In previous articles here, we discussed how ankle sprains can affect balance, walking and drop jumps. Other articles I wrote about ankle sprain epidemiology including reinjury rates and associated complications.
Now let’s turn to how ankle sprains affect running. If you are a runner experiencing pain, instability and dysfunction after an ankle sprain, this article should help you better understand how to treat ankle sprain and how ankle sprains affect running mechanics.
To summarize how walking is affected with chronic ankle instability due to ankle sprains:
- Changes in muscle function of the affected limb (ankle and hip)
- Change in perception of where the limb is being held in space (the ankle is held in slightly more inversion)
- Changes in ankle position and quality of movement when the foot comes into contact with the ground
- Changes in placement of body weight when foot is in contact with the ground (closer to the heel and inside of the foot)
- Change in timing of foot contact (foot is in a position of relative instability at time of contact)
The research we will discuss in this article focuses on 24 college aged athletes with a history of chronic ankle instability (CAI). Chronic ankle instability is classified as 1) History of significant ankle sprain 2) 2+ episodes of giving way in the past 6 months 3) Sensation of an unstable ankle. The runners were experienced, having run at least 20 miles/week for the past year. The runners with CAI were compared to a group of runners that did not have CAI. In this way, it could be determined what the difference between these two groups were.
Recent polls of collegiate and high school athletes suggest that about 25% experience CAI. Due to the high rate of reinjury and resulting dysfunction including time off from sport, specifically field sports such as soccer & football, studying the effects of CAI on running mechanics can help physical therapists improve outcomes for athletes. Our goal with physical therapy is to get athletes with ankle sprains back on the field at optimal performance and reduced injury risk. The literature suggests that between 40-70% of athletes will experience a second ankle sprain.
In this study, runners were placed on a treadmill and ground reaction forces were measured. The results demonstrate that peak forces and rate of loading (how fast the forefoot came into contact with the ground after heel strike) were significantly different between the runners in CAI group and non-CAI group. In effect, the runners experiencing CAI landed with a “stiffer” foot and ankle.
How do ankle sprains affect risk of injury?
When an athlete experiences CAI, it seems to be that there is a significant change in movement patterns. These compensatory movement patterns place greater stress on the ankle joint and muscles. Previous research demonstrates poor muscle function of the ankle and hip muscles. This can be driven by attempts to avoid pain, or may be a subconscious adaptation to dysfunctional muscles.
What does this mean for you, the athlete with the ankle sprain?
- Higher loading rates (more force) may result in increased risk of early degenerative changes of the cartilage. The joint needs time to heal to restore and repair any small injury that may have happened during exercise.When the joint is excessively stressed, the repair process is interrupted and the tissue fails to heal properly. Over time, this can result in irreparable injury, causing pain and dysfunction.
- Faster loading of the foot on the ground means that other body parts have to compensate to accommodate for a change in “normal” movement patterns. Over time, this may alter how the joint functions at the knee, hip and lower back, potentially causing further pain and dysfunction at these joint.
Post-traumatic osteoarthritis may develop in the affected ankle as well. This is characterized by early degeneration of joint cartilage due to the high velocity trauma (acute), in addition to altered joint movement after the injury (chronic, repetitive). Because ankle sprains occur most often in youth and adolescent athletes, this may cause painful walking and participation in sports later on in life. Of all post-traumatic osteoarthritis cases of the ankle, 80% could be attributed to an ankle sprain earlier in life.
Can my running mechanics improve with training?
Absolutely! Specifically designed programs can “rewire” the brain and body to perform more efficiently. Progressively challenging exercises in a controlled environment can significantly improve confidence and facilitate quality movement for a safe return to sport.
Injury prevention programs have successfully reduced lower limb injury by up to 80%. Given that 74% of athletes experience a repeat ankle injury of the same ankle, an 80% reduction could make or break an athletes career.
A well-structured and progressive balance and strength training program can help bring you one step closer to the field.
If you are an athlete experiencing dysfunction due to an ankle sprain, we can help you recover and return to sport without medication and without surgery.
Give our office a call so we can help you get back to being an athlete!