Ep 385: Lateral Ankle Sprains Masterclass

I've heard my ups and my downs. Welcome to Episode 385 of the Physical Performance Show. During this episode, our host Brad Bia, sports and exercise physiotherapist by trade and training, sits down with fellow physiotherapist Lewis Craig to talk about lateral ankle sprains. A special thank you to our show sponsors, Pillow Performance is range of sports nutritionals and Pogo Physios' telehealth consultations. Pillow Performance have led new frontier in the sports nutrition industry through their micro-nutrition innovation, and as therapists who have spent their career working with endurance athletes managing injury, this one really caught our attention. You may have also recently seen Pillow launch some of their new product lines under the banner of Performance Health. Like all Pillow products, this expansion is designed to maximize those crucial hours outside of training and racing, helping you return to the start line in peak condition. 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Head to PillowPerformance.shop or for our North American listeners, head to thefeed.com and use the code OneWord Capital's Physical Performance for 15% off your first purchase. So, let's get into this exciting episode. Lewis Kray, welcome to the Physical Performance Show. Thanks, Brad. Good to be back. Technically, this time I was thinking about it. It's actually been since episode 1.09 with Matt Fitzgerald when I was last on the show. That time, stepping into the host's side of things to talk about what at the time was his latest book, How Bad You Want It. Okay. So good to be back. So it's a return to the show, that's been many years, this will be circa episodes late 300s. I just want to acknowledge at the start of this show, this episode, I should say, you've been a fixer of pogo physio for greater than 10 years now. You're a clinician that's got a brilliant diagnostic mind, a really structured clinical process and then pleasantly, and everyone wins when we get better as clinicians, you close to finishing your sports, masters through University of Queensland. How close to the end of that at this time of recording, are you? Last semester, so a couple of subjects to remain and should hopefully be finished by the end of this year. Exciting. It's been really good to go back into the program. Well done. I know the statistics of registered physios. I think there's about 50,000 physios, is that my 25,000? Two and a half percent of the industry will go on to become titled physios in their respective field in this case that sports and exercise, so you really do earn your stripes in terms of that extra output that you have, and I've seen that with your clinical progression over the years, to the point that you're in a hot seat today, lachel ankle sprains. It's a huge topic, one of the most burdensome for athletes at large and certainly the population in terms of musculoskeletal ailments. And clinically, we both know we're both seeing that you can either do it really well or you can not do it well and there can be consequences. We both presented it recently at a goal coast orthopedic evening for a bunch of GPs in the room and other specialists. We're going to look through some of the material that you'd prepared for that as a basis for this recording. So, Luke, we're calling this a lateral ankle sprain masterclass, but just starting off, what level of burden and how frequent or prevalent are these lateral ankle sprain injuries for athletes? Well, as you mentioned, like it's a huge burden, lateral ankle sprains are the most common musculoskeletal injury in sport. We see like a really high prevalence across field sports, across court sports, contact and non-contact, it really doesn't discriminate and it's a huge problem across the board that sometimes people will take really lightly. It's just a simple lateral ankle sprain, we've probably all seen someone have a quick ankle sprain, walk it off, they're back and playing, don't think anything of it. And then someone who goes missing for months at a time. So it can get the reputation for not being a big deal, but it is a real problem in terms of prevalence and a real problem for those that go on to get recurrence, which unfortunately looks like potentially 40% of people. So, four out of 10 people who have an ankle sprain go on to develop a chronic instability. That's a lot, it is a lot. And instability is just kind of one part of the problem. People often will have pain, swelling, stiffness, creptitis, loss of range of motion and lots of different impairments that go on, but the one that people are most worried about is its increased instability. Loo, there's that pervasive, and respectfully, I'd say naive view that it's just an ankle sprain. Like, she'll be right, that sort of we're recording in Australia, that Aussie sort of, like, she'll be right. And I think over the decades, pleasingly, people are starting to appreciate whether that's coaches or the athlete themselves and definitely the practitioner world that, no, it's not just an ankle sprain. And you have heard, as have I, many people, you know, amongst the sports industry communities, say, well, what do we do with someone sprains their ACL? We're all gathered around. What's the best management? Is it conservative? Is it surgical? What are the implications, short-term, long-term for this athlete? Yeah, we know that 40% of athletes can go and have ongoing problems. We're now starting to see that same rigor of clinical process and consideration