ANKLE SPRAIN REHAB EXERCISES [OWEN FARRELL DISCUSSION]

I will start with an unusual ‘rehab’ intervention as it can go through all the stages – psychology! As with any sport, return from injury is a tough affair. Therefore the psychological impact of injury needs to be considered. Setting a realistic prognosis as early as possible to prepare the player for their journey can help. Goal setting/milestones can be helpful for the patient/athlete so they can see their progression. Integration into the team setting should also be a consideration e.g. The England captain should be able to join in with the entire upper limb strength training programme. This is an area that is perhaps neglected somewhat at amateur level sport however most professional athletes have access to psychological support. Physiotherapists certainly have a role to play here though as often we will be the ones doing most of the rehab and seeing the player regularly. It also worth pointing out that during this stage of rehab, he will be completing it with his club, not at international level!

If you think he’ll be resting up for the first few days, you’d be mistaken. Like all professional athletes, they need to remain top of their game, therefore changing their training immediately after injury is necessary. They need to maintain their cardiovascular function, their strength, coordination etc. With this lower limb injury, upper body gym training will still continue as normal. There may be some adaptions for standing exercises however he can continue training nonetheless.

Postoperatively, the first few days will focus on reducing swelling, pain and maintaining ankle range of motion. Simple movements of the ankle and knee, regular elevation and analgesia will all occur at this stage. The benefit of being an elite athlete is having access to a hydrotherapy pool. Once the wound is closed and healing well, it’s likely he’ll be in the pool completely with a combination of ankle mobility, strengthening and cardiovascular exercise. Another potentially useful piece of equipment, in this case, would be an anti-gravity or water treadmill that can be used in the early rehab stage. This allows the player to walk/run with reduced weight on the ankle and this can easily be progressed from 10% to 20% etc. another key aim of both hydrotherapy and anti-gravity treadmill training is to normalize the walking pattern (gait). As much as possible we want to avoid limping and altered biomechanics to minimize the risk of mechanical pains in other joints.

We can almost look at this as a building phase. We are trying to build the strength back up, improve mobility and coordination. And of course, avoiding significant pain during our rehab. This can be a lengthy phase of rehab dependent on the limitation that the patient presents with. In the England captain’s case, I would assume he progressed fairly well and had hopefully maintained a lot of his strength and power were given how quickly he had his surgery and how quick his prognosis was. If we were to see a patient with a severe lower limb injury that required weeks of non-weight bearing and bracing, the muscle wastage would be much more severe therefore this ‘building’ phase would be significantly longer.

• Return to full weight-bearing – if weight bearing is restricted. As emphasized in the previous stage, we want to ensure a normal gait patient before we progress to running.

• Return to weight-bearing strength training.

• Balance, proprioception and coordination training.

• Return to running – phased return via a return to running programme and impact programme. As strength building and control in the ankle return, the rehab plan will start to become more rugby focus and more functional.

• Start progression into sprinting and including direction changes.

• Sports specific drill e.g direct changes, high ball catching and landing.

• Then in this stage of recovery, we will start to see integration into team training on a phased return.

• Contact training - with rugby being such a physical sport, he will like to return to contact training on a 1 to 1 with coaches/physio’s/S&C – utilizing tackle bags and shields before progressing in rucking and mauling

• Strength testing, CV testing, speed, agility will all start to occur at the end of this stage to ensure the play is safe to return to play and full training