Understanding and Treating Lateral Ankle Sprains and their Consequences

Abstract

Lateral ankle sprains are a common consequence of physical activity. If not managed appropriately, a cascade of negative alterations to both the joint structure and a person's movement patterns continue to stress the injured ligaments. These alterations result in an individual entering a continuum of disability as evidenced by the ~30 % of ankle sprains that develop into chronic ankle instability (CAI) and up to 78 % of CAI cases that develop into post-traumatic ankle osteoarthritis (OA). Despite this knowledge, no significant improvements in treatment efficacy have been made using traditional treatment paradigms. Therefore, the purpose of this review is to (1) provide an overview of the consequences associated with acute lateral ankle sprains, CAI and post-traumatic ankle OA; (2) introduce the patient-, clinician-, laboratory (PCL)-oriented) model that addresses the lateral ankle sprains and their consequences from a constraints perspective; and (3) introduce the dynamic systems theory as the framework to illustrate how multiple post-injury adaptations create a singular pathology that predisposes individuals with lateral ankle sprains to fall into a continuum of disability. The consequences associated with lateral ankle sprains, CAI and ankle OA are similar and encompass alterations to the structure of the ankle joint (e.g. ligament laxity, positional faults, etc.) and the sensorimotor function responsible for proper ankle joint function (e.g. postural control, gait, etc.). Further, the impairments have been quantified across a range of patient-oriented (e.g. self-report questionnaires), clinician-oriented (e.g. bedside measures of range of motion and postural control), and laboratory-oriented (e.g. arthrometry, gait analysis) outcome measures. The interaction of PCL-oriented outcomes is critically important for understanding the phenomenon of CAI across the continuum of disability. Through the integration of all three sources of evidence, we can clearly see that an ankle sprain is more than just a peripheral musculoskeletal pathology with only local consequences. The dynamic systems theory illustrates that the organization of human movement/function is shaped by the interaction of (1) organismic constraints (health of the person); (2) task constraints; and (3) environmental constraints. However, ankle sprains increase the organismic constraints (i.e. changes in joint structure and sensorimotor function) that significantly hinder an individual's function and may be the underlying cause for the continuum of disability associated with CAI. To treat and/or prevent an individual from entering the continuum of disability, greater protection of the ankle ligaments is needed immediately after injury. Subsequent rehabilitation should then focus on goal-oriented rehabilitation (i.e. quality of the movement pattern) rather that task-oriented rehabilitation (i.e. do these exercises). When evaluating patients with ankle inversion trauma and/or instability, it is imperative to remember that an ankle sprain is not simply a lo...

Developing a Mouse Model of Chronic Ankle Instability

“…Although not an anticipated result, there is no empirical data suggesting a correlation between initial ankle sprain severity and the likelihood of developing CAI in humans (16). Thus, the equal rates of CAI development in both the mild and severe ankle sprain groups of the current investigation seem to support the hypothesis that the sensorimotor system's ability to successfully compensate for structural damage is critical for the prevention of CAI regardless of the severity of the initial sprain induced (21,31). However, the current results would also suggest that the greater the magnitude of structural damage, the greater the difficulty an organism will have in physical activity over its lifespan.…”

“…Such an animal model could also support and/or further develop contemporary theoretical models associated with CAI. Although multiple models exist and overlap, some have hypothesized that the development of CAI is due to a cascade of events that stem from the initial ankle sprain consequences (7,30,31). Furthermore, an animal model could be used to address Hertel's (7) call to focus on potential points of intervention to limit sensorimotor deficits (i.e., organismic constraints) via testing a range of outcomes at multiple time points after injury while also exploring the initial physiologic site of pathology.…”

“…Furthermore, an animal model could be used to address Hertel's (7) call to focus on potential points of intervention to limit sensorimotor deficits (i.e., organismic constraints) via testing a range of outcomes at multiple time points after injury while also exploring the initial physiologic site of pathology. An animal model could test the hypothesis of Wikstrom et al (31), using the dynamic systems theory as a framework, that limiting organismic constraints (i.e., residual symptoms) through effective initial treatments may inhibit the development of CAI more easily than a human model.…”

Predicting Manual Therapy Treatment Success in Patients With Chronic Ankle Instability: Improving Self-Reported Function

“…4 The condition of CAI is characterized by repeated episodes of giving way, feelings of ankle-joint instability, and recurrent sprains with or without mechanical instability of the joint. 3,5,6 Additionally, individuals classified with CAI typically have a number of structural or sensorimotor (or both) symptoms, 7,8 lowered quality-of-life scores, 9 and decreased physical activity levels. 10 Research has also shown a link between CAI and posttraumatic ankle osteoarthritis, with 68% to 78% of patients with CAI developing ankle osteoarthritis.…”

Erratum zu: Das instabile Sprunggelenk

“…Bei bis zu 20-40 % der Patienten entwickelt sich allerdings eine chronische Instabilität und eine damit verbundene Symptomatik bis hin zur Sprunggelenkarthrose [3,5,7,8]. Indikationsstellung, Zeitpunkt und Technik zur operativen Behandlung von Sprunggelenkinstabilitäten werden daher anhaltend diskutiert.…”