applied to the ankle, which is pleasing. Absolutely. Like, I think back to my early, early uni training and having my first ankle sprain then, and even lecturers at the time, you know, one or two treatments like ankle sprain, that will be right. And my journey spraining my ankle at the time was definitely not that between, I think, finishing my uni degree and two years of being a physio, I myself had had basically half a dozen ankle sprains on both sides before I was like, I need to be taking this extremely seriously. And that sort of peaked my early interest into a problem that I personally experienced. And then for my own clients thought, we're going to be taking this more serious too. This is in a simple fix for people. People have recurrent problems, ongoing instability, and we need to really do better in our assessment and our rehab to help make sure that people don't experience what I did at the time and then don't have long-term problems with it as well. So you've got the professional know-how and expertise, but then you've also had that lived personal experience with the impact that's had on you and at the time of recording that's 2026, you just missed you, you know, you're three hour marathon target via whisker, the Gold Coast marathon. But over the years, has your recurrent ankle sprain concerned cost you time from running in other participation? Yeah, absolutely. And I think the side step into trail running, maybe it plays more into part there. You know, you're running around Narang State, Forest, Springbrook, around the hills, catch an unstable surface and then ankle sprained, you're out for two weeks and then rinse and repeat. So this is obviously a lot more rehab that I would do again looking back and that I do for my clients now and also more prophylactic measures that we take to try and avoid that happening, so bracing and taping which we can talk about a little bit later. And I know that Jay here, tell has been a prior featured expert on the show whose work will you know, you'll discuss no doubt as we do this session. He's sites where it's his literatures in the updated ankle instability paper that came out that year seems to be a bit of a magic mark. If you can make it through to a year, your risk of recurrence really drops. And then I think I recall reading that you're 50 percent or maybe it's more or more likely to have another ankle sprained for the first six months, it's really high. That year marker is really important. So 40 percent, like we said before, go on to develop instability within the one year. So that can be a feeling of instability that can be recurrence. It can also just be a feeling of giving way. And then there's also some more, a couple of studies that look at some of the predictors. So someone who at two weeks can't single leg land, so if a small step, 30 centimeters, can they land on one leg or can they perform a drop jump? Or can they step off that 30 centimeter step into a drop jump? It's kind of a line with predictors of those who go on to develop chronic ankle instability after a year. So it's one that we can kind of pick up on as an early measure, but also that year is a real important time point. And just those predictors, could you just outline those again, just clearly so there's I am. study from Doherty back in 2016 and they looked at a couple of different time points and one of the time points being two weeks post injury and they looked at those who couldn't couldn't perform a single leg landing so landing on just on one leg, stick in the landing and then those who could step off the same step on two feet and do a drop jump so quick jump off the ground and essentially those that couldn't do it were much higher risk of going on to develop chronic chronic ankle instability so if you think of most people that two weeks and you go oh this person definitely couldn't hop and jump there might be a really at risk population. So it's a nice little clinical screening tool to identify it. Blue assessment for these injuries, something I personally know over my years I've fortunately grown better at and it's a big broad topic. What are the key considerations for the assessment of a lateral ankle sprain and I guess by lateral we should probably point that out we're talking about your classic mechanism rolling over to the side. When we come to assessment we go what are the priorities at our assessment. Firstly it's to make sure that you should be treating that ankle. How you should treat that ankle appropriately first. Is it a fracture? Is it something that I myself actually need to treat or should I be referring this on? So I'm looking at rolling out the things that I better should hand over to an orthopedic surgeon or a sports doctor to run the show. The second thing is I want to come up with an accurate diagnosis. So I want to know what structures structure or structures because there is a lot in the lateral ankle have been injured because that's going to ultimately affect what we choose from a management perspective and some of the time frames were prognosis that we're thinking and then the third part is to alongside identifying our diagnosis is to pick up the impairments. So what are the things that we've lost early and lost along the way of our rehab that we're going to need to address to get this person back to 100% back to their sport, back to changing directions, cutting, hopping or in the case of someone who just wants to go out for an active walk. They've got to be able to still make sure they don't roll their ankle on