Ankle FAQ's: All Your Questions About Ankle Pain Answered

Ankle FAQ’s
All Your Questions About Ankle Pain

Answered
In the following report, I’ll answer the most common

questions about ankle injuries, including what happens,
what gets injured and what it all means - because if
you’re trying to get back to full activity, chances are
you’ll need to understand what is going on. And who
better to explain it than a Sports Physiotherapist.
Greg Dea, Sports Physiotherapist

Attention: Anyone with ankle pain or injury…
All Your Questions About Ankle Pain Answered

Dear: Ankle Pain Sufferer
From: Greg Dea, Sports Physiotherapist
There are startling facts about ankle injuries. Search the table of contents to find your
question answered.
Contents
The Bad News ................................................................................................................................ 4
The Good News ............................................................................................................................. 7
Frequently Asked Questions ........................................................................................................ 8
Q. What is an acute ankle injury? ........................................................................................... 8
Q. How do they occur? ........................................................................................................... 8
Q. What is usually injured? ..................................................................................................... 9
Q. What is a ligament? ............................................................................................................ 9
Q. What happens after injury? .............................................................................................. 10
Q. What is injured in more severe or complex sprains? ....................................................... 10
Q. What does it mean to injure cartilage? ............................................................................. 11
Q. Is exercise good for ankle injuries, or should I just rest? ................................................. 12

Greg Dea- Sports Physiotherapist at BodyFitNT Ph: 8981 2886
Sports and Spinal Manual Therapy, Elite Performance-Targeted Exercise Rehabilitation, Sports
Specific Musculoskeletal Assessments, Western Acupuncture and Dry Needling
Q. So if too much rest is bad for cartilage, what sort of exercise should I be doing? .......... 13
Q. Does having weak ankles make me more likely to get an injury? ................................... 13
Q. What if I’ve got arthritis in my ankle? ............................................................................. 14
Q. Can I do too much exercise for my ankle injury? ............................................................ 15
Q. Can I resume normal activities straight after injury? ....................................................... 16
Q. How is an accurate diagnosis of an ankle injury made? .................................................. 18
Q. What can be done to help injured ankle cartilage? .......................................................... 20
Q. How long do they take to recover? .................................................................................. 21
What now? ........................................................................................................................... 23
DOCUMENT TERMS OF USE ........................................................................................ 24
The Bad News
First let me tell you the bad news.

1. If you play sport, expect an injury of some sort.
2. In fact, expect a lower limb injury more than anywhere else.
a. The lower extremity is the most common site for soccer injuries, accounting for
64-88% of all injuries1.
3. Then, expect that the ankle and its ligaments be amongst the most likely joints to be
injured.
Figure 1 Soccer girl rolls her ankle. © Julie Johnson. From iStockPhotos.com 2008
1
(Surve, Schwellnus, Noakes, & Lombard, 1994)
a. Two recent large-scale studies in the USA revealed the ankle to be the most
common injury in high school2 and intercollegiate athletes3.
b. Estimates are that as many as 1600 ankle sprains will occur every day in the
Netherlands, totaling 600,000 per year4 with over 1.8 million ankle injuries per
year at 5,000 per day in the United Kingdom5 and 23,000 ankle injuries will occur
in the USA every day, or 4,000,000 every year6, costing the USA an estimated
$4.22billion in 20087.
4. Expect that the ligaments will not be significantly healed for at least 6 weeks, and even
after 3 months, a moderate percentage of you will still have some laxity and instability8.
5. Also expect a good chance of injuring your ankle again. Ankle sprains inevitably lead to
a reduction in the ability to dorsiflex, which is the action of bringing the foot towards the
shin. This movement is essential for lunging. A reduction in ankle lunge testing range of
movement is associated with an increased risk of ankle injury9. Re-injury after lateral
ligament sprain has been indicated at as high as 80% of the population10.
2
(Fernandez, Yard, & Comstock, 2007)
3
(Hootman, Dick, & Agel, 2007)
4
(van Rijn et al., 2008)
5
(van Rijn et al., 2008)
6
(Ashton-Miller, Wojtys, Huston, & Fry-Welch, 2001)
7
(Curtis, Laudner, McLoda, & McCaw, 2008)
8
(Hubbard & Hicks-Little, 2008)
9
(Plisky, Rauh, Kaminski, & Underwood, 2006)
10
(Denegar, Hertel, & Fonseca, 2002)
6. Ankle injuries usually aren’t regarded as common causes of long term disability11 but
based on a questionnaire study of 648 patients with ankle inversion trauma, 16% of
patients reported ankle pain 7 years after the injury and 4% experienced pain at rest12.
11
(Kujala, Orava, Parkkari, Kaprio, & Sarna, 2003)
12
(Konradsen, Bech, Ehrenbjerg, & Nickelsen, 2002)
The Good News
Let me raise your hopes, with the good news. Ankle sprains can be stopped from happening in
the first place, but if it’s too late to help you prevent an ankle sprain and you’ve already suffered
an ankle injury, there have been documented cases of sprains up to grade 2 (out of 3, with 3
being most severe) returning to full sport in 10 days to 2 weeks13,14. We also know that you can
reduce the recurrence rate, that is, the chances of it happening again!
In the next section, I’ll answer the most common questions about ankle injuries, including what
happens, what gets injured and what it all means - because if you’re trying to get back to full
activity, chances are you’ll need to understand what is going on. And who better to explain it
than a Sports Physiotherapist.
Did you know?

