Mark, a 28 year old soccer player who rolled his ankle

Mark's Journey: Overcoming a Severe Ankle Sprain at Willoughby Health

Meet Mark, a 28-year-old soccer enthusiast who came to Willoughby Health with intense pain and swelling in his right ankle. Mark injured his ankle during a weekend soccer match when he landed awkwardly after jumping for a header. Let's follow Mark's journey from injury to recovery with our skilled Physiotherapist, Darcy.

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First Visit: Understanding Mark's Injury

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When Mark hobbled into Willoughby Health, Darcy began with a thorough assessment.

Questions Darcy Asked

Darcy started by asking Mark some important questions:

• How did the injury happen?
• Did you hear or feel a pop when you hurt your ankle?
• Could you continue playing after the injury?
• How much pain are you in on a scale of 0-10?
• Have you had any previous ankle injuries?
• What activities are difficult for you right now?
• Have you tried any treatments at home?

Mark explained that he felt a sharp pain and a popping sensation when he landed. He couldn't continue playing and his pain was about 9/10. He found it nearly impossible to put any weight on his right foot and had been using crutches since the injury.

[Suggested Image: A diagram of an ankle, highlighting the lateral ligaments]

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Physical Examination

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Next, Darcy performed a careful physical examination:

1. Observation: Mark's right ankle was visibly swollen and bruised, especially on the outer side.
2. Palpation: Darcy gently felt around Mark's ankle. Mark reported severe tenderness over the anterior talofibular ligament (ATFL) and calcaneofibular ligament (CFL).
3. Range of Motion (ROM) Tests: Using a goniometer, Darcy measured Mark's ankle movement. His right ankle had severely reduced ROM compared to his left:
     - Dorsiflexion: Right 5°, Left 20°
     - Plantarflexion: Right 20°, Left 45°
     - Inversion: Right 10°, Left 35°
     - Eversion: Right 5°, Left 20°
4. Knee to Wall Test: This test measures functional ankle dorsiflexion. Mark could only move his right knee 2 cm from the wall, compared to 10 cm on his left side.
5. Special Tests:
     - Anterior Drawer Test: Positive, with significant laxity noted
     - Talar Tilt Test: Positive, indicating instability

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Diagnostic Imaging: Confirming the Diagnosis

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Based on the initial assessment, Darcy suspected a grade 3 lateral ankle sprain. To confirm this and rule out any fractures, she referred Mark for some imaging tests.

X-rays

Mark had X-rays taken of his right ankle. These showed:

• No fractures or bone chips
• Widening of the ankle joint space, indicating severe ligament damage

Ultrasound

An ultrasound scan revealed:

• Complete tear of the ATFL
• Partial tear of the CFL
• Significant fluid around the ligaments

MRI Scan

The MRI provided detailed images of Mark's soft tissues:

• Complete tear of the ATFL
• High-grade partial tear of the CFL
• Bone bruising on the lateral talus
• No evidence of cartilage damage

These imaging results confirmed Darcy's initial diagnosis of a grade 3 lateral ankle sprain.

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Treatment Plan: Road to Recovery

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With a clear diagnosis, Darcy developed a comprehensive treatment plan for Mark.

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Initial Treatment (Days 1-14)

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1. PRICE Protocol:

• Protection: Mark was fitted with a walking boot to protect his ankle and allow controlled movement.
• Rest: Mark was advised to use crutches and avoid weight-bearing for two weeks.
• Ice: Apply ice packs for 15-20 minutes every 2-3 hours.
• Compression: An elastic bandage was applied to reduce swelling.
• Elevation: Mark was instructed to keep his foot elevated when resting.

2. Pain Management: ‍

• Darcy used gentle manual therapy techniques to help reduce pain.
• Mark was advised on appropriate over-the-counter pain medication.

3. Early Mobilisation Exercises:

• Ankle alphabets: Drawing the alphabet with his toes.\
• Gentle ankle pumps: Moving his foot up and down within a pain-free range.

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Follow-up Session (Day 7)

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Mark returned for a follow-up session. His pain had reduced to 6/10, but swelling was still significant.

1. Progress Assessment:
  - ROM was re-measured, showing slight improvements.
  - The knee to wall test showed a 0.5 cm improvement.

2. Manual Therapy:
  - Darcy performed gentle joint mobilisations to improve flexibility and reduce pain.
  - Soft tissue massage was applied to the calf muscles to reduce tension.

3. Exercise Progression:
  - Isometric strengthening exercises were introduced for all ankle movements.
  - Non-weight bearing balance exercises were started.

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Intermediate Phase (Weeks 3-6)

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As Mark's ankle began to heal, Darcy progressed his treatment:

1. Gradual Weight-Bearing:

• Mark transitioned out of the walking boot and into a supportive ankle brace.
• He began partial weight-bearing exercises, gradually increasing load as tolerated.