the side of the curb. They might not have to chop and cut and change directions. So assessment, those three parts, exclude the red flags or the fractures, the nasty things that we need to hand on to then go through our clinical test for an assessment and then three, okay, our assessment to figure out the impairments that we need to address. So the three parts to that assessment that are key and clinically and I think the athlete would identify, the practitioners certainly know this, coaches appreciate this but the better quality of the assessment, the more likely there's an accurate diagnosis, an accurate diagnosis just to forwards a smoother rehabilitation journey, less time spent, less time loss to training to sport, less mental burden, less dollars spent. It's just so key. And maybe we just explore those three components for the assessment. So Lou, with that first component screening for things that need referring on, what are we talking about fractures? Yep. So firstly, getting the person to tell you how it happened. So we want to kind of gauge the velocity of it. So was it really high speed? Was it from a height? How much force was involved to kind of gauge, like how much trauma should I expect from this? If we're looking to exclude fractures, we often use the Ottawa ankle rules. So can someone basically walk away from their ankle sprain? It's a really positive sign. The inability to weight bear is something that we really initially want to flag as a concern. And then if we're poking on their ankle, so the lateral malleolus is one spot. So the outside of your ankle, the big bony bit, your fibula on the outside, similar on the inside, your medial malleolus, and then on the lateral foot, the base of your fifth metatarsal. And that's a high wrist sight. So we do want to make sure we're not sore there. And then basically the opposite on the inside of your individual. So there's a couple of key bony landmarks that we're trying to make sure aren't sore. We want to also understand the velocity and the impact of the force to kind of gauge whether there's a high risk. And then there's also some clues in what we see at the foot. So is there a hematrosis? Is there a lot of bruising? Does that swelling come up really initially? And is the patient walking into the treatment room on day one, five, twelve after seeing you? So we want to try and rule out a fracture and ask ourselves if this person needs imaging if they haven't. So X-ray or MRI. Great. And then as to that second part of a, you know, the reason why assessment's a good assessment. So key, the differential, I guess in clinical terms, we call it a differential diagnosis or in simple terms, what is it? What have I done? What's the injury? This is quite difficult because there's many different presentations and subcategories of a lateral ankle sprain. Maybe you can just share some of those key things or diagnoses that can be incurred. Yeah, absolutely. And I think the important part about knowing the different areas that can get injured is that each of them has sort of subtle to more moderate to more severe implications for prognosis and things that could go wrong if they're not appropriately managed. So I found myself a foot and an ankle. I think it's probably a little bit easier just to kind of point through some of the structures as we go. So this one hasn't got a lot of our ligaments on there, but our typical ankle sprain, that's our lateral ankle sprain. So we catch the edge of the surface and we roll our foot outwards. So we get immediate pain on the outside of our ankle. So the primary restraint and the first one, we often sprain whether our foot's completely flat or we're a bit more up on our toes, is our ATFL, our anterior tailo-fibular ligament. If the speed, the falsity, the force is a little bit higher, then often what can come with it is the next one around which is our CFL. And basically we have some clinical tests as clinicians that we use to try and assess the laxity or the stiffness in that ligament and compare it to the other side to help gauge whether it's a small strain, hasn't been strained at all, or it's a complete, complete rupture. And similar for our CFL. ATFL and our CFL are our most common and 70 to 80% of our ankle sprains. They're the more bread and butter ones that we're typically used to seeing. From there, we also want to look at some of the other structures around the lateral part of our foot. We've also got our perineal tendons that wrap up around the outside. We can get tino-cyne avoidus of the sheath of that, the perineal tendon. We can also get split tears along the tendons of the outside as well. So we want to palpate around there and also test the loading of our perineal, so turning our foot outwards for our symptoms and where someone gets their pain. There's a couple of areas of not-to-miss. We have our bi-ruficate ligament, so why shaped little ligament on the outside of our foot? This is often more of a midfoot sprain, but can occur without typical lateral ankle sprains and can occur also when we twist the forefoot with a fixed ankle. People often present with localized pain and swelling more towards the outside of their foot and lower down. As a clinician, we need an indexes suspicion to make sure we do the proper clinical tests, but be that we're looking where that swelling is and getting someone to report where their pain is. We want to make sure that they haven't got a bi-ruficate sprain with it. Then even though we're talking about our lateral ankle sprains, we can