There are 26 bones (or 27 or 28 if you count the small sesamoid bones under the great toe), 33
joints, 107 ligaments, 19 muscles and tendons in each human foot. The 52 bones in your feet
make up about 25 percent of all the bones in your body.
13
(Wise, 2001)
14
(Glasoe, Allen, Awtry, & Yack, 1999)
Frequently Asked Questions
Q. What is an acute ankle injury?
A. Acute injuries are those that have just happened, i.e. very recently. These injuries are very
common in active people and usually involve damage to the lateral or outer ligaments of the
ankle. These ligaments connect the shaft of the leg, or shin, to the first bone of the foot, called
the talus. The ankle is also known as the talo-crural joint, because it involves the talus and the
crura (or shin – which includes the tibia and fibula bones)
Q. How do they occur?
A. Injuries typically occur during plantar flexion and inversion (toes pointing down and away to
the inside from the shin). An athlete with a lateral ankle ligament sprain commonly reports
having 'rolled over' the outside of their ankle.
AITFL
CFL
ATFL
Figure 3 Torn ankle ligaments © Greg Dea 2008
Q. What is usually injured?
A. The anterior talo-fibular ligament (ATFL) is most commonly torn. The calcaneo-fibular
ligament (CFL) and the posterior talo-fibular ligament (PTFL) can also be injured. In high ankle
sprains, the Anterior Inferior Tibio-Fibular Ligament (AITFL) is usually injured.
Q. What is a ligament?
A. A ligament is a type of tissue that connects two bones. It has a small amount of elasticity
meaning it can stretch a small amount. When it is stretched too far the ligament partially or fully
tears.
Together, the three ligaments mentioned above, the ATFL, CFL and PTFL, make up the “lateral
ligament complex”. With more severe injuries, sub-talar joint (STJ) ligaments are also affected.
The entire ankle and foot must be examined to ensure there are no other injuries because
occasionally a bone around the ankle or foot may be broken (see below). It is not uncommon to
have an injury with pain and swelling to soft tissue on the inside of the ankle as well as the
outside. This occurs when the bones of the foot and the shin traumatically contact each other
when the foot rolls to the outside. The most common structure injured in these cases is the
tendon of the tibialis posterior muscle.
Q. What happens after injury?
A. Ankle injuries are nearly always associated with pain, swelling and difficulty weight bearing.
The swelling and movement problems lead to what is known as “joint dysfunction”. The ankle
has two types of movement – physiological and accessory. The physiological movement is the
movement that we can voluntarily do – that is, move our foot up and down (dorsiflexion and
plantar flexion, respectively). The accessory movements are those we cannot do voluntarily but
which occur when outside forces are applied to our ankle. In the ankle, the accessory movement
is known as a glide and the talus slides forwards and backwards underneath the tibia and fibula.
These are known as anterior glide and posterior glide and the implications of the reduced glides
are discussed further in the section under range of movement. In short, though, ankle injuries are
usually associated with a loss of movement of both physiological and accessory movements.
Occasionally a more severe injury suffers cartilage damage to the top surface of the talus bone,
and this presents as persistent pain on weight bearing and persistent swelling. The talus is located
above the heel bone, deep in the ankle, and joins with the shin above it to form the ankle joint.
These injuries need to be followed up with a doctor and further investigations are required, for
example, a CT scan or MRI scan.
Q. What is injured in more severe or complex sprains?
A. If you can imagine that landing on your foot and ankle puts a lot of pressure through the joint,
then picture this. Inside the ankle joint on the inside surface of both bones is a thin layer, about
1mm thick, of very low friction “cartilage”. This helps the shin and foot bones slide over each
