Dance Injuries – Lateral Ankle Sprain

By Dr. Evangelos Mylonas

A few weeks ago I had the privilege of attending the Calgary International Salsa  Congress. It was a spectacular show featuring some of world’s best salsa performers and instructors, local professionals, and dance troupes from all over North America. I was amazed at the level of competition and impressed by the quality of the production, the dancers skills, and the organization of the Salsa Congress itself. It was truly a world class salsa event. As I observed the dancers on stage, I couldn’t help but admire them for their passion and dedication to their art.

What is a Lateral Ankle Sprain

A lateral ankle sprain refers to an overstretching and/or tearing of the ligaments on the outside of the ankle. This usually occurs when a dancer jumps and lands improperly rolling the ankle to the outside. This causes the ligaments to stretch beyond their normal ranges resulting in a sprain (also common with runners).

Ligaments are tough, fibrous bands that attach bones to other bones. Their primary function is to stabilize the junction between two or more bones, commonly referred to as a joint. The lateral ankle is stabilized by three ligaments. These are:

• Anterior Talofibular Ligament (ATFL)
• Calcaneofibular Ligament (CFL)
•  Posterior Talofibular Ligament (PTFL)

Of these three ligaments, the most commonly injured during an inversion sprain is the Anterior Talofibular ligament (ATFL). The function of the ATFL is to prevent the talus bone of the ankle from moving forward in relation to the fibula bone of the ankle. For example, when a ballet dancer repetitively rises up on the toes to perform relevé (a heel raise) this places a considerable amount of mechanical stress on the ATFL as it resists the forward movement of the talus bone. If the dancer’s ankle starts to invert (roll outward) due to fatigue or a slight loss of balance while performing this movement, this predisposes the ligament to injury. Once the forces applied to the
ATFL exceeds its structural limits the ligament tears resulting in a sprain.

Grading an Inversion Ankle Sprain

Inversion sprains are graded based on how many ligament fibres have been torn and to what degree ankle joint stability has been affected.

• Grade I Sprain: A few ligament fibres are stretched and torn, but joint stability is not affected. There may be mild tenderness and swelling.
• Grade II Sprain: A moderate number of ligament fibres are torn (partial tear of the ligament) and there is usually moderate tenderness, bruising and swelling around the ankle. There is some joint instability upon physical examination.
• Grade III Sprain: There is a complete tear of the ligament accompanied by significant tenderness, bruising and swelling. The ankle joint is unstable

Fascia and the Ankle’s Kinetic Chain

All the structures of the ankle’s kinetic chain are bound together and interconnected by the fascia. More importantly though, we need to recognize that the fascia is much more than simple connective tissue. Fascia is embedded with neurological receptors that help coordinate muscle movement and relay important information regarding mechanical stress and joint position to the brain. Fascia is an integral part of our  body’s anatomy and it is plays an essential role in all human movement. Therefore, when treating an inversion sprain we need to focus on more than just the damaged ankle ligaments. Superficially, acute lateral ankle sprains tend to heal with time, however if you want to see a full resolution and properly rehabilitate the injured ankle, you have to address the ankle’s kinetic chain and its fascial interconnections.

Our Perspective in Treating Inversion Sprains

When we evaluate an inversion sprain (at Kinetic Health) we assess the degree of injury to the ligaments and to all the related soft-tissue (muscles, tendons, ligaments,  fascia and nerves) and bony structures (ankle, knee, hip, pelvis and spine) that are involved in performing, coordinating, and stabilizing ankle motion. As we’ve mentioned before in previous articles, we always look at the “big picture” not just the site of injury. This is especially true when looking at lateral ankle sprains. In most patients, we find that soft-tissue restrictions and muscle imbalances along the ankle’s kinetic chain often accompany the damage to the ankle ligaments.