Ankle sprains and fractures

Should I get physical therapy?

Every PT has an origin story about why they decided to become a physical therapist and many of those stories start with an injury.  My path to becoming a physical therapist had a few different origins, but one of those did start with an injury… and a not so great PT experience.  As a kid I was bouncing around, climbing trees, and asking for a trampoline, so my mom signed me up for gymnastics.  I fell in love with the sport. I loved flipping around to fun music on the floor, sailing off the bars into the pit, and flying off the vault.  

I don’t remember when or how it happened for the first time but at some point I “rolled” my ankle.  I rested, iced, hopped around for a few days, then went back to gymnastics.  I was proud of myself for being “tough” and not complaining.  But then it happened again.  And again.  And again.  Each time setting me back in the sport I loved.  Each time forcing me to sit out for days or weeks.  Once occurring the night before State Meet, which I prepared for all season.  I worked hard to get back each time.  I didn’t know there was any other option.  

After one particularly bad sprain, I was prescribed physical therapy.  I went for 2-3 visits (and I did think… hmm, this is a pretty cool job), then was discharged.  I’m sure it helped a little, but I didn’t learn how to keep this from happening again.  I didn’t know what criteria I should meet to return to my sport safely.  I didn’t know why this kept happening to me.  I still had a long and fun gymnastics career, however now as a PT I look back and wonder what it would have been like without all of those physical, mental and emotional setbacks.  

It has been reported that as many as 28, 000 ankle injuries occur in the US every day (1) and some report that up to 45% of all athletic injuries are ankle sprains (2). Yet, many athletes never undergo physical therapy after an ankle sprain.  And even if they do, it may not include the focus on education needed to help an athlete (or a non athlete!) to prevent future injuries.  

So, should you seek physical therapy after an ankle sprain or fracture?  Yes!  

5 reasons you should seek physical therapy after an ankle sprain or fracture

1. Proprioception.  Your ankle contains little receptors called proprioceptors that help you know where your foot and ankle are in space.  Why is this important?  Well otherwise you’d have to walk around looking at your feet all day!  But seriously, your proprioception is extremely important.  It allows your body to know where to place your foot without “rolling your ankle” and to self correct if it encounters a surprise landing, such as off the edge of a mat, off a stair or curb, on an unstable surface, or if you trip or stumble.  Proprioceptors don’t just go back to normal after the pain and swelling associated with an ankle sprain or fracture resolve.  You have to strengthen them just like muscles.  How do you do that?  Well there are a lot of ways, but you typically start with basic balance exercises and can work your way up to fun, creative sport-specific drills.  

2. Range of motion.  Seems simple enough.  But there are some very important details.  The ankle joint is more stable in a “flexed” or “dorsiflexed” position rather than a “pointed” position.  While getting a point back is important and might seem like the top priority for a dancer or gymnast, you also have to make sure you regain your full dorsiflexion so your ankle is able to move into its more stable position when needed. 

3. Strength.  Your muscles can quickly lose strength after an ankle injury.  Even if you feel like you are strong again, it is important to have your strength properly tested.  What may seem like a small asymmetry of strength can turn into a quick re-injury or may lead to an overuse injury in the future.

4. Safety for return to sport.  When should you hit the field again?  When is it ok to run, jump, do drills, scrimmage, or play in games?  We can help you with that.  There are evidence based criteria that compare you to your own normal and allow us to provide a more organized and research based return to sport progression.

5. Education.  We love you but we don’t want to see you back for the same injuries time after time.  You can just stop by, say hi, and tell us how awesome you’re doing!  We want to empower you to learn how to take care of your body and to prevent future injuries.  You should “graduate” PT with a sustainable home exercise program and understand why it is important to continue to work on your strength, flexibility, balance, etc. 

So, if you’ve recently had an ankle sprain or fracture, come in (or schedule a virtual visit) and see what makes our physical therapists the best of the best in Newton!  If you’ve had ankle sprains or fractures in the past and continue to have pain or decreased function, you can benefit from physical therapy too.  And if you aren’t currently injured but would like to prevent future ankle sprains, schedule a Wellness Visit with one of our physical therapists.  I hope you enjoyed learning a little bit about ankle sprains and physical therapy.  Stay healthy, stay strong, and keep those proprioceptors firing! 

To schedule a physical therapy evaluation or a Wellness Visit contact us at office@girlfitrocks.com.

Kate Hamilton, PT, DPT

Orthopedic Clinical Specialist

References

1. Adams J, Barton E, Collings J, DeBlieux P, Gisondi M, Nadel E. Emergency Medicine. Philadelphia, PA: Saunders, Elsevier, Inc, 2008; pp. 897–898.
2. Ferran NA, Maffulli N; Epidemiology of sprains of the lateral ankle ligament complex. Foot Ankle Clin, 2006, Sep; 11(3):659-62.