• Lionel Pannunzio PT / SCS

Ankle Sprains in Soccer Players


Introduction


Ankle sprains are one of the most common soccer Injury among youth and adult soccer players. In fact, researchers have estimated that ankle injuries account for 10 to 30% of all sports related injuries in young athletes and from 16 to 29% of all soccer specific injuries.

The old belief was these are benign condition that will heal without any treatment. right? well not really. Ankle sprains symptoms can linger for many months and residual instability can last for months and can set you up for a re-injury in the future if you don't treat it properly the 1st time


What is an Ankle Sprain ?





Sprains are injuries to ligaments (the bands of tissue that hold joints together). Ankle sprains occur when the foot twists or turns beyond its normal range of movement, causing the ligaments connecting the bones of the leg, ankle, and foot to overstretch or tear.

The ligaments on the outer (lateral) side of the ankle are the ones most commonly injured. Ligaments on the inner (medial) side of the ankle, or above the ankle bone, can also be sprained, but are injured less frequently.

An ankle sprain usually takes between 2 weeks to 2 months to heal. The ankle will feel better after a few weeks, and be fully strengthened in a few months. A severely sprained ligament, however, can take 9 months to 1 year to heal.

Recurrent ankle sprains are common; once an ankle ligament is sprained, it is often reinjured. In fact, 73% of people who have sprained an ankle once are likely to do so again. Reinjury is especially likely if muscle strength and balance are not fully restored to, or improved beyond, preinjury levels.



How does it feel?


Right after an ankle sprain, you may experience:

  • Pain

  • Swelling

  • Inability to stand or walk on the affected foot

  • Throbbing

  • Stiffness

  • Weakness

  • A feeling of instability in the ankle joint

After most sprains, you feel pain right away at the site of the ligament stretch or tear. Often, the ankle starts to swell immediately and may bruise. The ankle area usually is tender to the touch, and when you move the ankle, it hurts. In more severe sprains, you may hear or feel something tear, along with a "pop" or "snap."




How Is It Diagnosed?


If you see your physical therapist first, the physical therapist will examine your ankle, take your health history, and ask questions such as:

How did you get injured?, Did you feel a pop, snap, or tear?, What activities are you having trouble doing?, What activities do you want to get back to doing?


Your physical therapist will gently press around your ankle to see if it is painful to the touch, and may use additional tests to determine if other parts of your foot are injured. Your physical therapist will test your strength and flexibility, observe how you can move your foot and leg, and watch how you walk.


Depending on how badly a ligament is damaged, or how many ligaments are injured, your ankle sprain may be classified as:

Grade 1 (mild).

The ligament is overstretched.

Grade 2 (moderate).

The ligament is overstretched or partially torn.

Grade 3 (severe). The ligament is completely torn.


Your physical therapist also will test and screen for other, more serious conditions that could be causing the pain and swelling. To provide a definitive diagnosis, your physical therapist may collaborate with an orthopedic physician or other health care provider, who may order further tests, such as an x-ray, to confirm the diagnosis and to rule out other damage to the ankle, including a fracture.



How Can a Physical Therapist Help?


Physical therapists help people with ankle sprains recover more quickly than they would without treatment.

The time it takes to heal an ankle sprain varies, but results can often be achieved in 2 to 8 weeks.

Your physical therapist will work with you to design a specific treatment program that meets your needs and goals.

During the first 24 to 48 hours following your diagnosis, your physical therapist may advise you to:

  • Rest the area by avoiding any activity that causes pain.

  • Apply ice packs to the area for 15 to 20 minutes every 2 hours.

  • Consult with a physician for further services, such as medication or diagnostic tests.

  • Walk on the affected foot as soon, and as much as you are able, without making the pain or swelling worse.

  • Use crutches or other walking aids to help alleviate pain and support balance.

  • Wrap your ankle or use an ankle brace for support and to prevent swelling.

  • These self-treatments will allow you to be as active as possible with the least amount of pain, and will help speed healing. 





Reduce Pain and Swelling. You will learn how to avoid or modify your daily and sports activities to allow healing to begin. Your physical therapist may use different types of treatments and technologies to control and reduce your pain and swelling, including ice, heat, ultrasound, electrical stimulation, taping, specific exercises, and hands-on therapy, such as specialized massage.