still get medial symptoms, so symptoms on the other side of our ankle. So when we get a high velocity lateral ankle sprain, we can actually partially tear our deltoid ligament on the inside. Now that's a much thicker, stronger ligament, and it has a much more important stability role. So we want to make sure we're not missing tears of the inside of our deltoid ligament and there's clinical tests to do so, and we want to make sure that we support and offload that really nicely early. Now when someone says they've also got a lateral ankle sprain, they might not actually have a lateral ankle sprain mechanism. So we need to get clear as a clinician what their foot and ankle actually did, because sometimes what they're describing is a different twisting force, and that again can injure the deltoid, but can also be your typical cindus-mosis injury. So their foot's planted and they rotate outwards, and it can sometimes happen with a typical lateral ankle sprain, but is much more common. So our cindus-mosis, our A-I-T-R-F-L, can occur, and we can get different grades. So grade one, we're not too concerned about, but grade two, A and B are a really important pick-up as our grade three, because they can often be our surgical, surgical cases. So we need an indexes suspicion from the mechanism, and then we need a cluster of clinical tests, our squeeze test, our dorsiflexion external rotation test, and for the non-clinetician, they're probably not too important, but if we're trying to wait there and our knees coming over our toe and we're getting high lateral ankle pain, then that's another clinical test and sign that we want to be thinking about our cindus-mosis. So that's kind of a round-the-room structural overview of some of the different ankle sprain injuries. It's a big area, it's huge, right? And so many that I've missed some, including like your tailored dome, and that's your one where you fall from a high and we get pain at the bone at the joint and again one that can be easily missed on an X-ray and can really hold up our rehab not to mention nerve injury as well. So yeah, big complicated area. I think one thing that jumped out to me just with my clinical life thus far is just that importance of the athlete being able to be clear with the practitioner on the mechanism and you know I think sometimes when you're trying to take a history and you feel like you think you've got it but you're not 100% sure I've learned over the years just to be like no I need to be 100% clear and oh often where they can like can you try and demo what you were doing and sometimes it's not until they actually get up and try and demonstrate depending on their level of function that you oh okay that's different to how I'd envisioned I'm so pleased I looked at that because he's what we actually might be dealing with and not what I was thinking initially so that's pretty key absolutely and the clinical test Lou I mean there's many but you've touched on a few and the audio form doesn't really lend itself nor does this is set into going through those but if you if you've incurred any ankle sprain be sure to be working with someone that's experienced in the field and can run through those tests from a diagnostic point of view the other reason that we put a premium as practitioner's on a good assessment Lou is to identify what you termed as impairments so can you share what that means and why that's important yeah so we have some good clinical guidelines as a good consensus the roast assessment which roast consensus which talks about all the things that we as physios in a lateral ankle sprain should be assessing these include things like our swelling our range of motion our joint glides our special tests balance strength power probably late stage and we need to make sure that we're thinking of all the different components that can get impaired for lack of a better word when someone has an ankle sprain because if we're not assessing all these different areas and measuring them then we actually don't know a) what's normal and b) what their sort of so what their baseline is and then we need to make sure that we're getting them back up to where they should be if not beyond that for return to play essentially I guess it's the the quality of the the job done to identify impairments largely predicts the outcome of the athlete if something's missed something will be missed less likelihood to have a full and satisfying outcome those categories of impairments Lou I know I personally will like group those impairments into the three groupings that Jay here tell with his updated model of chronic ankle instability put forwards and the scientific terms but pathomechanical impairments motor behavioural and sensory perceptual what do you use clinically do you sort of work through that same framework with that in your mind as you take an athlete through their assessment looking for these impairments or do you something different no like that model is really good and depending on where someone is in their ankle sprain history sometimes it's even worthwhile bringing out the graphic and showing someone that this is how complicated it can be and this is the things that we're actually picking up for for you if it's someone's first time that might be a bit scary but and when we walk that line as a clinician to go I don't want to scare this person into the risks of instability but I do want them to take it seriously to make sure that they address all the things that need to address so they don't end up back here so they don't