Get rid of the ankle sprain : causes and remediations.

In your sports practice, have you ever twisted your ankle alone or while walking on one foot ? Have you ? Now that I’ve brought back some good (or bad) memories, I’m going to present you with a prevention and reathletisation approach to reduce this recurring problem as much as possible. 

Ankle sprains account for more than 40% of sports injuries across all sports (KAMINSKI.T & al, 2013), which indicates that these concerns must be constantly taken into account in the care of our athletes. In basketball, they represent more than 15% of non-contact injuries during a career. 

The causes can be multiple and varied as well as completely different in nature. I will go back in detail to all the parameters that favour this type of injury, which does not stop athletes for very long, but which is omnipresent in our competitive sports activities.  

I) Small point on sprains 

1) Anatomical reminders 

In simple terms, the ankle joint is made up of several bones : 

– The tibia 

– The fibula (or fibula)

– The talus (bone of the foot)

– The calcaneus (foot bone)

– The navicualire (foot bones)

90% of the body weight rests on the tibia and 10% on the fibula. The load is transmitted on the slope and is distributed 50% forward on the navicular and 50% backward on the calcaneus. The ankle is a key joint just to support the body in a standing position. It is a so-called “mobile” joint and must therefore allow a large number of movements (approach of Mike Boyle exposed in the book by Benjamin Del Moral). 

The muscles attached to this joint are : 

– The gastrocnemius (or twins)

– Nuclear power 

– The anterior tibial 

It allows several movements in different planes : 

– Plantar flexion

– Dorsal flexion 

– The adduction, orientates the toe inwards 

– Abduction, directs the toe out. 

– The pronation, orientates the toe inwards.

– The supination, directs the toe out

2) Differents mecanisms of sprains

There are two main types of sprains : 

– Inversion of the foot (plantar flexion associated with internal rotation of the joint). It stresses the lateral ankle ligament (deltoid ligaments).

– Eversion of the foot (plantar flexion associated with external rotation of the joint). It mainly stresses the peroneo-anterior ligament and the calcaneofibular ligament). 

There are also different stages of sprains : 

– Stage I sprain : it simply stretches the ligament(s). There are no other particular signs (absence of haematomas, …) but the joint can still swell. The joint is still functional. 

– Stage II sprain : it is accompanied by a slight tear of the ligament in addition to its stretching. The pain is more severe, swelling and bruising appear quickly. Movement is more limited and painful. 

– Stage III sprain : usually a cracking or tearing sensation is felt. The pain is very intense and the movements very complicated. Often it is impossible to lean on the joint. Here too, swelling and bruising occur very quickly. 

3) Causes of sprains 

As presented more in the introduction, the causes of ankle sprains are many and varied. Like injuries in general, there are non-contact and contact sprains. 

a) Non-contact injuries

Among non-contact injuries, the constraints of basketball practice are a fairly significant threat. The numerous changes of direction and jumps (more than 50 per game) are key actions of the activity to perform but are risky in terms of injuries. 

Lack of ankle mobility associated with incorrect foot position (foot too pronated inward or supinator outward) can lead to repeated sprains. These sprains can occur during the key actions mentioned above. A more supine, outward-facing foot will more easily lead to “lateral” ankle sprains (eversion). This was demonstrated in January 2020 by Spanish researchers in the Professional Basketball League (Liga Endesa). The lack of mobility, often linked to over-immobility following a sprain, can cause pain in the ankle but also in the upper joint levels (knee, back, …). In basketball, the larger sizes present a favourable ground for the lack of mobility due to the faster growth of the members. If prevention work during this key period is not carried out, these cases can be found more easily.

These concerns can create a problem called Chronic Ankle Instability (CAI). This occurs after a large number of sprains without necessarily taking the time to correct any imbalances or simply taking the time to return to sport. 

CAI can result in several weaknesses that can be easily measured. There is a correlation between a lack of hip strength and control, mainly abductors, and ankle sprains (Power.C, Journal of Athletic Training, 2017). Some logic follows from these observations. For example, if the pelvis is out of control during a landing, the centre of gravity will not be in an optimal position. Therefore, offsets will be created that can cause stress on the ankles. 

The second correlation demonstrated is that with lack of neuro-cognitive control (Jaber.H, PLOS, 2018). Subjects with CAI had lower scores on cognitive tasks such as attention and memory (visual or composite). However, these tasks were performed on computers and not in the field. The results can still be used to determine important points when re-athletizing a sprain. Therefore, information gathering work will need to be incorporated into this important phase. 

The constraints of information gathering such as the position of partners and opponents as well as the environment are key factors in the practice of basketball.

b) Contact injuries

 The presence of partners and opponents can also be an additional risk of injury. On a small field and with constant interaction, walking or falling on one foot is not harmless. During a jump and especially landings, contact is quickly made. This can disrupt motor control and thus lead to several sprained ankles. 

During changes of direction, contacts are also present. A disturbance during these decisive actions is also a threat to ankle sprains.

II) How can all these risks be reduced? 

