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Ep 385: Lateral Ankle Sprains Masterclass
In episode 385 of The Physical Performance Show, host Brad Beer sits down with fellow physiotherapist Lewis Craig for a lateral ankle sprain masterclass. Drawing on material the pair recently presented at a Gold Coast orthopedic evening, Brad and Lewis cover the burden and prevalence of lateral ankle sprains, the three-part clinical assessment process, key differential diagnoses, rehabilitation phases, and preventative strategies including bracing and taping. The episode explores why lateral ankle sprains — despite their reputation as a minor injury — carry a significant risk of chronic ankle instability, and why a thorough, structured assessment is essential to a smooth recovery. Brad and Lewis unpack the different ligament and tendon structures that can be involved, the red flags practitioners need to rule out, the impairment categories drawn from Jay Hertel's model of chronic ankle instability, and how rehabilitation should progress from protection through to return to sport and long-term prevention. Show Sponsor: Pogo Physio also offers online Telehealth Consultations for endurance athletes managing bone, tendon, or joint issues — book online at https://www.pogophysio.com.au. And... PILLAR Performance is leading a new frontier in the sports nutrition industry through micronutrition innovation. Their Performance Health range is designed to support the crucial hours outside of training and racing, helping athletes return to the start line in peak condition. One of their newest releases is Collagen Repair, developed in collaboration with Gelita Laboratories and featuring the clinically trialled collagen peptide TENDOFORT. For 15% off your first purchase, head to pillarperformance.shop or, for North American listeners, thefeed.com and use the code PHYSICALPERFORMANCE at checkout. Pillar Performance continues to lead the way in sports nutrition through micro-nutrition innovation, now expanding into the Performance Health range. One of their newest releases, Collagen Repair, was developed with Gelita Laboratories (Germany) using a clinically trialled collagen peptide (Tendofort) to support tendon and ligament health in conditions like hamstring tendinopathy, Achilles tendonitis, shin splints, and patellofemoral pain. Head to Pogo Physio also offers online Telehealth Consultations for endurance athletes managing bone, tendon, or joint issues — book online at https://www.pillarperformance.shop (or https://www.thefeed.com for North American listeners) and use code PHYSICALPERFORMANCE for 15% off your first purchase.   Partners / links mentioned: Ortho Tools (Cumberland Ankle Instability Tool / CAIT): mentioned in-episode as the online questionnaire resource Contact: Lewis Craig — l.craig@pogophysio.com.au In this episode, you'll hear: Episode context: Lewis Craig's return to the show after being last on around episode 109, and his progress toward finishing his Sports Masters through the University of Queensland The burden of lateral ankle sprains: why they're the most common musculoskeletal injury in sport across field and court sports, contact and non-contact alike Recurrence risk: why roughly 40% of people who sprain their ankle go on to develop chronic instability, and why the one-year mark is a key risk-reduction milestone Early predictors of chronic ankle instability: the Doherty 2016 study on single-leg landing and drop-jump testing at two weeks post-injury The three priorities of assessment: ruling out red flags and fractures, forming an accurate diagnosis, and identifying impairments Screening for fractures: mechanism of injury, the Ottawa ankle rules, weight-bearing ability, and key bony landmarks to palpate Differential diagnosis: ATFL and CFL sprains (70–80% of ankle sprains), peroneal tendon injuries, bifurcate ligament sprains, deltoid ligament tears, syndesmosis injuries, and talar dome injuries Why getting a clear mechanism of injury from the athlete is critical to an accurate diagnosis Identifying impairments: the ROAST consensus and Jay Hertel's updated model of chronic ankle instability — pathomechanical, sensory-perceptual and motor-behavioural impairments Clinical and objective testing: balance progressions, calf raise endurance and strength benchmarks, and power tests including triple hop, crossover hop and timed lateral hop The role of patient-reported outcome tools: the Cumberland Ankle Instability Tool (CAIT) and FAAM, and why they're useful for tracking progress and motivation Rehabilitation framework: protection and appropriate early loading, followed by strength, stability and mobility phases Managing specific injury types: use of moon boots, orthotics, low-dye taping and ASO ankle braces depending on the structures involved Addressing dorsiflexion loss: why regaining ankle range of motion is often one of the hardest parts of rehab, and the Torillin infographic on identifying the source of restriction Late-stage rehab and return-to-sport: hopping, change of direction, and integrating exercises into an athlete's normal training week for ongoing prevention Bracing and taping as secondary/tertiary prevention strategies