Recurrent Ankle Injuries in Adolescents: Causes, Treatment, and Prevention

Adolescence is a critical time for physical development, with sports and physical activities playing a crucial role in shaping young bodies. However, as teenagers grow, and sports become that bit more competitive, it is also a period when injuries, particularly ankle injuries, grow more common. Without proper treatment, an individual ankle injury can often reoccur, and end up becoming a chronic complaint. This can impact a teenagers mobility, athletic performance, and mood, as they may end up missing out on playing the sports they love!

In this post, we’ll explore the common causes of recurrent ankle injuries in adolescents, the importance of proper treatment, and techniques for preventing future injuries.

Why Are Ankle Injuries Common in Adolescents?

The ankle is a complex joint that bears a significant load during physical activity. Sports which involve a high amount of turning, stepping, cutting, or pivoting, all place a significantly higher amount of load on the ankle. This can leave adolescent particularly vulnerable to suffering ankle sprains or ligament injuries. This can be due to a variety of factors such as:
1. Growth and Development: 
Growth spurts can lead to imbalances in muscle length, strength, and coordination, which can all lead to an increased incidence of injury.
2. Multidirectional Sports: 
Sports like football, hurling, Rugby, soccer, and basketball place high stress on the ankle with repetitive jumping, cutting, turning, and pivoting.
3. Insufficient Conditioning: 
Lack of adequate training in strength, flexibility, balance, and proprioception can also increase the risk of injury.

Common Causes of Recurrent Ankle Injuries

One of the major issues facing athletes as they return to sport following an acute ankle sprain, is the elevated risk of recurrence. Many athletes suffer a low grade ankle ligament injury, feel sore and swollen for a few days, and once the initial symptoms pass, rush to return to sport. However, if the cause of the injury is not addressed, and the previously healthy ligaments are more lax, there is a significantly increased likelihood that the injury may reoccur. This can be prevented by proper treatment of the acute injury, addressing any biomechanical issues that may have contributed to the initial injury, and increasing muscle strength, to help them to compensate for the increased ligament laxity.

Recurrent Ankle Injuries

Why Do Ankle Injuries Reoccur Without Sufficient Rehabilitation?

Incomplete Healing of Ligaments
An ankle sprain involves stretching or tearing of ligaments, the tissues that stabilise the joint. If not given sufficient time to heal, the ankle remains unstable and at high risk of reinjury when returning to play.

Residual Muscle Weakness
Many patients will be prescribed a boot, particularly after a high grade ankle sprain. Being in a boot for an extended period time will cause the supporting muscles of the ankle to weaken. This weakness needs to be addressed before making a full return to play.

Poor Proprioception
Proprioception is our awareness of the position of a limb in space. Our ligaments play a huge role in providing us this awareness. If the proprioception is effected by a ligament injury, which it commonly is, this will contribute massively to the feeling of instability on the ankle when running or landing.

Altered Movement Patterns
Pain or discomfort from an initial injury can cause us to adopt compensatory movement patterns, such as running with an altered gait, favouring the opposite side, or modifying how we jump and land. These altered mechanics can place undue stress on the ankle, leading to longer lasting chronic ankle issues.

The Importance of Proper Treatment

Ankle injury rehab should begin immediately after the injury is sustained, from the initial management of the injury through until the return to play procedures. 
Treatment should start slowly and be progressed as the patient is capable until a safe return to spot can be made. A successful rehab may follow some of the following steps:

1. Acute Management:
Rest, Ice, Compression, and Elevation to reduce swelling and pain after the injury is sustained, and can be helpful for up to 72 hours post injury.

2. Bracing or Taping:
This will provide stability and support of the ankle helping to prevent further injury. In more severe injury a boot may be used, or if necessary a physio may tape the ankle for a few days to provide some support.

3. Rehabilitation:
The initial goals of this phase are restoring range of motion, strength, and proprioception; before progressing onto more intense exercises that include hopping, skipping, and jumping on the injured ankle.

4. Gradual Return to Play:
Progressive reintroduction of sporting activities as the patient grows more and more confident and capable on the injured ankle.

Prevention Strategies

Preventing recurrent ankle injuries in adolescents can be a challenging task. Various sports have their own individual demands. However, there are some things that will be beneficial in the majority of patients:

1. Strength Training:
Strengthening the muscles of the lower leg and foot will help support the ankle joint in fulfilling its role as well as possible.

2. Flexibility Training:
Ensuring the knee, hip, and ankle are mobile and flexible will allow the lower limb to remain as stable and robust as possible.

3. Proprioception Exercises:
Training the balance of the patient in challenging positions, aswell as using drills that improve stability and coordination can be helpful to ensure the ankle is sturdy and stable when playing.

4. Proper Footwear:
Well-fitted boots or shoes with adequate foot and ankle support can be helpful for remaining injury free.

5. Sport-Specific Training:
Ensuring proper technique during the individual activities specific to the patients sport.

PMC Physio Reccomendation

At PMC Physiotherapy, our team of expert chartered physiotherapists is dedicated to helping athletes recover from injuries like ankle problems, empowering them to stay active and reach performance goals safely. If your teen is dealing with an ankle injury or wants to prevent future issues, book an appointment with one of our specialists at PMC Physiotherapy to start a personalised recovery plan.

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PMC Physiotherapy Clinic, Unit 36, Dunboyne Business Park, Dunboyne, Co Meath

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01 8253 997

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info@pmcphysiotherapy.ie