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Ankle Sprains in Soccer - Prevention and Rehabilitation

 

Ankle sprains are the most common injury in soccer, accounting for nearly 20% of all soccer injuries. Understanding ankle sprains, including prevention and rehabilitation strategies, can be incredibly helpful in minimizing the risk of being sidelined by an ankle sprain.

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A sprain occurs when a ligament, which connects bone to bone, is stretched or stressed beyond its capacity, resulting in the tearing of fibers.  Sprains occur at the lateral (outside) ankle, medial (inside) ankle, or between the tibia and fibula, known as a high ankle sprain. 

 

A lateral ankle sprain is the most common type of ankle sprain and often involves the Anterior Talofibular Ligament (ATFL).  This results from excessive inversion and plantarflexion (pointing toes down and turning inward).  For example, this can happen if your ankle “rolls” when landing on another player’s foot or by stepping into a divot while running.  The pain, tenderness, or bruising is primarily on the outside of the ankle. 

 

If the injury occurs to the medial side of the ankle, the sprain likely affects the Deltoid Ligament and occurs when the ankle is forced into excessive eversion (rotating foot outward).  For example, when two soccer players approach a ball, each connecting and driving the ball toward each other, the player with more force drives the ball through, while the other player’s foot gives way.  If the ankle is forced beyond its eversion range of motion, then the medial ankle ligaments can become injured.

A High Ankle sprain involves the ligaments that hold the tibia and fibula together, and often occurs from extreme dorsiflexion (toes upward) and/or rotation, such as a plant-and-twist action, which forces the lower tibia and fibula bones to pull apart slightly, stressing the structures that hold them together.  Pain may be located deep in the ankle or lower leg.  A high ankle sprain requires a longer healing time compared to the other types of sprains.

 

Sprains are classified by the severity of tissue damage.  Click here to see characteristics of sprains (Grades I, II, III).

Prevention

 

Some risk factors that make soccer athletes susceptible to experiencing ankle sprains are preventable!  You cannot avoid landing on another player’s foot, stepping into a divot, or direct contact, because such actions are the nature of the sport.  However, stronger muscles throughout the lower extremity as well as a well-trained proprioceptive system will help provide a more effective (automatic) correction back to neutral when the ankle is moving toward its limit of motion. 

 

Strength and control at the hip and core are massively important for controlling mechanics all the way down to the ankle.  Therefore, it is critical to work on dynamic stability of the gluteals, hip rotators, hamstrings, quadriceps, calf, and ankle inverter/everter muscles to properly maintain neutral mechanics in soccer-specific activities.  Performing single leg balance activities on an unstable surface and practicing quick footwork and ball control are effective strategies to achieve good functional strength and proprioception.

 

In order to reduce the potential for suffering an ankle sprain on the soccer field, it is important to participate in a comprehensive training program, incorporating total body strengthening, utilizing multiple planes of motion, and practicing in dynamic environments.  Emphasize hip and core stability as well as proprioceptive balance and agility exercises to round out the training program and you will be more equipped to manage awkward and unexpected forces across the ankle.

 

Click here to see a video of some excellent exercises for soccer-specific balance, stabilization, and lower extremity strengthening. 

Rehabilitation

 

The highest risk factor for experiencing an ankle sprain is having a history of a previous ankle sprain.  Because the rate of reinjury after spraining an ankle is incredibly high, it is important to ensure proper healing through rehabilitation after an injury occurs.  A Physical Therapist can be helpful in strategically and appropriately progressing you through the stages of healing.

 

When a ligament is stretched beyond its capacity, it enters a state of acute inflammation.  Follow the acronym “PRICEMEM”: Protect, Rest, Ice, Compress, Elevate, Manual Therapy, Early Motion, Medication.  Click here to read more about “PRICEMEM” and how to manage an acute injury.

 

In the case of an ankle sprain, ice for approximately 20 minutes, several times per day, for the first 2-3 days or until there is no longer pain at rest.  Then, continue with an ice regiment as needed to manage swelling and pain, likely 1-2 times per day.  You must protect the tissue from further injury, which might involve temporary use of crutches, a boot, or a brace, if walking is painful.  It is recommended to seek medical consult to rule out a fracture, particularly if weightbearing continues to be painful.  Incorporate early motion by making circles or writing the alphabet in the air using your ankle (this should be kept painfree, so modify as needed).  Manual therapy by a skilled Physical Therapist can be very effective in decreasing swelling and restoring proper mobility of the many joints and soft tissues throughout the foot.

 

Once inflammation has subsided and mobility is normalizing, emphasis should be on strengthening and proprioceptive retraining.  Strengthening muscles across the ankle, particularly the peroneal and tibialis posterior muscles, will help to protect the ligaments from overuse or trauma.  Try using a Theraband (resistance band) for inversion and eversion exercises.  Gradually resume hip, and core strengthening (as described in Part I) with proper mechanics to protect the ankle from abnormal forces and overuse.

 

Another critical component of rehabilitation is proprioceptive retraining.  Sensory receptors throughout the body send messages to the brain and spinal cord about joint position and motion (especially important if your ankle is beginning to “roll”).  The body responds to the messages by coordinating a response to restore an intended position or movement.  If proprioception is impaired, which often results from spraining an ankle, then your body may not correct itself as quickly, allowing the ankle to roll too far and become reinjured.   As an exercise, try balancing on one foot while standing on an unstable surface (pillow, dynadisc, BOSU).  You can make this more challenging by tossing a ball with your hands or volleying a soccer ball with the other foot at the same time.  A good orthopedic physical therapist will advance these exercises as appropriate and provide cues for prope