A neuroplasticity-informed approach
Ankle sprains are among the most frequent musculoskeletal injuries in the US
With an estimated four million cases per year. While many individuals recover with rest, ice, compression and elevation (RICE), a substantial number suffer recurrent or chronic ankle instability. A recent article, “Your sprained ankle can also be a brain injury. Here’s how,” reframes this common injury through the lens of neuroplasticity, asserting that ankle sprains not only damage local ligaments and tissues but also induce changes in how the central nervous system (CNS) processes sensory and motor signals.
These insights carry important implications for doctors of chiropractic (DCs), doctors of physical therapy (DPTs), athletic trainers (ATCs) and orthopedic surgeons, all of whom collaborate in designing and delivering both conservative and surgical interventions that emphasize a more holistic recovery path.
This article presents an integrated approach to treating ankle sprains that unites the novel neuroplasticity perspective with traditional and modern surgical reconstruction methods—particularly those emphasizing early mobilization. This information highlights the complementary roles of DCs, DPTs, ATCs and orthopedic surgeons.
Neuroplasticity: The central component of ankle sprains
Neuroplasticity describes the brain’s ability to reorganize or rewire neural pathways based on new or altered sensory inputs. In the context of ankle sprains, disrupted proprioceptive signaling from the injured limb can lead the brain to recalibrate movement patterns in maladaptive ways. Research by doctoral student Ashley Marchant suggests movement perception becomes less accurate when lower-limb loading deviates significantly from normal gravitational conditions. Following an ankle sprain, altered gait and ligament damage diminish the accuracy of these inputs, promoting compensatory patterns that may remain “hardwired” if not addressed via specific neuromuscular retraining.
Rehabilitation gaps and the high risk of reinjury
Despite clearance to resume activity, athletes and active individuals with a history of sprains often face a two- to eightfold increased risk of reinjury. Conventional rehabilitation typically addresses muscle strength, flexibility and cardiovascular fitness but can overlook the neurological dimension of healing. This oversight can leave deficits in balance and proprioception unresolved, contributing to repeated ankle trauma.
DCs offer a holistic approach that emphasizes alignment, manual manipulation and proprioceptive re-education to optimize joint and neuromuscular function throughout the kinetic chain.
DPTs specialize in restoring functional movement by combining manual therapy, targeted exercises and patient education. They often coordinate longer-term rehabilitation protocols aimed at gait retraining and sensorimotor integration.
ATCs play a pivotal role in on-field assessment, acute injury management and guided reconditioning programs. They work closely with clinicians to implement neuromuscular drills and progressive exercise routines.
By collaborating, these professionals can ensure all aspects of recovery—from local tissue repair to CNS reintegration—are cohesively addressed.
Assessing sensory systems: Vestibular, visual and proprioceptive
Over the past two decades, the University of Canberra and the Australian Institute of Sport have refined methods to measure function in three primary sensory systems:
Vestibular system. Inner ear organs are critical for detecting head position and movement, underpinning equilibrium.
Visual system. Evaluated partly through tests of pupil responses to light and eye movement tracking—vital for spatial orientation and balance.
Proprioceptive system. Mechanoreceptors in joints, muscles and skin (particularly around the ankle) that relay position sense information to the CNS form critical components for proprioception.
Lessons from astronauts: Sensory deprivation and downregulation
There have been parallels drawn between athletes recovering from ankle injuries and astronauts exposed to microgravity. In space, lack of normal load prompts the brain to “downregulate” leg motor pathways; astronauts often exhibit balance and gait problems upon returning to Earth. Likewise, an athlete or patient limiting weight-bearing or using a rigid immobilizer for weeks deprives the CNS of critical proprioceptive cues, increasing the likelihood of maladaptive changes persisting. Early mobilization and dynamic bracing can mitigate such negative plasticity by keeping sensorimotor feedback loops active.