other with minimal friction. When the shin and foot bones crunch against each other in a heavy
landing, such as when an athlete rolls their ankle, this layer of cartilage can be damaged. It does
not show up on x-ray, but usually shows up on a CT and/or MRI scan, and the extent of the
damage will determine whether the ankle recovers fully or not. It is definitely worth discussing
with your health practitioner the option to further investigate your ankle if it is not recovering.
Q. What does it mean to injure cartilage?
A. This is a big topic, so I’ll try to condense it. These are the key points:
1. It has been shown that movement and load may be used in a strengthening manner for
non-injured articular cartilage;
2. Once joint cartilage (known as articular cartilage) is injured though, it is less tolerant
to load immediately after injury;
a. This means weight bearing and even some non-weight bearing activities that
normally don’t cause joint pain may do so because of the decreased tolerance to
load after injury.
3. The decreased load tolerance of articular cartilage may persist beyond initial acute to
sub acute phases (sub-acute means after the first 72 hours of injury).
a. This means care with loading after this early phase.
I acknowledge that these statements might provoke more questions, so let’s see if I can answer
them for you.
Q. Is exercise good for ankle injuries, or should I just rest?
A. The straightforward answer is:
If you have an ankle injury, resting it for too long is bad for the cartilage inside the joint!
Some rest is important early on, but research has shown that too much rest is just as bad for
cartilage as having diseased cartilage.
In normal joints, a key player in cartilage health is a lubricating fluid between the bones, called
synovial fluid. The fluid is a mixture of carbohydrates, protein and fluid. It performs many roles
in the life of the joint. It’s worthwhile noting that non-movement, or immobilisation and disease
disrupt and deplete an essential part of cartilage, known as a proteoglycan. Proteoglycans are
proteins with complex carbohydrates attached to them. They are part of the fluid that lubricates
and nourishes joints, providing an extremely low friction interface between opposing cartilage
surfaces. The proteoglycan content of articular cartilage is disrupted and depleted in injury and
this affects nutrition and tolerance to movement and load.
We know that there is a need to move and load a joint to maintain its health and we base this
practice partly on the basis of knowing the effects of immobilisation of a joint.
With too much rest, the cartilage becomes weaker, thing, contains less proteoglycans and
more water15.
Similar changes occur in surrounding soft tissues, leading to a reduction in the joint’s range of
motion, tolerance to compressive and tensile loads, and torque generating capacity due to
muscular inhibition and weakness16.
15
(Norkin & Levangie, 2000)
16
(Norkin & Levangie, 2000)
Q. So if too much rest is bad for cartilage, what sort of exercise should I be doing?
A. If you are lucky enough not to have serious cartilage damage, you will be wise to follow a
gradual resumption of activity, such as provided in this book.
It has been shown that movement and load may be used in a strengthening manner for non-
injured articular cartilage.
Scientific research has shown that “regular running of moderate duration has been shown in a
number of animal models to increase the amount of proteoglycan present in the matrix of the
tissue”, thus probably increasing the strength against compressive loads of the articular
cartilage17.
Q. Does having weak ankles make me more likely to get an injury?
A. The answer is there is no evidence that having weak ankle muscles will predict ankle injury.
That doesn’t mean you shouldn’t strengthen your ankle muscles as much as you should improve
balance as part of a conditioning program for your activity.
17
(Saamanen, Tammi, Kiviranta, Jurvelin, & Helminen, 1989)