Improve Motion. Your physical therapist will choose specific activities and treatments to help restore normal movement in the ankle. These might begin with "passive" motions that the physical therapist performs for you to gently move your ankle and foot, and progress to “active” exercises and stretches that you do yourself.


Improve Flexibility. Your physical therapist will determine if any foot, ankle, or lower leg muscles are tight, begin to stretch them, and teach you how to stretch them.


Improve Strength. Ankle sprains may be related to weak, injured, or uncoordinated leg muscles. Certain exercises will aid healing at each stage of recovery; your physical therapist will choose and teach you the correct exercises and equipment to use, to steadily and safely restore your strength. These may include using cuff weights, stretch bands, and weight-lifting equipment.


Improve Endurance. Regaining your muscular endurance in the ankle and leg is important after an injury. Your physical therapist will teach you exercises to improve endurance, so you can return to your normal activities. Cardio-exercise equipment may be used, such as treadmills or stationary bicycles.


Improve Balance. Regaining your sense of balance is important after an injury. Your physical therapist will teach you exercises to improve your balance ability.


Restore Agility. Speed and accuracy of leg movement is important in athletics and in many daily activities. Your physical therapist will help you regain these skills in preparation for a return to sports and to your daily routine.


Learn a Home Program. Your physical therapist will teach you strengthening and stretching exercises to perform at home. These exercises will be specific for your needs; if you do them as prescribed by your physical therapist, you can speed your recovery.


Return to Activities. Your physical therapist will discuss activity goals with you and use them to set your work, sport, and home-life recovery goals. Your treatment program will help you reach your goals in the safest, fastest, and most effective way possible. Your physical therapist will teach you exercises, work retraining activities, and sport-specific techniques and drills to help you achieve your goals.


Speed Recovery Time. Your physical therapist is trained and experienced in choosing the best treatments and exercises to help you safely heal, return to your normal lifestyle, and reach your goals faster than you are likely to do on your own.




Early Stage Strengthening of Ankle



Seated Ankle Inversion with Anchored Resistance


Begin sitting upright with a resistance band looped around your foot and anchored around a table leg on the same side as your foot.


Rotate your ankle inward, pulling against the resistance, then slowly return to the starting position and repeat.


Make sure to keep your foot parallel to the floor and try to keep the rest of your leg still during the exercise.




Seated Ankle Eversion with Resistance Band


Begin sitting in an upright position with a resistance loop around both feet flat on the ground.


Lift your feet up, keeping your heels on the ground, then rotate them outward as far as is comfortable, pulling on the resistance band.


Slowly bring your feet back to the starting position and repeat.


Try to keep the knee in position and your legs relaxed and focus the movement on your ankles.




Late Stage Rehabilitation - Balance Training


A combination of strengthening and balance exercises are necessary to restore the Ankle and Foot’s Functions.


Side to Side Balance Re-training:


Most Ankle Sprains occur with the ankle rolling out.


Deviating the ankle in that direction will activate the safety mechanisms to prevent another sprain and fight all the muscle inhibitions post-injury.




Ankle Frontal and Lateral Landing on Bosu


These Bosu landing exercises will challenge the injured ankle to quick react and prevent rolling in or out.


Set up


Stand up in front or the side of a Bosu, be sure the Bosu will not slide on the floor.

Do a quick soft jump to the Bosu aiming for the center ( where the Logo is ) and try to balance your body on the injured foot.


Then slowly get down from Bosu and repeat.


As you get better and you are able to control the balance for 3-4 seconds immediately after landing, separate a little bit more from the Bosu for a longer jump.


Eventually you can create a short run and land in the same way





Conclusion:

  • There is no simple ankle sprain. Eventually if you don't recover properly from this injury it can cause not only chronic ankle pain and reinsures but also knee or hip problems down the road.

  • Rehabilitation must include strengthening and balance exercises like the one shown above.

  • Challenging the ankle in the directions of the injury is necessary to prevent a new injury

Lionel Pannunzio is a Physical Therapist Certified in Sports Injuries. With more than 20 years of experience helping athletes return to their sports after an injury. He is the Owner of White Bay Sports Physical Therapy and Fitness, conveniently located in the beautiful City of Weston, where he treats Soccer Player, Runners and Athletes of all ages

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Lionel Pannunzio

Physical Therapist



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