Recurrent ankle instability can be a troubling issue for many netball players. It is commonplace in netball, where up to 29% of injuries sustained in netball participation have been shown to involve the ankle. Of this cohort, up to 47% of club and inter-league netballers report recurrent ankle sprains, of which 64% have been found to experience moderate to severe ankle instability. These numbers likely under-represent the true prevalence of ankle instability within netballers, where many ankle sprains may not be reported and subsequently progress into ongoing instability.
By definition, chronic ankle instability involves:
Recurrent sprains to the ankle can result in mechanical changes to the ankle itself, such as joint laxity or stiffness and inflammatory changes to the ankle. Changes to the strength of muscles within the calf and around the ankle, alongside weakness around gluteal and core regions. Certain regions within the ankle can also demonstrate a reduction in the available range of motion, thus causing restrictions in the freedom of movement of the ankle. Alongside this, many with chronic ankle instability exhibit a reduction in the proprioception and balance of the leg, therefore increasing the risk of a recurrent ankle sprain.
New research now demonstrates how these changes to the ankle can contribute to sensory and behavioral impairments. For example, loss of confidence or becoming fearful of recurrent injury can result in an increase in the guarding behavior to the ankle, potentially modifying movement patterns when landing or changing direction.
Alongside this, recurrent injury to the ankle can result in changes to the sensitivity of the structures surrounding the ankle, therefore influencing pain processing within this region.
Current management of chronic ankle instability is dependent on an assessment of the ankle and its specific impairments. For most, non-operative management is first attempted, with surgery reserved and decided upon on an individual basis. Conservative management typically involves the provision of an exercise program, including strengthening, range of motion, and proprioceptive exercises. Manual therapy can be helpful in those with reduced ankle range of motion. Ankle taping has also been demonstrated to be effective in improving ankle joint proprioception and improving functional ankle stability.
Mitchell Walker is an APA Sport and Exercise Physiotherapist with a special interest in the prevention and management of lower limb injuries. Alongside OPSMC, he currently consults within the Netball Victoria Pathways program with experience in both the Vic Fury and Under 19’s State Team programs. Learn more about Mitchell at https://www.opsmc.com.au/person/mitchell-walker/
