Chronic ankle instability, as the name implies, is a chronic condition of instability affecting the ankle and it’s surrounding structures. It usually develops after a severe ankle sprain. However, some people are born with less stable ankles and these individuals are generally extra flexible throughout their bodies. Approximately 20% of ankle sprains lead to chronic ankle instability due to the resulting changes in ligament support, strength, postural control, muscle reaction time and sensation. 

What are the symptoms?

As well as being more susceptible to ankle sprains, people with chronic ankle instability may notice they feel cautious during high-intensity activities, running on uneven surfaces or when changing directions quickly. They may experience a sense of weakness or frequent ‘giving way’ around their ankle.

What are the causes?

The primary causes of this condition are ligament laxity, decreased muscle strength of the muscles surrounding the ankle and reduced proprioception. 

Following an ankle sprain, ligaments can be stretched and slightly looser than they were. In severe cases, they may have torn altogether, leaving the ankle less structurally sound. Without full rehabilitation, the surrounding muscles also become weaker and studies have shown that balance and sensation of the ankle can also be reduced. This means that the ankle is more likely to be injured again, creating a cycle of recurrent injuries, leading to further instability.

How can physiotherapy help?

Physiotherapy treatment for chronic ankle instability focuses on improving strength, control and balance with a variety of techniques and exercises. This approach can significantly improve ankle stability and reduce the risk of future sprains. Physiotherapists can help patients to regain confidence and get back to their best performance. 

In some cases, braces for support can be used. However, this can lead to dependence and further loss of strength and control if used unnecessarily. In cases of extreme ligament laxity or if physiotherapy fails, surgery to repair the damaged ligaments is considered. This is usually combined with a full physiotherapy rehabilitation program for greatest success.

If you don’t feel 100% confident with your ankle, come and have a chat with one of our physiotherapists to see if we can help improve your ankle stability.

​What is a wrist sprain?
Wrist sprains are a general term used to describe any injury to the wrist that doesn’t include a fracture, but is most likely to be a ligament injury. While this can indicate that they are not serious injuries, wrist sprains can be complicated injuries that require supervision and treatment to recover fully.
 
The wrist refers to the area where the bones of the forearm, the radius and ulna, meet and join the bones of the hand. The wrist is able to twist on itself and allows the hand to move to face palm up (supination) or palm down (pronation). The hand is also able to move up and down (flexion/extension) and side to side (abduction/adduction). To allow such complicated movements, the joint surfaces of the wrist are held together by a series of ligaments. When a wrist is sprained, it is usually these ligaments that have been damaged. 

What are the symptoms?
The primary symptom of a sprained wrist is pain with movement of the joint or when taking load, such as when holding a heavy object.
 
Ligament injuries are given a grading scale to indicate their severity, which can help to guide treatment. Grade 1 refers to a stretching or laxity of the ligament fibres and injuries of this grade usually heal with rest within 2-3 weeks. A grade 2 classification signifies that there has been a partial tear of the ligament fibres and will often need more time and treatment for recovery. Grade 3 tears refer to a full thickness rupture of a ligament and may require splinting or even surgery.

The most common cause of a wrist sprain is a fall onto an outstretched hand. Ligament injuries can also happen gradually through over use, although this is less common.

What is the treatment?
Your physiotherapist is able to help diagnosis a wrist sprain and can help to rule out a fracture. An X-ray might be required and your physiotherapist will perform special tests to help identify exactly which structure has been injured, also giving the injury a grade, to help guide treatment.
 
How can physio help?
The key to effective recovery for a wrist sprain is ensuring that the right treatment protocols are in place for your particular injury. Grade 1 sprains will recover best with gentle exercises and early strengthening while Grade 2 to 3 injuries may require splinting or even a surgical consultation for repair.
 
If surgery is the right course for you, your physiotherapist is able to guide you through this treatment pathway, helping you to prepare and recover from surgery to get the best outcome possible. 

Why are ankles particularly vulnerable to injuries related to poor balance?
 
Our ankles have to support our entire body weight when standing on one foot. To provide us with agility as well as stability, our ankles have the ability to move from side to side as well as backwards and forwards. There is a complicated process constantly operating to keep your foot in the correct position while supporting all this weight, particularly with quick changes of direction, activities done on tiptoes, jumping and landing.
 
If the ankle rolls excessively inwards, the ligaments on the outside of the ankle can be damaged and torn. Balance is an important part of keeping the ankle in the correct alignment and not twisting too far to either side during challenging activities.
 
A study of high school basketball players  by Timothy McGuine et al. in 2010 showed that students with poor balance were up to seven times more likely to sprain their ankle than students with good balance. Other studies have shown that balance training is an effective way of preventing falls in elderly populations.
 
Balance can vary from one leg to the other.
 
Most of us tend to favour one side of our body for all activities. This is more obvious in the upper body, with most of us identifying as either left or right handed. The same is also true for our lower body, with each of us favouring one leg over the other for balance activities. This can mean that one leg has better balance and strength than the other, leaving one leg more vulnerable to injury.
 
Reduced balance can mean your body has to work harder to perform activities, with muscles activating in a less coordinated way. Improving your balance can also improve your body’s efficiency of movement, which can, in turn, improve your overall performance without actually improving your muscle strength.
  
Balance can be trained rapidly.
 
Balance is one of the most overlooked dimensions of physical health however, the good news is that it can be improved relatively quickly. Do a quick check to see if you can stand on each leg for two minutes with your eyes closed. If this is difficult you might find that improving your balance is a great next step in your training program.
 
Your physiotherapist is able to identify any deficits in your balance is and is able to develop a training program for you to improve it. Come and see us for an appointment to see how we can help.​