When John was 16 years old, the full weight of an adolescent rugby scrum collapsed onto his left ankle. The resulting sprain was so bad that he was on crutches for five months. He confesses that his ankle never felt the same again. He also recalls that he sustained two further bad sprains during his late teens and early 20s. Mystery solved.  

The joint trauma, scar tissue and muscle wasting left in the wake of the ankle sprain left John with a severely unstable foot and ankle. And if you have an unstable ankle, you have an unstable leg, foundations being what they are. The chronic instability caused chronic wear and tear, not only in the ankle but also in the knee and hip. Yet it was more than three decades before John started to really feel the longer-term impact his ankle injury would have on the hip and knee.

As for John playing masters football on such a severely compromised leg, that was easily attributable to a combination of innate athleticism and sheer belligerence. Despite this, once he had seen the results of his gait analysis and finally understood why his left leg was so compromised, he played the last two matches of the season. Finally, he retired—instead, choosing to pursue general exercises and rehab to prevent further unnecessary joint degeneration. He had never connected the ankle sprains with the arthritis he had in that leg, nor had any of his previous healthcare providers.

Despite the common and somewhat irrefutable nature of case studies like John’s ankle, there is still some scholarly debate over the true prevalence of joint degeneration after injury; because the current data is far from conclusive. Yet there is so much data, clinically, statistically and anecdotally, there is a consensus about there at least being some level of correlation. And arthritis aside, there is certainly no doubt about the high prevalence of further pain and injuries after ankle sprains and the like.

A study published in the Journal of Athletic Training in 2019 highlighted what countless clinicians have known for a long time. Up to 70% of people who sustain an acute ankle sprain develop some level of residual physical disability in that leg. This study highlights the devastating potential of ankle sprains; and also the fact that we struggle to effectively rehab even the most straightforward musculoskeletal injuries.

We need to do a better job of injury care if we are going to conquer the pandemic of chronic pain we live in at this point in history. Unrehabilitated injuries and complex injuries contribute significantly to the pain burden. Walking must always come before running, individually and collectively. So, if we can’t get to grips with the humble ankle sprain, what chance do we have of conquering back pain, complex PTSD-associated pains and an opioid epidemic?

Improved injury management is as much a mindset as it is a set of rehab approaches. 

If we adopt a mindset where we assume that all but the most extreme injury events have something to reveal about the integrity of our musculoskeletal chains, we have made a giant step towards better care of injuries, complex injuries and complex pain.

If we adopt a mindset where we assume that the injuries seen on scans and x-rays are just the tip of the injury iceberg; and that other more subtle but significant soft tissue injuries play out ‘under the medical radar’. A world of injury and pain healing approaches opens up to us.

If we adopt a mindset where we are willing to give our painful and ‘injury-prone’ body parts the kind of long-term attention we give our teeth, we will have made another quantum leap towards preventing long-term pain and disability.

Once we have made this small handful of shifts in our belief structure around injuries and rehabilitation, we become open to proper use of the full injury and pain rehabilitation toolkit, in which the techniques and approaches are often surprisingly straightforward. Just like flossing your teeth daily and seeing a hygienist twice a year is straightforward.