"I have weak ankles"

Ever sprained your ankle? More than once? Does you ankle feel loose, or weak, or painful on relatively innocuous incidents (like stepping on a loose pebble)?

Ankle injuries, particularly lateral ankle sprain, are one of the most common sporting injuries and most common presentations to physiotherapy.

Some people go on to develop a cluster of problems after an ankle sprain that can persist for months, years, or even become lifelong.

"Chronic ankle instability" is a (kind of scary sounding) term coined to describe this situation, where there are several overlapping elements:

An initial injury involving an ankle sprain leading to some or all of these:

• Mechanical problems with the joint - this may mean a ligament that tore and healed poorly, or a lack of motion in part of the ankle.

• Sensory problems with the joint - altered sensation, excessive pain, or a fear of movement.

• Muscle problems (motor control if you like) around the joint - reduced strength, power, balance etc

This 'perfect storm' around the ankle then leads to either recurrent sprains, or perhaps just perception of instability (the ankle may not actually get injured again, but feels like it is giving way). Sometimes a torn ligament can be a problem only because the other two factors are also present. Ligament tear severity does not always predict chronic instability.

Physiotherapy can step in at any stage of this process - prevention of initial injury, rehabilitation and management of initial injury, or picking out parts of the 'problem' ankle that can be strengthened or improved on.

Check out the video below for a slow-motion example of something we might assess in the clinic - hopping and landing are movements that need a lot of strength and balance 'skill'. Often these demanding skills are missed when an ankle sprain returns to sport - don't ignore them!