The anterior talofibular ligament (ATFL) is one of the primary stabilizing structures on the lateral side of the ankle. It connects the talus (a bone in the foot) to the fibula (the smaller bone in the lower leg) and plays a crucial role in maintaining ankle stability, especially during activities involving inversion and plantarflexion (toes pointing down and inward). An anterior talofibular ligament sprain, commonly referred to as a lateral ankle sprain, is a prevalent injury, particularly among athletes and physically active individuals.
Ankle sprains are one of the most common musculoskeletal injuries, with an estimated incidence rate of about 2 per 1,000 persons in the general population. Sports such as basketball, soccer, volleyball, and trail running report higher rates of ankle sprains. For example, the incidence in basketball players can range from 3 to 5 per 1,000 athletes.
There is also a very high recurrence rate for ankle sprains, with estimates suggesting that up to 70% of individuals who sustain an initial ankle sprain may experience recurrent sprains or develop chronic ankle instability.
There are many factors that contribute to such a high reoccurrence rate including:
An ATFL sprain occurs when the ligament is stretched or torn due to excessive inversion, or rolling inward, of the foot and ankle. This type of injury often happens during activities that involve sudden changes in direction, uneven surfaces, or awkward landings from jumps.
Normal Ankle Range of Motion Values:
The severity of an ATFL sprain can vary widely, and it is typically classified into three grades:
Grade I Mild Sprain:
Grade II Moderate Sprain:
Grade III Severe Sprain:
It is important to consider tissue healing timeline for a ligament. The ATFL is made up of primarily Type I collagen fibers which provide resiliency to stretching. There are also some Type II collagen fibers, elastin fibers, ground substance (Glycosaminoglycans and Proteoglycans), water and fibroblasts. Most ligaments in the body including the ATFL do not have a rich blood supply, which causes slower healing time. Ligament repair may rely more on scar tissue formation for healing. For these reasons it is paramount that rehabilitation protocols emphasize progressive and controlled loading to encourage safe healing.
Early Ambulation
Early ambulation, or the act of walking and moving around shortly after an injury, is an important aspect of the recovery process following an ATFL sprain. Early ambulation can provide several benefits, including improved circulation, prevention of stiffness, and faster recovery. However, it must be approached with caution and proper guidance to avoid further injury. Adapting and accommodating to the response to progressive loading is key in dosing the load and resistance during the recovery period. The ability to progressively change the external environment to add load on the ligament during ambulation with the proprioceptive REAXRUN treadmill is highly advantageous.
The REAXRUN is the world's first and only proprioceptive treadmill.
It performs sudden and unpredictable inclinations in all directions while running.
The belt has a patented 3d motion that can reach different inclinations and angles, forcing the user to react to constant change.
We prefer the REAXRUN over a traditional treadmill because of the dynamic unpredictability of movement. This allows for a greater recruitment of muscle fibers and provides a greater challenge to the ankle during the recovery process. The unique design of the REAXRUN is the perfect tool to create a safe environment to load the ATFL and help prevent recurrence.
The REAXRUN can be utilized to properly rehabilitate an ankle sprain by utilizing and manipulating the maximum +/- 11% frontal inclination to help restore ankle plantar and dorsiflexion as well as the maximum +/- 14% lateral inclination to help restore ankle inversion and eversion.
It is important to understand that the ATFL and lateral ankle structures will be loaded most in the extreme lateral (inversion) and decline (plantar flexion) positions so these values should be gradually progressed as the tissue healing timeline progresses.
The following is a sample rehabilitation protocol following an ATFL sprain with REAXRUN programming considerations.
(This sample timeline is dependent on the severity of an individual case)
Acute: 0-3 days
Subacute: 3-7 days
Early rehabilitation: 1-2 weeks
Advanced rehabilitation: 2-4 weeks
Return to sport: 4-6 weeks and beyond
The REAXRUN ATFL rehab progression can be manipulated in various ways including speed, duration, predictability, frontal incline, and lateral incline. The lateral incline percentage will apply the most load to the ATFL, followed by the frontal incline. It is safer to manipulate the frontal incline to challenge plantarflexion and dorsiflexion first then add in lateral incline to challenge inversion and eversion as healing advances.
Once the ligament has progressed into the early rehabilitation phase then the unpredictable environment can be unlocked within the REAXRUN to initiate safe proprioception training. Speed progression should be progressed from pain free walking, to jogging in the early rehabilitation phase and then to running and sprinting in the advance to return to sport phases.
It is important to assess the outcome of each training session to determine if progression to the next phase is appropriate. Responses that incur additional swelling, pain or instability should delay progression until symptoms resolve.
Finally, as the ligament advances into later stages of healing, the inclination, predictability, speed and duration can all be manipulated to mimic sport. Successful progression and continued use of the REAXRUN will demonstrate the ability of the ATFL to withstand sudden and unpredictable stresses seen in the sports environment.
If you are having chronic ankle problems and need help getting back to doing the things you love, reach out to us at Stretch Affect for a comprehensive and safe physical therapy rehabilitation program in San Diego.
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