In her previous Ballet Blog focussing on Stress fractures in dancers, CSSM Physiotherapist, Kelsey, looked at what causes stress fractures, how they present in young dancers, what recovery might look like and how best to avoid them in the first place. In part 3 of our Ballet Blog series, Kelsey will discuss ankle sprain injuries and how these, when not rehabilitated correctly, can have a long-term impact on your dancing or other sporting career.
Ankle Sprains – How They Happen.
Your most typical, most common ankle sprain involves an inversion of the foot – toes direct inward, ankle rolls outward, usually in a plantarflexed (toes pointed downward) state. However, these can occur with the ankle in a flatter position. The severity of the injury will depend on a few factors
..Just to name a few.
Dancers will find the most risky time for an ankle sprain will be while they’re up on their toes, and when taking off or landing from a jump. Dancers require a large amount of ankle range and strength and body position awareness to help decrease the risks involved with being in these positions.
While this blog will discuss inversion ankle injuries that cause a lateral (outer side) ankle sprain, there are other ankle sprain types than can occur. The contents of this blog remain relevant for the other types of ankle sprains. An assessment is key to determining your issue and creating the best treatment and rehabilitation plan for your individual needs.
Consequences;
When an inversion ankle injury occurs, there can be pulling and tearing of ligaments, tendons, or muscles, and in some cases, fracturing (breaking) of bone. The most commonly torn ligament in an ankle sprain with an inversion mechanism is the anterior talofibular ligament (ATFL) situated on the upper, outer part of your ankle/foot.
With a greater roll of the joint, other ligaments that can be affected on the outside of the ankle include the posterior talofibular ligament (PTFL) and the calcaneofibular ligament (CFL).
The main role of these ligaments is to provide passive structure and security to your foot, but did you know that they also play an important role in proprioceptive feedback ie; help your brain to figure out where your foot and ankle are in space? Damage to these structures can decrease the amount of feedback being provided to your brain and decrease your proprioception, or what we then perceive to be as our balance.
When a ligament tear occurs, they are classified by grades 0 to 3 (and sometimes 4 depending on the literature) to provide a guide on the severity of the injury and in turn, this allows your Physiotherapist to better estimate how long your recovery might be. It’s important to note, however, that some people may recover faster, and some might take a little longer, even with the same severity of injury.
Immediate care;
In the first 1-3 days of your injury it is important to manage the pain and potential swelling that may occur. An assessment by our Dance Program Coordinator and Physiotherapist, Kelsey, will help to determine if your ankle needs any further investigations such as Xray imaging, if a fracture is suspected, or Ultrasound if greater tearing is suspected.
At CSSM, we will also be able to provide you with immediate advice and tools to manage your ankle injury such as crutches, compression, taping or rehabilitation aids and exercises depending on the severity of your injury.
Rehabilitation;
As soon as you’re able, we will assign some tasks for you to complete that will begin your rehabilitation journey. Pay attention to the frequency, intensity, duration and type of exercise you’re asked to complete. If you’re ever concerned about your rehabilitation instructions, contact us early! We appreciate your questions and want to make your rehabilitative process as smooth as possible.
Some of the tasks that you will be assigned throughout your recovery will include;
Prevention;
Did you know that following one ankle sprain, you have a greater likelihood of not only re-injuring the same ankle, but the other one as well? This is where many people fall short in continuing their rehabilitation into not only returning to sport, but prevention of further injuries. This is why addressing other biomechanical, strength and proprioceptive issues within the same and the other leg is so important. Just getting rid of the pain isn’t enough.
Without ongoing rehabilitation and working to get your ankle to better than pre-injury strength and abilities,
Dancers will find the most risky time for an ankle sprain will be while they’re up en pointe, and sometimes when taking off or landing from a jump. When conducting a pre-pointe assessment, we look for many factors that will enable you to minimise your risk of injury while in this position. Some of these include;
Following your pre-pointe, we provide you with exercises and instructions to aid in your strength and assist you in making the necessary improvements to maximise your dancing career. While you continue to dance or participate in sport and activity, you may need to do some of these exercises as ongoing prevention for further injury. Ever tried to balance on one foot for the whole time you brush your teeth? This is just one simple way to add in foot and ankle strength and proprioception training in your daily life!
Complications from too little recovery also extend into chronic ankle instability. This is where your ankle has not recovered from the initial injury well enough and may have also caused repeated sprains or other issues. If this sounds like you, you’re not too late! Your muscles and tendons have an amazing ability to adapt and get stronger. Have a chat with Physiotherapist, Kelsey, about how to get your ankle back to full performance and the best tools you can use to get you there.
References
Karanjkar, S., Phansopkar, P., Deshmukh, N., Nandanwar, R., & Bhagwani, R. (2023). A tailor-made rehabilitation for patients with talofibular and talocalcaneal ligament tear: A. Medical Science, 27, e135ms2872. DOI: https://doi.org/10.54905/disssi/v27i133/e135ms2872
Katakura, M., Kedgley, A. E., Shaw, J. W., Mattiussi, A. M., Kelly, S., Clark, R., … & Calder, J. D. (2023). Epidemiological characteristics of foot and ankle injuries in 2 professional ballet companies: a 3-season cohort study of 588 medical attention injuries and 255 time-loss injuries. Orthopaedic journal of sports medicine, 11(2), 23259671221134131. DOI: 10.1177/23259671221134131
Michels, F., Wastyn, H., Pottel, H., Stockmans, F., Vereecke, E., & Matricali, G. (2022). The presence of persistent symptoms 12 months following a first lateral ankle sprain: a systematic review and meta-analysis. Foot and Ankle Surgery, 28(7), 817-826. DOI: https://doi.org/10.1016/j.fas.2021.12.002
Wagemans, J., Bleakley, C., Taeymans, J., Schurz, A. P., Kuppens, K., Baur, H., & Vissers, D. (2022). Exercise-based rehabilitation reduces reinjury following acute lateral ankle sprain: A systematic review update with meta-analysis. Plos one, 17(2), e0262023. DOI: https://doi.org/10.1371/journal.pone.0262023
About Kelsey
Kelsey is a Physiotherapist, dance program coordinator and Myotherapy Team Lead at CSSM. She has 17 years of dance training and is no stranger to working within elite sporting environments including the AFL and with independent athletics athletes.
Kelsey has also done her fair share of teaching and coaching, initially choreographing tap and jazz routines for a local school for two years and then taking her talents to a different area and coaching rock-climbing for state and national juniors for five years. Talk about diversity! If you have a chat with her, you may find yourself talking about snow sports too!
In addition to her clinical role, she has worked with LaTrobe University in assisting the first year Masters of Physiotherapy students in their learning during clinical placement. While she has a strong desire to complete further studies, Kelsey is focussing her efforts on her dance athletes and improving her knowledge and skills in this area.
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