In this part I will focus on the key points that can help avoid the risks of so-called “non-contact” sprains. You can find examples of exercises in our guide provided for this purpose. 

a) Mobility

First of all, the first key point is to develop ankle mobility. This joint needs to be mobile because it has a direct impact on the stability of other key joints such as the knee. Ankle mobility also helps to preserve it in abnormal situations (as mentioned above in the sprain mechanisms). 

The interest will be to gain ankle mobility with the development of dorsiflexion (dorsal flexion). This gain will also allow the joint to move better in other situations (e.g. during a squat). 

These postures are performed in each training sequence during pre-training routines or as a warm-up during weight training sessions. 

The use of certain tools such as the floss can also accelerate gains in joint mobility. 

b) Proprioception 

Proprioception is defined as the ability, conscious or unconscious, to perceive parts of one’s body in relation to one another. 

For the ankle, it will be necessary to develop the ability of the joint to situate itself in space and also in action. This can be done statically or dynamically, on a stable or unstable plane and in unipodal or bipodal support. 

Progressivity would involve moving from a stable to an unstable plane, from static to dynamic postures, and from bipodal to unipodal support. 

Proprioception must be built into each individual routine and can also be a specific sequence during collective field start-up. 

Integrating also the notion of interaction with another person can be interesting to progress on this point in basketball. Another key point can be the implementation of jumps in these routines as they are also an important risk factor for sprains.

c) Muscle strengthening

Although the ankle is a mobile joint, it must also be stable to withstand all the stresses that may be applied to it during sports practice. A stable, and therefore reinforced, joint will allow your athletes to reduce their risk of sprains. 

The key will be to strengthen the triceps sural as well as the flexors and extensors of the ankle. 

These strengthening phases can also be integrated into individual routines but can also be an integral part of weight training sessions. 

As presented in the causes of injury, strengthening the pelvic muscles can be interesting to increase motor control while playing on a basketball court.

III) How to act when a sprain occurs

The PEACE & LOVE protocol can allow you to take optimal care when a sprain occurs: 

– Protection, avoid activities and movements that increase pain in the first few days after the injury. 

– Elevation, raise the injured part above the heart as often as possible.

– Avoid anti-inflammatory drugs because they reduce tissue healing, also avoid ice. 

– Compression, use elastic bands or taping to reduce swelling. 

– Education, your body knows best. Avoid unnecessary passive treatments and medication and let nature play its part. 

– Load, let pain guide your gradual return to normal activities. Your body will tell you when it is safe to increase the load. 

– Optimism, condition your brain for optimal healing by being confident and positive. 

– Vascularize, choose non-painful activities to increase blood flow and repair tissue. 

– Exercise, restore mobility, strength and proprioception by taking an active approach to recovery. 

This approach will make it easier for you to manage the reathletization of an ankle sprain.

Conclusion 

The ankle joint is a complex joint because it is very important in many sporting activities but also in everyday life such as walking or even just standing. Protecting and strengthening this joint is therefore a priority in physical preparation and all the more so in an activity such as basketball. 

Acting on controllable elements such as mobility, reinforcement or proprioception can considerably reduce ankle injuries. You can find an approach to work in the “little ankle guide” provided for this purpose in our shop. 

To go further, the ankle is a key point in the management of other pathologies in the knee and back. It can also be the first point to analyse when injuries occur at these levels. 

In any case, ankle sprains remain the most common injury in all sports and even more so in basketball ! 

See you soon on the courts 

Clément

Bibliography 

  1. Hip Strength as a Predictor of Ankle Sprains in Male Soccer Players: A Prospective Study. Powers.M, Journal of Athletic training Jan 2017.
  2. Neuromuscular Control of Ankle and Hip During Performance of the Star Excursion Balance Test in Subjects With and Without Chronic Ankle Instability. Hatem Jaber, Août 2018, PLOS One. 
  3. National Athletic Trainers’ Association Position Statement: Conservative Management and Prevention of Ankle Sprains in Athletes, Kaminski.T, Journal of Athletic training, Juillet/août 2013. 
  4. A Large-Scale Study on Epidemiology and Risk Factors for Chronic Ankle Instability in Young Adults, Hershkovitch.O, Journal of foot and ankle surgery, Avril 2015. 
  5. Males with chronic ankle instability demonstrate deficits in neurocognitive function compared to control and copers, AB. Rosen, Research in Sports Medecine an International Journal 
  6. Is There Any Association Between Foot Posture and Lower Limb–Related Injuries in Professional Male Basketball Players ? A Cross-Sectional Study, Lopezosa.E, Clinical Journal of Sports Medecine, Janvier 2020. 
  7. Benjamin Del Moral, « Préparation Physique : Prophylaxie et Performance des qualités physiques », éditions PhysiquePerformance, 2014.  
  8. The relationship of foot and ankle mobility to the frontal plane projection angle in asymptomatic adults, Narelle Wyndow, Amy De Jong, Krystal Rial, Kylie Tucker, Natalie Collins, Bill Vicenzino, Trevor Russell & Kay Crossley, Journal of Foot and Ankle Research (2016).