Chronic Ankle instability in Netball
Ankle sprains are one of the most common injuries in netball players and can range in severity. Minor sprains may only take a week of rest and rehab, whereas more serious sprains can take much longer. The ankle accounts for 40% of netball injuries due to the amount of jumping, running and change of direction.
Once you have sprained your ankle, you’re at risk of chronic ankle instability. It’s because the ankle is a very complex joint that has to go through a large degree of mobility in all directions. After a sprain the ligaments remain weak and the muscles don’t work as well.
Ligament injuries rarely heal completely, unlike muscles, which have a much better blood supply and heal quickly. Even once the pain resolves, the ligaments are never as strong as they were before the injury. As a result ligaments can end up weaker or more lax. If this happens repeatedly over time, it can lead to chronic ankle instability. This is even more reason to rehab your ankle after an injury.
Because the biomechanics of the ankle are so complicated, instability after incomplete rehabilitation is quite common. The symptoms include a feeling of ‘giving way’ of the outer (lateral) side of the ankle, swelling and pain, and recurrent sprains. The ‘giving way’ occurs when you’re walking or active, but can also happen if you’re just standing, and the ability to balance normally is affected.
Proper rehabilitation is needed to strengthen the muscles around the ankle and “retrain” the tissues within the ankle that affect balance. If you don’t take steps to treat ankle instability, not only are you at risk for lots more ankle sprains, but also the development of post-traumatic arthritis.
Risk Factors for Chronic Ankle instability
In addition to playing Netball there are a number of other factors that can predispose you to Chronic Ankle instability
Repeated ankle injuries
As previously mentioned, previous injury to the ankle is what ultimately leads to ankle instability. The soft tissues may be stretched or torn and the bones may be fractured or bruised. If these tissues have been damaged and are not rehabilitated properly, it can lead to prolonged weakness and a high risk of re-injury.
Foot posture
Netballers with high arches, known as a cavus foot type, are at a high risk of repeated lateral ankle sprains because there is increased pressure on the outside of the ankle.
Those with low arches, known as a planus foot type, are also at risk. In this foot type, the soft tissue and joints within the feet tend to be hypermobile and flexible, which ultimately contributes to reduced balance and strength.
Training surfaces
Training on proper surfaces is very important for a number of reasons, but it mostly reduces your risk of injury in general. Any environment where the ankle has to work harder to keep you balanced and functioning, the higher the risk of injury is - watch out for wet Netball Courts
Footwear
Improper footwear can contribute to repeated ankle sprains. Netball runners are designed with ankle stability in mind but make sure you choose the correct pair for your foot posture
Body composition/BMI
A higher body mass index (BMI) can increase the risk of repeated ankle sprains due to the amount of force being applied to the ankle and feet in general.
Treatment
Physiotherapy is the cornerstone of the effective treatment of chronic ankle instability. At Kinetic Balance we will design a program involving treatments and exercises to strengthen the ankle, improve balance and range of motion, and retrain your muscles.
Active rehabilitation is really the mainstay of treatment for this condition. Your physiotherapy treatment will involve strengthening the entire lower limb, more specific ankle muscle exercises, joint mobilisation for any foot or ankle stiffness, range of motion exercises and proprioceptive retraining. The latter is the little sensors found in our ligaments and joints that tell our body where we are in space. The treatment goals are to increase support around your ankle joint, improve your balance to help you avoid any more sprains
Proprioception improvement will increase your awareness of the position of your foot while it’s bearing weight, and will also build strength.
Your physio will focus on strengthening the lateral peroneal muscles as well as the medial muscles, in order to maintain the balance of forces acting on your ankle. It’s important to do this to help compensate for the lax ligaments and keep the joint stable. A good programme will also include some higher level plyometric exercises specific to Netball such as jump and landing in different directions on 2 feet then 1 foot.
Some patients wear an ankle brace or tape up their ankle for netball to gain support for the ankle and keep it from rolling. However, there’s no substitute for training and strengthening the muscles around the ankle so you don’t have to rely on tape for support.
In severe cases you may have to consider surgery, depending on to what degree the ligaments have been damaged; stretched or completely torn.