end up with another ankle sprain so I'll use Jay Herzell's model I probably won't always use those words for the patient but we'll kind of assess the joint assess the range of motion assess the laxity assess the pathomechanical aspects of the joint then we look at the sensory impairments so things like your balance your proprioception how someone's moving and then we look at more the the modified the motor outcomes so someone's strength you know calf strength lateral ankle strength someone's power and not just their ankle but their whole kinetic chain as well so leaving no stone left unturned a good assessments of thorough one I know clinically here at Pogo you know we have an hour for an initial appointment unless a return patient with a new presentation and we can get that done in 30 minutes but if you're doing it thoroughly often can use every minute of that right but I think something important you said that not to scare a patient or an athlete but it's our job as practitioners to inform them and it's always how we deliver the information it's key information for people to have and I guess some of those tests you know people would likely have done things like the needle wall test the lunge test calf raising at the right point I think in clinic a lot of the sports based practices we use things like the handheld dynamometers to assess force production into eversion and inversion positions anything that you've found in recent times that some of you must do tests that you like to include looking for impairments if you think about all those things that we've kind of listed it's nice to give them to people as return to sport or progression criteria so we put a number on your 30 second balance test okay yep you should be able to do that with your eyes open very early okay can we do it with your eyes closed can you do it with neck rotation side to side can you do it on an unstable surface so we want to use all those different domains as progression criteria throughout someone's rehab and importantly then to give them the tick of approval that they can get back to their activity from terms of like particular tests so we just talked about balance and the different sort of stages of balance if you will so eyes open eyes closed unstable unstable surfaces looking left to right and then you're adding in different objects perturbation so that's kind of one element from a strength perspective we're looking at inversion eversion again we're looking in comparison to the other side but also if that person's been really inactive for two weeks then maybe that's not a great comparator and we actually want it just to be better we also look at the calf have they got good calf raise endurance so we need a minimum 20 calf raises single leg on the metronome like you said ballet quality one beat up one beat down to get to that run stage we also want to look at sort of six and eight max calf strength at later stages and then probably jumping a bit too far ahead but there's power tests as well sort of triple hop tests six meter crossover hops and then a really good one is just a sort of timed 30 centimeter lateral hop so can they clear two it's a tape 30 centimeters apart and then what are we getting for time are we better than the non affected side are we getting close to sort of 50 reps over 30 seconds so having those objective markers can I think motivate patients and athletes going through the journey and also help the practitioner make decisions around readiness for sport and exposure to whatever they're trying to get back to and so the impairments really see the rehabilitation efforts where are the big big rocks what are the small rocks and Lu in terms of assessment is anything you add in terms of the relevance of like questionnaires things like you know the you know clinically we might use the cumble and ankle instability tool the Kate as it's abbreviated to any tips you share around the use of those and when they're appropriate yeah every patient so a cumballon for everyone it probably better captures instability for those that have had more longstanding foot and ankle trouble there's the farty or the fam f double a m which kind of just captures a few more domains but the the cumballons probably the best to capture feelings of instability and and every patient through the door can benefit from that it's just a an extra step to understand that we're not missing anything with our with our assessment and our return to play criteria and planning and planning yeah and Jay hotel talks about that dichotomy of ankle instability people cope or they won't cope and I know they use some objective numbers for like schools on those tests to sort of flag the group that might not be coping alongside their reporting of symptoms so I think if you've been badly in ankle sprains and maybe haven't filled in a question air like that it might be a good thing to look up CAIT you'll find it online fill it in find out what score is see what that means also also tools also tools we love it tools and I go for just just a quick easy one people get there be back initially the gamifies it the gamifies the rehab can I get a bigger score next time I do it I find it can be quite motivating motivating let's go into rehabilitation a big topic obviously it's always who should be always individualized key considerations heal who I guess you've mentioned the importance of a you've mentioned the burden of this problem if it's not managed well the importance of assess an assessment to develop an accurate diagnosis to make