Surgical reconstruction embracing early motion
When conservative measures fail—or in severe ligament ruptures—surgical repair or reconstruction is indicated. Findings support the value of stabilizing damaged ligaments while supporting early mobilization:
Broström procedure and modifications. This technique anatomically reattaches torn ligaments to the fibula. Minimally invasive or arthroscopic variations can reduce post-operative morbidity, permitting carefully guided weight-bearing sooner.
Internal brace augmentation. High-strength suture tape placed between the fibula and talus creates an internal support or “checkrein.”, This method bolsters ligament integrity, paving the way for more rapid rehabilitation without significantly increasing the risk of elongation or re-tearing. In addition to suture tape, a variety of engineered absorbable textiles are not as rigid as suture tape.
Tendon graft reconstructions. In excessive or irreparable damage cases, some surgeons employ tendon grafts for lasting ankle stabilization. Despite a more complex recovery, tendon graft repairs can still integrate progressive loading early in the healing timeline, fostering better neuromuscular adaptation.
Arthroscopic-assisted techniques. There is support for arthroscopic repair for direct assessment of intra-articular pathology and minimal soft-tissue disruption., Such precision can expedite the safe commencement of gentle range-of-motion exercises post-surgery.
Integration in post-operative rehabilitation
Early mobilization is only successful if paired with a carefully designed rehab program—here, the synergy among DCs, DPTs and ATCs proves invaluable:
DCs use hands-on adjustments to optimize joint alignment and function while integrating specialized sensorimotor activities to restore and enhance proprioceptive awareness.
DPTs develop comprehensive exercise regimens, including progressive weight-bearing, balance drills and motor-control exercises. Their expertise in manual therapy techniques also helps minimize stiffness and soft tissue adhesions.
ATCs provide essential on-field and clinical support, ensuring patients adhere to controlled activity modifications and bridging the final return-to-play phase. ATCs often spearhead sport-specific drills and real-time movement corrections.
Advanced bracing, a promising development in ankle sprain rehabilitation, offers dynamic modular support that can significantly reduce the risk of reinjury. This innovation, when combined with early mobilization and other holistic approaches, provides a hopeful outlook for the future of ankle sprain treatment.
A 2023 review highlights the effectiveness of advanced ankle braces in preventing recurrent injuries. The choice of a supportive device during the injury, post-operative and rehabilitation phases should include the following features:
Preserve proprioception. Featuring tacky, skin-contact materials for enhanced sensory feedback.
Accommodate edema. Conforming fabric allows for fluctuations in swelling without compromising support.
Customize support. Removable or adjustable stirrups ensure the brace evolves with the patient’s rehab status, aligning with the principle of controlled early mobilization.
A neuroplastic perspective: Fostering optimal outcomes
Recognizing ankle sprains as peripheral and central injuries informs a more holistic approach to treatment and prevention. Incorporating neuroplasticity-based strategies—such as balance training, dual-task drills and sensory re-education—alongside progressive loading and advanced bracing can expedite a safer return to activity. For older adults, these principles also underpin fall-prevention efforts, as moderate but consistent stimulation of sensory pathways helps maintain a stable gait and reduce fall risk.
Note: Clinical protocols vary based on patient factors and surgical procedures. Individuals should consult qualified healthcare professionals for personalized recommendations.
David Kay, MD, is an accomplished orthopedic surgeon and inventor. He is the founder of OrthoHelix, a company dedicated to the design and development of innovative orthopedic devices. Kay’s work at OrthoHelix has led to multiple patents for new medical devices, including a patented system for the treatment of distal radius fractures and a patented method for the reduction and fixation of fractures of the proximal humerus as well as a complete platform for foot and ankle reconstruction. Kay is also the co-founder of Vero Ankle (veroankle.com). In addition to his work in the industry, Kay has made significant contributions to the field of orthopedic surgery through his numerous innovations. He can be reached at dbkay50@gmail.com.