Figure 2 The ankle joint “hot” with pain, similar to that which occurs in osteoarthritis and chronic pain.
© Sebastian Kaulitzki. From iStockPhoto.com 2008
Q. What if I’ve got arthritis in my ankle?
A. Sufferers of arthritis are not exempt from doing ankle rehab. For those interested, I explain in
the next question and answer discussions how arthritis develops in the ankle.
Having arthritis shouldn’t necessarily be seen as the end of rehabilitation, or impact training and
competing however. There are examples cited in the scientific literature of successful returns to
running from diseases such as Rheumatoid Arthritis, with a 53 year old man returning to
marathon running.18 Not everyone has that goal, and not everyone has the goal of returning to
running at all. And if you never return to running but impact sport, you can still complete stages
of this program consistently and your ankles should be better off. If you aim to return to running
and you suffer from arthritis in the feet and ankles, it has however been suggested that sufferers
of arthritis not increase their running distance by more than 5% per week19. The key point here
is to know that the force transmitted through the body at ground contact in running at 10km/h is
18
(Bluestone, 1983)
19
(Allen, 1990)
2.8 (+/-0.3) times body weight (BW).20 So if you weigh 80kg (or 178lbs) running at 10km/h (just
over 6 miles/h) puts nearly 240kg (or nearly 540lbs) through your body at contact with the
ground. This figure rises at the ankle, to about 9-14 times BW, 7.3-9.5 BW through the knee
joint, and 5.2 (+/-0.4) BW through the hip. So, for those of you suffering from arthritis in these
joints, 10km/h running is going to stress them significantly. It is also worth noting that as well as
increased forces, there are also increased ranges of movement required at the hip, knee and ankle
in running compared to walking, so be sure your doctor or physiotherapist assesses you as having
an adequate range of pain-free movement. The altered movement of the body that can occur with
arthritis (altered biomechanics) can lead to injury when the body is overused, and the key word is
overused.
There is research in other areas of the body, namely the knee, that indicate a role for improving
strength improves the symptoms of osteoarthritis. Such research into knee osteoarthritis has
shown that quadriceps muscle (at the front of the thigh) weakness is a risk factor in women for
development of osteoarthritis, implying that knee strength training can prevent degenerative knee
joint disease21.
Q. Can I do too much exercise for my ankle injury?
A. The answer is yes. From a clinical perspective, one might draw on the above experimental
observations to simply deduce that exercise is of paramount importance in the health of ankle
joints. Caution is advised though, for the effects of excessive load are also described in the
literature.
20
(Westby, 2001)
21
(Bennell & Hinman, 2005)
“Cartilage subjected to constant compressive loading will creep and may undergo excessive
permanent deformation when subjected to loading during the creep phase. Cell death may
occur with rigid sustained pressure at focal points on the cartilage and permeability will be
decreased”22.
In injured joints, disruption to normal cartilage content, integrity and properties, such as that
which occurs following joint injury, prolonged immobilization, inflammation, infection and
indeed overused cartilage, implies that these joints are likely to require altered loads.
Physiotherapists are in a niche position to understand and apply the above implications.
Q. Can I resume normal activities straight after injury?
A. Whilst it is recommended to start a process towards normal activities, caution and support is
required.
Joint cartilage is less tolerant to load immediately after injury.
In tissue around the joint, known as the capsule, some of those same cells responsible for
production of certain cartilage components also produce enzymes that damage the cartilage. As
part of joint injury, inflammation, infection or prolonged immobilisation, such enzymes enter the