2. Exercise Progression:

Darcy designed a progressive strengthening program including:

• Theraband exercises for all ankle movements
• Single-leg balance exercises
• Calf raises (initially bilateral, progressing to single-leg)

3. Gait Re-education: ‍

• Mark worked with Darcy to improve his walking pattern, gradually increasing walking distance.

4. Manual Therapy:

• Joint mobilisations were progressed to improve ankle ROM.
• Soft tissue techniques were applied to address any muscle tightness.

5. Taping:

• Darcy applied rigid tape to provide support during exercises and daily activities.

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Advanced Rehabilitation (Weeks 7-12)

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As Mark's strength and stability improved, Darcy focused on preparing him for a return to soccer:

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1. Sport-Specific Exercises: ‍

• Agility drills: Ladder drills, cone weaves, and shuttle runs.
• Jumping and landing practice: Focus on proper technique and ankle stability.
• Soccer-specific movements: Quick direction changes, kicking drills.

2. Plyometric Training: ‍

• Box jumps
• Hop sequences
• Depth jumps

3. Strength and Conditioning: ‍

• Darcy designed a gym program to improve Mark's overall lower body strength and endurance. This consisted of machine based leg weights which didn't require weight bearing on the ankle (e.g. leg extensions, hamstring curls). He also did some upper body workouts and cycling to keep his fitness up whilst his ankle healed.

4. Balance and Proprioception: ‍

• Advanced exercises on unstable surfaces like BOSU balls and balance boards.

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Monitoring Progress

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Throughout Mark's treatment, Darcy regularly assessed his progress:

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1. ROM and Strength:

• By week 12, Mark's ankle ROM had returned to 90% compared to his uninjured side.
• His strength was 85% compared to his uninjured side.

2. Functional Tests:

• Single-leg hop test: Mark achieved 80% distance compared to his uninjured leg.
• Figure-8 hop test: Mark completed the course with good speed and stability.

3. Pain and Swelling:

• Mark reported no pain during daily activities and only mild discomfort after intense exercise.
• Swelling had reduced significantly but was still noticeable after activity.

4. Patient-Reported Outcome Measures: ‍

• Darcy used the Foot and Ankle Ability Measure (FAAM) to track Mark's perceived function. His scores improved from 30% at initial assessment to 85% by week 12.

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Return to Sport

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After 12 weeks of dedicated rehabilitation, Mark was ready to begin his return to soccer:

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1. Graduated Return: ‍

• Mark started with non-contact training sessions, gradually increasing intensity and duration.
• He wore an ankle brace for additional support during training and matches.

2. Final Assessment: ‍

• Darcy performed a comprehensive assessment, including strength testing, agility drills, and sport-specific movements.
• Mark demonstrated good ankle stability and confidence in most tasks, but still had some hesitation during rapid direction changes.

3. Ongoing Management: ‍

• Darcy provided Mark with a maintenance exercise program to continue at home.
• Regular check-ups were scheduled to monitor his progress and address any concerns.

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Long-term Management and Prevention

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To help prevent future ankle sprains, Darcy provided Mark with strategies for long-term management:

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1. Regular Exercise:

• Darcy designed a home exercise program focusing on ankle strength, flexibility, and balance.
• Mark was encouraged to maintain this routine, especially during the soccer season.

2. Proper Warm-up:

• Darcy emphasised the importance of a thorough warm-up before playing soccer.
• He provided a specific warm-up routine targeting the ankles and lower legs.

3. Appropriate Footwear:

• Mark was advised on choosing soccer boots that provide adequate ankle support.

4. Taping and Bracing: ‍

• Darcy taught Mark how to apply rigid sports tape for additional support during matches.
• They discussed the ongoing use of an ankle brace during high-risk activities.

5. Regular Check-ups: ‍

• Darcy advised periodic assessments to address any minor issues before they became significant problems.

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Take home message: A Successful Recovery

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Mark's case demonstrates the effectiveness of a comprehensive physiotherapy approach to treating a grade 3 lateral ankle sprain. Through Darcy's expert care at Willoughby Health, Mark progressed from a severely painful and unstable ankle to a successful return to soccer.

Key factors in Mark's successful recovery included:

• Accurate initial assessment and diagnosis
• Appropriate use of diagnostic imaging
• A tailored, progressive rehabilitation program
• Regular monitoring and adjustment of the treatment plan
• Patient education and home exercise program

Mark's dedication to his rehabilitation, combined with Darcy's expertise, resulted in a strong recovery and reduced risk of future ankle injuries. If you're dealing with a sports injury or any musculoskeletal problem, don't hesitate to reach out to our team at Willoughby Health. We're here to help you get back to doing what you love!

Remember, every person's journey with an ankle sprain is unique, and treatment plans are always tailored to individual needs. Our experienced physiotherapists at Willoughby Health are ready to guide you through your own path to recovery, just as Darcy did for Mark.