Thread by @RodWhiteley

@ChrisMBleakley kicking off the chronic ankle instability session #SportsScienceWeek @BarcaInnoHub bringing all the latest from the recent 7th International ankle retreat 3 days ago

One of the "big 6" injuries in soccer, while most injuries are classified as minor to moderate in terms of time loss, a worrying proportion go on to develop chronic ankle instability
6 candidates for risk factors to develop CAI

Our best interventions (from 74 RCT'S, 54 of which are positive), unfortunately these results likely due to p-hacking & most were not clinically meaningful.
Therapeutic exercise seems to be the only modality that has evidence - halving the risk of reinjury, BUT non athlete data

Of the interventions that worked, half of the time postural/balance exercises, then single plane strength
Most recent model is far more complex than this with many components not being addressed

The story so far

Most evidence for importance lies in a few domains

High jump is a great demonstration of the importance of all the joints of the foot involved in eversion & inversion
Check out the image on the right & the shoe/eversion

No chance for reflexes to help prevent an ankle sprain since they happen way too quickly

Restoration of sensorimotor function is a great reason to do early "hands on" treatment - PNF is a great option
NB: this is not to change arthrokinematics, it's to help restore appropriate sensory & motor function

Simple stepping down onto an inclined board reveals errors especially at larger angles of inversion

Strength deficits obvious target for rehab. Early on isolate, perform correct eccentrics, and concentric.
"foot yoga" is a good way to engage peroneus longus & relearn how to keep the medial column on the ground

Doing eccentrics at the ankle is difficult due to the complex nature of the tendon's crossing the ankle joint
Side lying, isolated with positional feedback

Great peroneal burner on the left & right here. High tension required - no place for yellow theraband here

Nice soft surface progressions here

Imprest to consider the medial and lateral ligaments in the transverse plane - "giving the talus a hug"

Great way to heavily load the intrinsics

Forward max vertical jump followed by a cut, case control study - huge variation in movement seen - eventually able to make 7 sub groups in the CAI subjects, but 12 "normal" categories
Some take aways though: landing more inverted, more stiffly, esp knee & hip

No need for proximal control to stop at the hip - think about the trunk

Think about ankle injury as a complex neuromechanical injury. Average rehab works for the average patient, but will have a ceiling effect with athletes.
Add some variability to get them away from landing stiffly in inversion with an inversion torque