cartilage and damage it23. Experiments have shown that the damage is immediate in single
inflammatory reactions to synovial joints, lasting 5-6 days before repair begins again, with
restoration of normal cartilage proteoglycan content and biomechanical properties at 3-4
22
Walker, cited in (Levangie & Norkin, 2005; Norkin & Levangie, 2000)
23
Buckwalter at al, cited in (Ewing, Arthroscopy Association of North America., & Bristol-
Myers/Zimmer (Firm), 1990)
weeks24. This means that when an athlete injures an ankle the body goes into repair mode. This is
known as inflammation. If the initial injury is the only injury that occurs in the healing process,
then there is only one peak in inflammation, and it runs it course through a reactionary phase,
repair phase and remodelling phase. What this means for an athlete with an injured ankle is that
at least initially there is a decreased load bearing capacity of the cartilage and the cartilage may
not regain its strength for at least 3 weeks. As physiotherapists, we provide exercise prescription
that should be individually adjusted to account for such time frames.
The decreased load tolerance of articular cartilage may persist beyond initial acute to sub
acute phases.
Earlier I mentioned that damage occurs in single inflammatory reactions. Many times however
there are repeated twists or rolls after the first injury. Each new aggravation can cause a spike in
the inflammatory process, with more reactions (the first phase). The consequences of repeated
bouts of inflammation due to ongoing damaging stimulus are that these repeat damages can make
the cartilage weaker still, perhaps for the life of the individual25. For example, studies into the
effect of joint instability in canine knees (via cruciate ligament transection) have shown the
following events happen to cartilage after ligament injury26:
1. Cartilage disruption immediately after injury;
2. Later, however, the articular cartilage shows changes consistent with secondary
osteoarthritis
a. There is increased water content, increased synovial fluid content and
subchondral bone thickening.
24
(Lowther & Gillard, 1976)
25
Handley, in (Zuluaga, 1995)
26
Brandt et al, cited in (Norkin & Levangie, 2000)
Q. How is an accurate diagnosis of an ankle injury made?
A. The following guidelines for obtaining a diagnosis are up-to-date and based on information
from the Cochrane Collaboration, an organisation whose mission is “to ensure that patients
receive effective interventions for the best health outcomes based on up-to-date evidence, and
that healthcare providers have up-to-date and easy access to the latest evidence.”27
• Clinical tests include those for disruption of ligaments, and include the anterior drawer
test of ATFL function and inversion tilt test of both ATFL and CFL function. The
reliability of these tests has been questioned in recent systematic reviews28, and it has
been suggested that these tests alone are not sufficient to accurately determine the extent
of ligament damage because of the large variation in individual variation29.
• Radiographic tests usually include x-rays, but only if there is tenderness to touch at the
back of the fibula bone, or at the base of the 5th metatarsal, on the outside of the foot.
This is according to the Ottawa Ankle Rules.
27
www.cochrane.org
28
29
(Fujii, Luo, Kitaoka, & An, 2000)
Ottawa ankle and foot rules30
An ankle x-ray
ray is required only if there is any pain in the malleolar zone and any of these
findings:
• Bone tenderness at A
• Bone tenderness at B
• Inabilities to take weight both immed
immediately
iately and in the casualty department/clinic.
A foot x-ray
ray is required if there is any pain in the mid
mid-foot
foot zone and any of these findings:
• Bone tenderness at C
• Bone tenderness at D
• Inabilities to bear weight both immediately and in the casualty departm
department/clinic.
ent/clinic.
30
http://www.gp-training.net/rheum/ottawa.htm
et/rheum/ottawa.htm
Sports and Spinal Manual Therapy, Elite Performance

