Within the last week, the Eagles’ number one corner, Ronald Darby, and the Phillies’ outfielder, Pedro Florimón, both suffered an ankle dislocation. The most obvious concern of a die-hard sports fan is how long these players will be out of action, and from a physical therapy prospective, the answer, of course, is “it depends”.
An ankle dislocation is a rare traumatic injury with only 1% of reported dislocations involving the ankle joint. As such, there is limited evidence on prognosis and clinical management for ankle dislocations. This injury is most common in falls, motor vehicle accidents, and, sports. It usually involves a fracture to the bony structures of the joint, as well as ligamentous, neurovascular (nerves/vessels) and skin involvement. Medial displacement of the foot (foot rolling inward) is most common with this type of injury, as is the case of both Darby and Florimón.
In sports, an ankle displacement is likely to occur when an athlete is in a plantar flexed (foot pointing down) position, which is also the position that many ankle sprains occur in. You can see here that both athletes have their foot pointed down while loading the heel, as well as being overextended in their step, which places them in a more vulnerable position for this type of injury to occur.
The amount of time and the recovery of function after experiencing a dislocation depend on multiple factors, including neurovascular compromise; the joint(s) involved, and associated fracture(s). The two sports injuries mentioned in this article are examples of each extreme in terms of timelines of recovery. Darby is projected to be out for six weeks, whereas Pedro’s season has ended. Regardless of the timeline of recovery, physical therapy management remains focused on minimizing loss of function and graded return to activity.
If we imagine an uncomplicated ankle dislocation, such as is the case for Darby, physical rehabilitation goal number one is to reduce pain, and throughout the course of rehab, the athlete is going to let pain guide the treatment. With this in mind, as soon as the athlete enters the clinic, the PT is likely to begin with passive, non-weight-bearing mobilizations to the ankle in order to regain some lost motion that is likely after a period of casting. This will be followed by a progression to active motion and strength exercises for the ankle and foot, as well as motion and strength exercises for the trunk and upper extremity. Weight-bearing will be graded throughout the process, which is partially determined by the athlete’s ability to tolerate it.
Once the athlete is cleared to bear his/her full weight, rehabilitation can then begin to focus on more sport-specific exercises. These will likely target ankle stability, core stability, functional strength, and the ability to control movement (motor control). One might wonder, why is Ronald Darby returning to play so fast? From a physical therapy perspective, tissue healing occurs no more quickly for an athlete than for an average person. However, he is able to dedicate more time to his rehab, which ultimately improves recovery time. An important goal in tissue healing is to optimize the athlete’s environment so that healing can occur properly, and that is precisely what early and frequent rehab can do for a high-performance athlete.
Another worry from a fan’s perspective is whether the athlete will suffer a drop-off in performance or get re-injured. If rehabilitation is not executed properly, the athlete is at risk for both of these. Proper rehab must be consistent and, therefore, must include a continuum of care involving a system that tracks the athlete over time through a comprehensive array of health services. As such, physical therapists must communicate well with both the surgeons and athletic trainers.
Ideally, an athlete will not return to his/her sport until they can meet certain performance criteria. This should be extensive, not just a few simple tests, when determining if the athlete is ready. Physical therapists and the athletic trainer will play a big role in this decision-making. For more information on physical therapy treatments, please contact us at 3DPT.