to reduce recurrence Long-term consequences of poorly managed ankle sprains, including links to post-traumatic osteoarthritis and eventual ankle surgery The biggest mistake athletes make: assuming rehab is "done" once they can run, despite still having deficits in power, change of direction and stability Lewis's top tip: get every ankle sprain properly assessed, no matter how minor Quotes / takeaways: "It's just a simple lateral ankle sprain... and then someone who goes missing for months at a time." "Four out of ten people who have an ankle sprain go on to develop a chronic instability." "The better quality of the assessment, the more likely there's an accurate diagnosis." "It's really hard to sprain your ankle when it's really well strapped or with an appropriate brace." "Once someone gets running... you can run in a straight line really well and have really considerable deficits still." "Get it assessed. Understand what you've done and understand what impairments you might have." Time Stamps: 00:17 – Episode introduction and breakthrough experience 00:23 – Episode 385 introduction: lateral ankle sprain masterclass with Lewis Craig 00:50 – Sponsor: PILLAR Performance and Performance Health 01:15 – Collagen Repair: formulation, TENDOFORT and collagen health 01:44 – 15% PILLAR Performance discount with code PHYSICALPERFORMANCE 02:19 – Welcoming Lewis Craig back to the show 02:48 – Lewis's tenure at Pogo Physio and progress on his Sports Masters at UQ 03:45 – Introducing today's topic: lateral ankle sprains 04:37 – How common and burdensome are lateral ankle sprains? 05:36 – The "she'll be right" attitude and why it's changing 07:02 – Lewis's personal history with recurrent ankle sprains 08:02 – Impact on Lewis's own running and trail running 08:28 – The one-year mark and recurrence risk statistics 09:26 – Predictors of chronic ankle instability: single-leg landing and drop jump 09:53 – The Doherty 2016 study explained 10:51 – The three priorities of assessment 11:21 – Ruling out red flags and fractures 12:45 – Why assessment quality drives rehab outcomes 13:14 – Screening for fractures: mechanism, Ottawa ankle rules, bony landmarks 14:39 – Deciding on imaging: x-ray or MRI 15:06 – Differential diagnosis: the many subcategories of ankle sprain 15:35 – ATFL and CFL: the most common ligament sprains 16:35 – Peroneal tendon injuries 17:04 – Bifurcate ligament sprains 18:04 – Deltoid ligament tears with lateral ankle sprains 18:33 – Syndesmosis injuries and mechanism differences 19:31 – Clinical tests for syndesmosis 20:01 – Talar dome injuries and other easily missed diagnoses 20:30 – Why getting a clear mechanism from the athlete matters 21:29 – Identifying impairments: what it means and why it's important 22:51 – Jay Hertel's model of chronic ankle instability 23:48 – Balancing patient education without causing fear 24:17 – Motor outcomes: strength, power and kinetic chain 24:43 – Assessment time and thoroughness at Pogo Physio 25:08 – Objective testing: dynamometers, balance and calf tests 25:38 – Balance test progressions as return-to-sport criteria 26:37 – Strength testing: inversion, eversion and calf raise endurance 27:07 – Power testing: triple hop, crossover hop and lateral hop tests 27:33 – Using objective markers to guide return-to-sport decisions 28:01 – Patient questionnaires: Cumberland Ankle Instability Tool (CAIT) and FAAM 28:57 – Coping vs non-coping athletes and objective scoring 29:25 – Moving into rehabilitation: individualised management 29:54 – Protection and appropriate early loading 30:20 – Moon boots and protecting specific structures 31:16 – ASO ankle braces for lower-grade sprains 31:45 – The strength, stability, mobility rehab framework 32:14 – Early loading phase: range of motion, balance and strength 32:43 – Addressing dorsiflexion loss 33:13 – The Torillin infographic on restriction sources 33:40 – Progressing balance and strength exercises 34:10 – Preventative efforts and integrating rehab into training 34:40 – Late-stage rehab and return-to-play criteria 35:39 – Bracing and taping to prevent recurrence 36:08 – Long-term consequences: osteoarthritis and ankle surgery risk 37:34 – Lewis's own experience with taping and bracing 38:02 – The biggest mistake athletes make in managing ankle sprains 39:29 – Lewis's top tip: get every ankle sprain assessed 40:27 – Where to reach Lewis Craig for questions 40:52 – Episode close and sponsor reminder 41:20 – Pogo Physio Telehealth Consultations and closing details THE TEAM: Join the The Physical Performance Show LEARNINGS membership through weekly podcasts here: https://www.patreon.com/TPPShow Our goal is to get you back to your Physical Best. Find out more about Telehealth Consultations and book online. Your Hosts: 🏃 Brad Beer - Instagram & X @Bradbeer and YouTube on @PogophysioAu 💪 Lewis Craig - Physiotherapist and Clinical Lead, Pogo Physio Instagram: @_lewiscraig_ The Physical Performance Show can be found at: Facebook: facebook.com/thephysicalperformanceshowpodcast X: @tppshow1 Instagram: @physicalperformanceshow Please direct any questions, comments, and feedback to the above social media handles.
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