond the acute phase and rehab is appropriate, articles such as the one cited below (abstract) can be useful. The Effect of a 4-Week Comprehensive Rehabilitation Program on Postural Control and Lower Extremity Function in Individuals With Chronic Ankle Instability
Authors: Sheri A. Hale, Lauren C. Olmsted-Kramer, Jay Hertel
STUDY DESIGN: Prospective, randomized controlled trial. OBJECTIVE: To examine the effects of a 4-week rehabilitation program for chronic ankle instability (CAI) on postural control and lower extremity function. BACKGROUND: CAI is associated with residual symptoms, performance deficits, and reinjury. Managing CAI is challenging and more evidence is needed to guide effective treatment. METHODS AND MEASURES: Subjects with unilateral CAI were randomly assigned to the rehabilitation (CAI-rehab, n=16) or control (CAI-control, n=13) group. Subjects without CAI were assigned to a healthy group (n=19). Baseline testing included the (1) center of pressure velocity (COPV), 2) star excursion balance test (SEBT), and 3) Foot and Ankle Disability Index (FADI) and FADI-Sports Subscale (FADI-Sport). The CAI-rehab group completed 4 weeks of rehabilitation that addressed range of motion, strength, neuromuscular control, and functional tasks. After 4 weeks, all subjects were retested. Nonparametric analyses for group differences and between-group comparisons were performed. RESULTS: Subjects with CAI demonstrated deficits in postural control and SEBT reach tasks in the involved limb compared to the uninvolved limb and reported functional deficits on the involved limb compared to healthy subjects. Following rehabilitation, the CAI-rehab group had greater SEBT reach improvements on the involved limb than the other groups and greater improvements in FADI and FADI-Sport scores. CONCLUSIONS: These results demonstrate postural control and functional limitations exist in individuals with CAI. In addition, rehabilitation appears to improve these functional limitations. Finally, there is evidence to suggest the SEBT may be a good functional measure to monitor change after rehabilitation for CAI.
J Orthop Sports Phys Ther. 2007;37(6):303-311, Epub 16 April 2007. doi:10.2519/jospt.2007.2322
Authors: Sheri A. Hale, Lauren C. Olmsted-Kramer, Jay Hertel
STUDY DESIGN: Prospective, randomized controlled trial. OBJECTIVE: To examine the effects of a 4-week rehabilitation program for chronic ankle instability (CAI) on postural control and lower extremity function. BACKGROUND: CAI is associated with residual symptoms, performance deficits, and reinjury. Managing CAI is challenging and more evidence is needed to guide effective treatment. METHODS AND MEASURES: Subjects with unilateral CAI were randomly assigned to the rehabilitation (CAI-rehab, n=16) or control (CAI-control, n=13) group. Subjects without CAI were assigned to a healthy group (n=19). Baseline testing included the (1) center of pressure velocity (COPV), 2) star excursion balance test (SEBT), and 3) Foot and Ankle Disability Index (FADI) and FADI-Sports Subscale (FADI-Sport). The CAI-rehab group completed 4 weeks of rehabilitation that addressed range of motion, strength, neuromuscular control, and functional tasks. After 4 weeks, all subjects were retested. Nonparametric analyses for group differences and between-group comparisons were performed. RESULTS: Subjects with CAI demonstrated deficits in postural control and SEBT reach tasks in the involved limb compared to the uninvolved limb and reported functional deficits on the involved limb compared to healthy subjects. Following rehabilitation, the CAI-rehab group had greater SEBT reach improvements on the involved limb than the other groups and greater improvements in FADI and FADI-Sport scores. CONCLUSIONS: These results demonstrate postural control and functional limitations exist in individuals with CAI. In addition, rehabilitation appears to improve these functional limitations. Finally, there is evidence to suggest the SEBT may be a good functional measure to monitor change after rehabilitation for CAI.
J Orthop Sports Phys Ther. 2007;37(6):303-311, Epub 16 April 2007. doi:10.2519/jospt.2007.2322