sure we don't need to we being practitioners rule on to a different practitioner type or send for a scans and the importance of identifying these impairments now have found these impairments we need to get that athlete back out there on the pitch the field running one of the considerations what do we do I think the first step in in my management typically is protection and appropriate loading so we come from the diagnosis and we land on okay how do we best manage this in the short term and often that looks like some degree of protection to the injured tissue and a grade three ankle spray and really swollen first time very painful that they might actually do really well in a boot. I think a moon boot for someone who's having difficulty weight bearing is a really nice easy starting point even if it might just be three days so the first sort of step is how do we protect the right tissue so we've talked about some of the differentials so like the deltoid ligament, the bioruficate so those types might better benefit from an orthotic in the boot or some like load eye taping to make sure that we're taking extra pressure off those structures as well and again similar for ascenders Moses so we want to first make sure that we're not stretching that pathological tissue where it's already loose and try to get some early healing and scar formation but we also know it's for the low grade ankle sprains where we are safe to still walk out of a moon boot if it's a grade one two but we still want to protect it from sprains so an ASO angle brace is a really nice easy option just to lace up stabilizer for our ankle get them pretty much from any pharmacy amazon all over the place at the moment and you typically will see people playing netball basketball in them quite comfortably as well so my first step is okay what's our diagnosis okay now how do we protect that tissue and then how do we get the appropriate early loading in and then that flows into okay now I'm addressing these impairments that are coming with it and we're talking about your typical lateral ankle sprain here not so much is syndesmosis management or some of these nuance just to we'd this would be another couple hours of exploration next stage I know I believe you work from the Vincencinotype framework the strength stability mobility phase correct yeah so everyone can come up with a lot of practitioners who come up with different ways to kind of sort of break down the different phases often that protection and then we get into early loading them in that early loading phase we've got some strength components we've got some mobility components and we've got some stability components so at its most simple that's range of motion balance and strength and so the bane of most people's not most people but a lot of people post ankle sprain and especially post surgical ankle surgery is getting dorsi flexion back so that's the knee over toes movement it's a really important range of movement and if we're immobilized for a long time or we've got a big source while an ankle it can be really hard to get that back so one of the first things we're focused on as practitioners is how can I appropriately try to address that there is a really complicated but neat infographic from Torillon it talks about you know where is someone restricted calf front of ankle lateral gutter posterior like is it because what we do to try and address that restriction depends on what's what's causing it and often early it's just swelling so we're trying to address that so we're addressing mobility early we're trying to do the appropriate strength so that might be double at calf raises that can be lateral e-version so turning your foot outwards into a ferro band and then we're also doing the appropriate balance exercise which is often singled like balance eyes open at this point yeah with lots of progressions rise it goes so many progressions yeah you're only limited by imagination and the sport that they play and and people like to get a ball in their hand or a stick depending on what they put their sport is earlier earlier they're not so if we can you know integrate it in because sometimes it isn't super exciting but we do know it's really important and if we can show people that they aren't perfect then we can keep them keep them challenged through their rehab and let's say sound athletes return to play and I know that's a broad discussion there around rehabilitation efforts but they're directed at the individuals impairments which once again have come from a good assessment hopefully we talk about you know prevention what need what role is there for preventative efforts ongoing and this can include exercise or perhaps brace in how do you structure that in terms of your clinical process and advice to your patients so if we get to a late stage rehab where we've improved our strength we addressed our impairments from balance mobility and we've done our hopping change direction we're basically passing our return to play criteria then the late stage exercises that they're doing we want to try integrate them within their normal week so if you're usually doing two days in the gym three days in the gym you're doing some field training then we want to try work our exercises at the late stage into whatever they're doing so that then becomes a ongoing part of their management and we'll become a preventative form of training for them so that secondary prevention or tertiary prevention trying to prevent again so we try to keep their late stage exercises in their normal