Lateral Ankle Sprain series, Part 2: No Such Thing As A Minor Ankle Sprain

With all of the hype surrounding the upcoming Olympics, I felt like this was a great time to bring in some real life examples. This past week wrapped up the US Gymnastics and Track & Field trials – and what an exciting week it’s been. So far between Gymnastics, Track & Field, and Swimming it seems like in order to make the US Olympic team you have to start breaking some records.

Given that we are on the ankle sprain series, I wanted to draw everyone’s attention to the 200m Finals of the Track and Field Trials on July 10. Below is a video of the finals heat, many top contenders in the field vying for 1 of 3 spots on the Olympic roster. In lane 5, is Allyson Felix, the reining 200m Olympic champion from 2012. Prior to the 200m qualifiers, Felix had already qualified for Rio in the 400m, winning the 2016 trials a few days ago. Coming into the trials this year, Felix has been dealing with an ankle injury to her R leg after a misstep in a training session back in late April – forcing her to pull out of a couple meets in May and June. In an interview with her coach following the injury, he said “(The injury) is 80 percent better in less than a week”. I’m not sure that a grade 2 ankle sprain is 80% better in less than 7 days (some public education may be needed for this coach). Felix, herself, said “The speed wasn’t there” for her in the 200m trials.

If you’ve been keeping up with the news, you’ll know that Felix missed making the Olympic team for the 200m by .01s (what a photo finish), still running a blistering 22.50s. Take a look at the video below (excuse the woman yelling in the background):

The slow-motion play back begins at about 4:35. If you pay attention to Felix (in all blue, lane 5) as she’s pushing towards the finish line, you’ll notice that she does not get the same push with her R leg as she does with her L leg, she has asymmetrical strides bilaterally, and her hamstring prematurely contracts on her R side reducing her quad contraction that she needs for her push (leading to less hip extension as well).

Following an ankle injury, there is a change in neuromuscular activation and firing due to the body’s mechanism of protection. Peroneal activation is delayed, glute med activation is impaired, increased MTrPs develop in the  lateral gastrocs, increased activation of hamstrings. I’m assuming that with Felix being a high profile athlete, she’s getting/gotten some of the best rehab since her injury, but this just goes to show that even 2 months out, she is STILL dealing with the residual effects of an ankle sprain – grade 2.

Friel et al. found that not only is ipsilateral hip abductor weakness noted following an inversion ankle sprain, but that plantarflexion ROM is also limited on the involved side. This also means that the force that can be generated from the involved side is significantly less. As you can tell from the above video, that is exactly what happened to Allyson Felix in the 200m finals.

How many of you are reading this thinking: “She missed it because the other girls were faster” or “it was just bad luck”? Just a week ago, she blew away the competition in the 400m with a time of 49.68s. She had the speed for the 400m, however after 3 rounds in the 400m and 2 rounds in the 200m trials, by the time the 200m finals came around, she could no longer compensate and hide her ankle injury and it’s residual impairments.

On the flip side, she has been dealing with injuries (like most athletes) for a good part of her career, may also have chronic ankle instability. In 2010 she had to pull out of a meet due an ankle injury. She tore her hamstring in 2013 during the 200m event. Who’s to say that these past injuries did not contribute to her “misstep” 2 months ago?

Felix missed Rio in the 200m by .01s not simply because she didn’t have the speed. She didn’t have the most efficient movement pattern down the stretch. From the start, she was placing a lot of pressure on her R ankle – it’s her first “pull” step out of the blocks (she pushes off with her L). Down the stretch, she was not able to make the final push with her glutes and quads/gastroc-soleus, and the asymmetry of her stride decreased the amount of force she could generate.

For those who think ankle sprains don’t affect your performance, even months/years down the line: Allyson Felix missed the Olympic roster by .01s …. all because of an ankle sprain.

References:

Hertel, J. Functional anatomy, pathomechanics, and pathophysiology of lateral ankle sprains. Journal of Athletic training. 2002;37(4):364–375

Friel, K et al. Ipsilateral hip abductor weakness after inversion ankle sprain. J Athl Train. 2006; 41(1): 74–78.

http://www.globetrottingbyphiliphersh.com/home/2016/4/28/news-of-allyson-felix-misstep-sends-coach-into-brief-thankfully-despair

 

 

 

 

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