Welcome back to the dancer blog! Recently we discussed the Os Trigonum. We went over
what it is, how it forms and the impact it can have on a dancer. This week, we’re continuing our discussion on injuries common to dancers with a breakdown of the ankle sprain. We will be discussing the anatomy of the ankle, the various types of ankle sprains as well as the grading system. We will also discuss how you as a dancer can approach dealing with an ankle sprain.
Ok, let’s start with the anatomy. The ankle joint is actually composed of three bones; the Tibia (your shin bone), the Fibula (a long thin bone on the lateral side of your Tibia) and the Talus which sits beneath the Tibia and Fibula and on top of the calcaneus (your heel bone). Together these three bones create the ankle joint.
The ankle joint is held together with the aid of several ligaments. To avoid becoming overly
complex simply understand that there are several ligaments that connect the various bones of the ankle to one another. Principally, there are ligaments that connect the Fibula to the Talus on the lateral side of the ankle, ligaments that connect the Tibia and Fibula together at the top of the ankle and ligaments that connect the Tibia to the Talus on the medial side of the ankle.
What this means is that there are essentially three types of ankle sprains that can occur
depending on which ligaments are involved. The first and most common ankle sprain is the
lateral or inversion ankle sprain. This injury occurs when weight is applied to an inverted foot
putting stress on the lateral ligaments. This sort of injury is common when dancers land from a leap with a sickled foot or roll out when attempting to piqué onto their supporting leg.
The next kind of ankle sprain is the medial or eversion ankle sprain. This injury occurs when the foot everts or wings out and stress is put on the medial ligaments. This injury is less common particularly in the dancer population due to dance placing a heavier emphasis on external rotation or “turn-out.” That said, landing improperly from a leap, such as landing on a winged foot or rolling in on your supporting leg, can readily cause this sort of injury in dancers.
Finally we have the high ankle sprain or “syndesmotic” ankle sprain. This is a rare ankle injury that occurs when a lot of force is put on the ankle in conjunction with external rotation which puts stress on the ligaments between the Tibia and Fibula. The part about external rotation should stick right out to you as this is something dancers do all of the time. The most common mechanism of injury for a high ankle sprain is when the athlete lands from a jump onto an externally rotated leg: or as a dancer would describe it, landing from literally any given jump in the book. It’s important to note that this injury is still pretty uncommon, even among dancers, as the ligaments involved are some of the strongest in the ankle. However, populations such as dancers do see an increased prevalence of this sort of injury.
So those are the various types of ankle sprain. Now before we move on, I do want to make a
note here that with any ankle injury, if severe enough, multiple groups of ligaments may be
involved. The degree to which they’re injured is classified based on a grading system: Grades I, II and III. A Grade I sprain means that the ligaments are overstretched but not torn. Grad II means that the ligaments are partially torn but not ruptured. And Grade III sprains means that the ligaments are ruptured all the way through.
Ok so now that we understand the ankle, how we can sprain it and how to grade that sprain,
what can we do to prevent such an injury or at the very least manage it once it has occurred.
Let’s start with prevention. Essentially, there are three big tips that healthcare providers like to point to when it comes to preventing ankle injuries, sprains or otherwise. These are; maintain strong ankle muscles and range of motion within the ankle joint itself, wear proper well-fitted footwear and similarly utilize braces and other compressive devices or clothing to aid in ankle stability. The last tip is often applied to those recovering from a recent ankle sprain as well.
So let’s see how that stacks up the dance. Tip one: maintain strong ankle muscles and range of motion within the ankle joint itself. That’s a big ‘ol CHECK! Ankle strength is huge in preventing ankle sprains, same with mobility. Strength and mobility go hand in hand and play off of each other. The good news is, dance is built around ankle strengthening and stability. Whether it's ballet, jazz, modern or any other technique, a lot of dance training emphasises ankle strengthening exercises. Just think about how often a dancer moves through a relevé position. That position is all about ankle strength and stability.
Ok tip 2: wear proper well-fitted footwear. Well this is where it really depends on the technique of dance that the dancer is engaged in. Techniques like hip hop, tap and social dance styles often use footwear that could be supportive of the ankle joint. However, techniques like ballet, jazz and modern generally utilize very minimalistic footwear or no footwear at all. So that makes this tip only so so.
What about tip 3: utilize braces and other compressive devices or clothing to aid in ankle
stability. This one is, in my experience, almost universally impractical. Dance costuming is kind of all over the place. You might be wearing anything from a three piece suite to biker shorts or even next to no clothing at all. Depending on the performance, wearing a brace or utilizing compressive clothing may be out of the question. Of course, when it comes to training, braces and compressive clothing is absolutely possible and should be encouraged when necessary.
Looking at these tips it should be easy to see that as dancers, we don’t have a lot of options
when it comes to injury prevention for our ankles. That’s why ankle strengthening and stability exercises are so so SO important for dancers. And like I’ve mentioned before, these exercises need to take into account how a dancer functions biomechanically. Otherwise, we don’t provide the support our ankles need in order to dance.
So what should you do if you already have a sprained ankle. Growing up as a dancer I’ve heard a lot of different ways to handle a sprained ankle. Anything from rest and stay off it to ignore the pain and work through it. Well, today I’m going to give you some advice as to what can actually help speed up your sprained ankle’s recovery.
You may have heard of the RICE protocol. This acronym stands for Rest, Ice, Compress and
Elevate. I like RICE… kinda. Research shows that rest and immobility over time actually make injuries worse more often than not. This is because when we have swelling pilus immobilization, chemical adhesions can form in our joints that restrict its range of motion. This can make recovery take longer and increase the chance of reinjury.
This isn’t to suggest however, that if you have an ankle sprain that you’re best bet is to r