week and then alongside that then we often try go for taping or bracing so really good robust measures to prevent reoccurrence is it's really hard to spray your ankle with it's really well strapped or with an appropriate brace like that sort of ASO style lace up ankle brace we talked about again if you're landing in basketball on someone's foot with a high force then again sometimes it doesn't matter what you do it is hard to prevent those type of injuries but it's a simple step that someone could do post ankles brain to try and avoid reoccurrence taping and bracing and it's in the athletes best interest to avoid recurrence for not only the impact it is in their short term view of I can't do sport I'm off injured but also and I'm in my 40s now and you start to really experience some of the legacy sporting injuries that you might have accrued in the decades to get to I certainly have with my knees are sore but I've clinically seen the 40 plus year old often soccer player or basketball player and they've started to develop you know the effects of joint osteoarthritis whether that's the main ankle joint the Taylor career joint or the subtailer joint from sometimes not managing these ankle sprains let basic lateral ankle sprains well over time the most the majority of ankle surgery with post-traumatic arthritis are from ankle sprains so that is a real possibility in a real sequelae I was early in my career thinking about all the ankle sprains I had and seeing some people having ankle fusions and ankle replacements and they all saying oh yeah it started with ankle sprains and I'm trying to compartmentalize that and go yep they probably didn't do this and they probably didn't do that but ultimately their journey was yeah ankle sprains had a bunch got some osteoarthritis progressed over time and unfortunately ended up needing surgery from my own running when I was running trails I got to a point where I was silly for me to not quickly take my ankle it just saved me that two three four weeks out at a time that I thought was easily preventable just by adding a bit of tape or a brace I think it just comes back to ankle sprains our import that shouldn't be take they should be taken seriously assessed thoroughly and treated appropriately if this is not just something to push under the carpet and get back out there as soon as you feel okay well it's a big topic what would be in bringing this to a close your top the top mistake you see athletes themselves making when it comes to managing their lateral ankle sprains the biggest mistake both frustrating mistake you see I think once someone gets running it's very it's such a momentum generator but you can run in a straight line really well and have really considerable deficit still so I wouldn't say it's a pet peeve but once someone gets running and they think I'm good and I probably as a clinician haven't done my job well if I've got to return to running and they're convinced they're okay I really like to make sure that they know at that return to run point what other potential deficits they still have and they still should really chase so power changes direction cutting they still might be missing some a little bit of ankle range they still might not be as stable as they could be and they still might not be taking those preventative exercises seriously about continuing them from a long-term perspective so I think it's that running time point where people go I can I can run now and it doesn't feel so bad and then thinking that the job sort of done done yeah and you could be led by you you hopefully sound thinking clinician to not get away with that for their own sake and it comes back to education doesn't in communication Lou if you could boil everything you've learned to date in your clinical career about managing lateral ankle sprains into one piece of advice what like that top tip what would that top tip be for lateral ankle sprains specifically just to get them assessed like you have an ankle sprain get it assessed understand what you've done and understand what impairments you might have and what you need to do to address it maybe forward so I think just a just an assessment for someone who's had an ankle sprain no matter how minor is a really the sort of key stuff. Get it assessed. - Yep. - Lou, thank you for sharing around this topic. It's a, we're calling it a master class. We appreciate that there's so many areas that this could be further explored around or into, but I think that's been excellent. Thank you and you're the freshly appointed clinical lead here at Pogo Physio and for a good reason. And certainly if you're listening in and you've been battling with lateral ankle sprains, perhaps recurring, see your local practitioner. If you're concerned, you don't have access for whatever reason. Reach out to Lewis here at [email protected]. That are you and I know you'll be happy to help anyone with their questions. - Absolutely. Thanks for having me back on the show. - Thanks so much for listening to episode 385 of the physical performance show. And thank you to our host Brad Beer and Lewis Craig for your keen insights. - And of course, to today's show sponsors, pillow performances range of sports nutritionals and Pogo Physios online telehealth consultations. If you're an endurance athlete struggling with bone, tendon or joint related concerns out online telehealth consultations with Brad Beer or any of the Pogo Physio team are an ideal way to help you get back to your physical best. You can reach us at pogophysio.com.au.