Performance-Targeted
Targeted Exercise Rehabilitation,
Rehabilitat Sports
Specific Musculoskeletal Assessments, Weste
Western
rn Acupuncture and Dry Needling
If the symptoms persist for a couple of weeks, a fracture may have been missed by the x-ray, or a
cartilage or bone-cartilage (known as osteochondral) lesion may have occurred (and this will
rarely show on x-ray) and a CT scan is recommended, as well as a supportive brace. If the CT
scan shows that there is a fracture, an orthopaedic surgeon should review the athlete. Usually
when the fracture fragments are not out of place, 6 weeks of non-weight bearing on crutches
followed by functional rehabilitation (such as the following rehabilitation program) has been
known to be sufficient for a good to full recovery.31
Q. What can be done to help injured ankle cartilage?
A. All is not lost for articular cartilage following injury or immobilisation. There exist strategies
of exercise rehabilitation that may enhance cartilage repair.
Continuous passive motion (CPM) of joints has been used in rehabilitative settings for many
years. This stems from research on rabbits that shows CPM to “enhance articular cartilage repair
after full thickness injury or septic inflammation to the tissue. The details of how this works are
not entirely clear, but the knowledge base continues to grow. Recently published research in
cattle joints showed that rehabilitative CPM stimulates biosynthesis of PRG4, or lubricin, a
cartilage-to-cartilage lubricant32.
Extending the literature search to human studies links CPM to post operative articular cartilage
repair, commonly in the knee and patellofemoral joints. Less is published about repairs and
rehabilitation following ankle cartilage injuries, but those that have been published cites
promising early results with low numbers of ankle cartilage repairs33.
31
(Bonvin, Montet, Copercini, Martinoli, & Bianchi, 2003)
32
(Nugent-Derfus et al., 2007)
33
(Dorotka, Kotz, Trattnig, & Nehrer, 2004; Petersen, Brittberg, & Lindahl, 2003)
In the knee studies, however, medical professionals in Scandinavia have concluded that CPM
was better than active motion at restoring hyaline-like cartilage to full thickness articular
surfaces34. The evaluating criteria were surgical outcome classifications based on Brittberg’s
original symptom scores of excellent, good, fair and poor for autologous chondrocyte
implantation (ACI) to the femorotibial articular surface of the knee joint (1994). The validity of
such a scale is unknown. In a later paper, Brittberg and colleagues summarised the results of
many years of treating patients with such implantation, stating that CPM, gradual protected
weight bearing and gradual closed chain exercise program is used as rehabilitation for extensive
cartilage injuries in knee injuries35.
Q. How long do they take to recover?
A. With the injuries being graded based on the degree of disruption to the lateral ligament
complex, return to sport varies. Clearly, injuries without cartilage and bone damage i.e. lower
grade simple injuries take less time. Some research has attempted to clarify the ligament healing
time –
“Significant improvements in mechanical stability did not occur until at least 6 weeks to 3
months after injury, but a moderate percentage of participants still had objective mechanical
laxity and subjective ankle instability”.36
If you haven’t had cartilage or bone damage, then whether your ligament has fully
healed or not, you can often return to play much earlier. In these cases, you should definitely use
protective taping or bracing (see below for further information on taping and bracing), and you
should definitely be cleared to play by a qualified health professional. There have been
34
(Alfredson & Lorentzon, 1999)
35
(Brittberg, Peterson, Sjogren-Jansson, Tallheden, & Lindahl, 2003)
36
documented cases of sprains up to grade 2 (out of 3, with 3 being most severe) returning to full
sport in 10 days to 2 weeks37-38. One of these athletes was placed in an immobilizing walking
brace for 1 week whilst the other was strapped and mobilized continuously.
Epidemiological research reveals some interesting trends.
1. In data collected over 5 seasons of women’s collegiate basketball, nearly a quarter of all
injuries in games and practice were ankle ligament sprains39.
a. Ankles were almost twice as likely to be injured in women’s collegiate basketball
games when compared to practice.
b. They are then more than twice as to be injured in pre-season practice when
compared to regular practice.
c. Nearly half of the ankle injuries occurred during landing.
d. Players with a previous ankle injury were 5 times more likely to suffer another
ankle injury.
2. Depending on the rehabilitation process, shoes worn, contact with another player, and
landing circumstances, the chances of sustaining another ankle injury are between
30% according to the above mentioned study and 70%40.
Recommendations from the collegiate basketball study mentioned above were that
“athletes with a history of ankle injury should be educated as to the increased risk after an
initial injury, should undergo proper rehabilitation, and should pursue preventive
strategies (e.g. Taping or bracing, balance training).”
37
Wise P, (APA Sports Physiotherapist). From Ankle Injury to Grand Final in 10 days. Sports
Physio magazine. Australian Physiotherapy Association.

