Issue 147

The ankle is a complex structure that consists of numerous bones, ligaments and tendons, any of which can be injured in an accident or as a result of damage from training. 

We’ll cover some of the most common injuries to the ankle and examine how they happen and some basic steps you can take to recover. 

This article is not a substitute for examination and treatment by a qualified medical professional. If you have an injury yourself, it is highly recommended that you consult a doctor, physiotherapist or osteopath for appropriate advice. 

HOE ANKLE INJURIES HAPPEN

Sports injuries typically happen in one of two ways. There are those that happen as the result of one particular incident. For example, you may twist your ankle as you try to defend a takedown, or someone might put a toe-hold on you too quickly for you to tap.

Usually, you are immediately aware that something is wrong. We call these ‘acute onset’ injuries. 

The other kind of injury that sportspeople deal with are those that creep up on you gradually, sometimes over weeks or months.

They begin as a minor niggle that becomes worse as you carry on training on it.

Sometimes the problem will improve with rest, but often fighters will complain that as soon as they start training again, the pain comes back. These are ‘insidious onset’ injuries.

COMMON TYPES OF ANKLE INJURY

This article will focus on the ‘acute onset injuries’: ligament sprains, fractures and tendon ruptures.

Of these, the most common by far is the lateral ligament sprain, which usually involves the Anterior Talo-Fibular Ligament (ATFL).

This typically happens when someone ‘goes over on’ their ankle. Ligament injuries are graded by severity a grade one injury is a stretching of the ligament, a grade two injury represents a partial tear, while a grade three injury is a complete rupture.

More severe ligament injuries will require immobilization of the ankle in a cast and may need surgery.

It is often difficult to tell the difference between a ligament sprain and a fracture of one of the bones in the ankle.

If you are unable to move your foot, have difficulty putting weight on your ankle, or there is severe swelling or discoloration around the joint then head straight to the ER for a full assessment. 

TREATMENT

If your injury does not require hospital treatment, there is a lot that you can do to improve your own recovery.

In the first two to three days following the injury, you should use PRICE (Protection, Rest, Ice, Compression, Elevation). By using this protocol, you can reduce the inflammation and improve your recovery time.

The sooner you can do this after injury the better.

Ice packs should be applied for up to 20 minutes every two to three hours. A bag of frozen peas, wrapped in a damp tea towel makes a handy substitute if you don’t have an ice pack handy.

Never apply ice directly to the skin.

REHALIBATION

Ankle injuries can often become recurring problems.

To avoid having a persistent ‘weak ankle’ that interferes with your training, it is important that you rehabilitate it correctly. 

This is best done in consultation with a sports injury professional such as a physiotherapist or osteopath who understands the demands of your sport.

An injury will often affect the way that you use your body, and without proper treatment and rehabilitation you may find that it can lead to future problems. 

For example an ankle injury may affect the way you walk, which in turn can alter the mechanics of your knees, hips and lower back. 

A rehabilitation program for a mild (grade one) ligament sprain might include the following progression. (as pain allows)

• Mobility exercises to restore range of motion

• Resisted exercises to restore muscle strength 

• Proprioceptive (balance) training

• Walking and running drills 

• Jumping and hopping drills

• MMA-specific movements and drills

Proprioceptive (balance) training is an important aspect of ankle rehabilitation.

This is all about re-educating the feedback mechanisms that allow your brain to accurately control the position of your ankle. It’s crucial for preventing the injury from recurring.

In the early stages of injury, these should be done with the advice and supervision of your therapist. 

The simplest type of proprioceptive exercise is to practice standing on one leg. (Stand next to a wall for support in case you need it.)

This can be made more difficult by closing your eyes. Once you can do this, you can improve further by using an unstable surface such as a wobble board. These are relatively inexpensive, and handy to have in the gym. 

Walking and running drills should build up from running in straight lines, to side steps, zig zags, figure eights and direction changes.

It is important to build up gradually to each new movement to avoid re-injuring the ankle. 

Jumping and hopping drills place the most stress on the ankle and shouldn’t be attempted until you are able to walk, run and change directions without pain.

The drills should begin with small up/down jumps and progress onto forward/back and side to side movements. Turns and twists can also be added. 

Finally, it’s important to work up to MMA-specific movements. Shadowboxing and pad or bag work allow you to test the ankle in a more controlled scenario.

Grappling-specific movements can also be drilled, for example by practising specific techniques then working against a partner who is giving you some light resistance before returning to full training. 

If you have any issues or concerns about your progress, then you should speak to your doctor or therapist.

You should also discuss your injury and rehabilitation plan with your coaches, so that they understand what stage you are at and what training you are able to do. 

Returning to training from an injury can be slow and frustrating for a fighter. Rehablitation may be boring and tedious but by doing it correctly you are likely to return to action faster, injury-free and prevent future problems.

Wobble boards are always useful to have around and come in a variety of shapes and sizes. If you don’t have access to one you can also simply stand on one leg on a pillow.

UFC CASE STUDY

Duane Ludwig vs Darren Elkins UFC LIVE 1

Duane Ludwig suffers a broken ankle in March last year at the UFC Versus debut in Broomfield, Colorado.

During the opening round of a preliminary matchup against Darren Elkins, Ludwig is taken down by his opponent. As he falls, his foot buckles underneath himself forcing his ankle to snap and the fight to be stopped after just 44 seconds.

Ludwig required three pins in his ankle and was on crutches for three months. 

In a tragically identical incident just two months later at UFC 113, popular Canadian middleweight Jason McDonald fell during his bout with Jon Salter. His leg twisted beneath him and his ankle severely dislocated. 

ANKLE PROTECTION

Anklets and ankle supports provide varying amounts of protection to the ankle joint and the bones in the foot.

They also take the sting out of a misguided kick, and help prevent cuts and abrasions on the top of the foot during prolonged pad work or mat burns this can reduce the risk of infection.

The psychological benefits of wearing anklets are also noted by many MMA fighters.

Offering stability and comfort, fighters are given that extra confidence boost that just may give them the edge in battle.

HOW TO APPLY A COMPRESSION BANDAGE

1) Use a cohesive bandage; available from most pharmacies, these are ideal for a compression wrap. The material sticks to itself but not to the skin underneath, making it easy to remove. They can be reused several times. A crepe bandage is another option but will need to be secured using tape.

2) Use the cohesive bandage to make a ring round the foot, starting by going from outside to inside across the top of the foot. Pull up on the outside edge of the foot. This prevents the injured ligament from becoming stretched.

3) Pass the bandage up and behind the lower leg from inside to outside.

4) Wrap the bandage once round the lower leg, and then pass it down to the inside of the foot to complete the figure of eight.

5) Keep wrapping, overlapping each layer with the last until the bandage is used up. Use light tension throughout, bearing in mind that it will become tighter with each layer.

The idea is to provide a strong compression of the area, but without cutting off blood supply. Keep checking the toes – if they turn pale or blue, reduce the tension immediately.