Acute lateral ankle sprain to chronic ankle instability: a pathway of dysfunction

Abstract

Lateral ankle sprains (LAS) have been reported as one of the most common musculoskeletal injuries observed in sports and in individuals who are recreationally active. Approximately 40% of individuals who sustain a LAS develop a condition known as chronic ankle instability (CAI). Years of research has identified numerous impairments associated with CAI such as decreases in range of motion (ROM), strength, postural control, and altered movement patterns during functional activities when compared to individuals with no LAS history. As a result, an impairment-based rehabilitation model was developed to treat the common impairments associated with CAI. The impairment-based rehabilitation model has been shown to be an effective rehabilitation strategy at improving both clinical and patient-oriented outcomes in patients with CAI. To date, the efficacy of an impairment-based rehabilitation model has not been evaluated in patients with an acute LAS. Prior to implementing an impairment-based model for the treatment of an acute LAS, similarities between impairments associated with acute LAS and CAI across the spectrum of the healing process is warranted. Therefore, the purpose of this review paper is to compare and contrast impairments and treatment techniques in individuals with an acute LAS, sub-acute LAS, and CAI. A secondary purpose of this review is to provide clinical commentary on the management of acute LAS and speculate how the implementation of an impairment-based rehabilitation strategy for the treatment of acute LAS could minimize the development of CAI. The main findings of this review were that similar impairments (decreased ROM, strength, postural control, and functional activities) are observed in patients with acute LAS, sub-acute LAS, and CAI, suggesting that the impairments associated with CAI are a continuation from the original impairments developed during the initial LAS. Therefore, the use of an impairment-based model may be advantageous when treating patients with an acute LAS.

Effects of Combining High-Definition Transcranial Direct Current Stimulation with Short-Foot Exercise on Chronic Ankle Instability: A Pilot Randomized and Double-Blinded Study

“…Labbe et al [ 39 ] demonstrated that tDCS targeting the right S1 improved vibrotactile detection and the discrimination threshold of the middle finger in healthy younger adults compared to sham. The diminished proprioception in CAI could lead to the overall sensory dysfunction of the ankle joint [ 40 ], which could cause dysfunction of muscles and nerves. This functional impairment may be more affected by the cerebral cortex [ 41 ].…”

Analysis of medical services provided to patients with ankle sprains in Korea between 2015 and 2017: a cross-sectional study of the health insurance review and assessment service national patient sample database

“…However, 30% of patients have been reported to be injured again because patients tend to exercise or exercise before recovery. 28 According to previous research, overuse of painkillers 29 and steroid injections 30 is not recommended. Therefore, the fact that the proportion of Western prescriptions and injections decreased over the 3 years is considered positive.…”

Delayed Exercise Therapy after acute Ankle Sprain Increases Functional Ankle Instability – The Later, the Worse: A Retrospective Analysis.

“…In patients with CAI, Miklovic et al (2018) identi ed four impairments domains (range of motion, strength, proprioception, functional tasks) that were likely not adequately treated after the primary LAS. Consequently, the authors recommend considering these functional de cits already at an early stage during rehabilitation after an acute LAS to prevent persistent or even chronic symptoms (13).…”