38
(Glasoe, Allen, Awtry, & Yack, 1999)
39
(Agel et al., 2007)
40
(Hertel, 2002)
If you have had cartilage damage, it is not possible to define a return to sport time, if
returning to sport is possible at all. Don’t despair, though, returning to walking and higher levels
of fitness, including weight training is very likely.
So there you are – almost all you need to know about ankle sprains and rehabilitation!
What now?
If you’ve made it this far and want
to undergo a rehabilitation
program, make an appointment to
see Sports Physio Greg Dea at
BodyFit NT on 8981 2886 today.
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Ankle FAQ’s

All Your Questions About Ankle Pain

In the following report, I’ll answer the most common

Greg Dea, Sports Physiotherapist

All Your Questions About Ankle Pain Answered

The Good News ............................................................................................................................. 7

Frequently Asked Questions ........................................................................................................ 8

Q. What is an acute ankle injury? ........................................................................................... 8

Q. How do they occur? ........................................................................................................... 8

Q. What is usually injured? ..................................................................................................... 9

Q. What is a ligament? ............................................................................................................ 9

Q. What happens after injury? .............................................................................................. 10

Q. What is injured in more severe or complex sprains? ....................................................... 10

Q. What does it mean to injure cartilage? ............................................................................. 11

Q. Is exercise good for ankle injuries, or should I just rest? ................................................. 12

Q. What if I’ve got arthritis in my ankle? ............................................................................. 14

Q. Can I do too much exercise for my ankle injury? ............................................................ 15

Q. Can I resume normal activities straight after injury? ....................................................... 16

Q. How is an accurate diagnosis of an ankle injury made? .................................................. 18

Q. What can be done to help injured ankle cartilage? .......................................................... 20

Q. How long do they take to recover? .................................................................................. 21

What now? ........................................................................................................................... 23

DOCUMENT TERMS OF USE ........................................................................................ 24

Greg Dea- Sports Physiotherapist at BodyFitNT Ph: 8981 2886

First let me tell you the bad news.

Greg Dea- Sports Physiotherapist at BodyFitNT Ph: 8981 2886

Greg Dea- Sports Physiotherapist at BodyFitNT Ph: 8981 2886

Greg Dea- Sports Physiotherapist at BodyFitNT Ph: 8981 2886

Did you know?

Greg Dea- Sports Physiotherapist at BodyFitNT Ph: 8981 2886

Q. How do they occur?

Figure 3 Torn ankle ligaments © Greg Dea 2008

Greg Dea- Sports Physiotherapist at BodyFitNT Ph: 8981 2886

Greg Dea- Sports Physiotherapist at BodyFitNT Ph: 8981 2886

Q. What is injured in more severe or complex sprains?

Greg Dea- Sports Physiotherapist at BodyFitNT Ph: 8981 2886

Greg Dea- Sports Physiotherapist at BodyFitNT Ph: 8981 2886

A. The straightforward answer is:

Greg Dea- Sports Physiotherapist at BodyFitNT Ph: 8981 2886

Q. Does having weak ankles make me more likely to get an injury?

Greg Dea- Sports Physiotherapist at BodyFitNT Ph: 8981 2886

© Sebastian Kaulitzki. From iStockPhoto.com 2008

Q. What if I’ve got arthritis in my ankle?

Greg Dea- Sports Physiotherapist at BodyFitNT Ph: 8981 2886

Q. Can I do too much exercise for my ankle injury?

Greg Dea- Sports Physiotherapist at BodyFitNT Ph: 8981 2886

Q. Can I resume normal activities straight after injury?

Joint cartilage is less tolerant to load immediately after injury.

Myers/Zimmer (Firm), 1990)

Greg Dea- Sports Physiotherapist at BodyFitNT Ph: 8981 2886

Greg Dea- Sports Physiotherapist at BodyFitNT Ph: 8981 2886

Greg Dea- Sports Physiotherapist at BodyFitNT Ph: 8981 2886

Greg Dea- Sports Physiotherapist at BodyFitNT Ph: 8981 2886

Sports and Spinal Manual Therapy, Elite Performance

Q. What can be done to help injured ankle cartilage?

Greg Dea- Sports Physiotherapist at BodyFitNT Ph: 8981 2886

Q. How long do they take to recover?

Greg Dea- Sports Physiotherapist at BodyFitNT Ph: 8981 2886

Physio magazine. Australian Physiotherapy Association.

Greg Dea- Sports Physiotherapist at BodyFitNT Ph: 8981 2886

If you’ve made it this far and want

program, make an appointment to