AFL Injuries: High Ankle Sprain (Syndesmosis)

AFL Injuries: High Ankle Sprain (Syndesmosis)

A high ankle sprain also known as a syndesmosis injury involves the ligaments that connect the two lower leg bones: the tibia and fibula. These ligaments stabilise the ankle joint, especially during weight-bearing and rotational movements. Unlike typical lateral ankle sprains that affect the outer ligaments of the ankle, high ankle sprains occur above the ankle joint and can be more debilitating and slower to heal. In AFL athletes, where running, tackling, and jumping are constant, syndesmosis injuries can significantly impact performance and playing time (1).

McGraw Hill Education (Australia). Illustration by Vicky Earle. From Brukner P, Khan K. Brukner & Khan’s Clinical Sports Medicine: Volume 1: Injuries. 5th ed. Sydney: McGraw Hill, 2017.

MECHANISM OF INJURY

In AFL, high ankle sprains typically occur when a player’s foot is planted and an outer rotational force is applied, such as when being tackled or changing direction sharply. This torque can force the tibia and fibula apart, overstretching or tearing the syndesmotic ligaments. It’s also seen when another player lands on the foot or lower leg during a contest. Unlike common ankle sprains, athletes with a syndesmosis injury often experience pain with walking, pushing off, or pivoting, but may not have significant swelling or bruising (2).

PHASES OF REHAB

1. Acute Phase (0–2 weeks):

The priority is inflammation control and protection. Rest, ice, compression, and elevation (RICE), along with a moon boot or crutches, are used to offload the injured area. Early diagnosis and imaging, particularly MRI, help determine injury severity.

2. Sub-Acute Phase (2–6 weeks):

Once pain subsides, rehab focuses on restoring range of motion, beginning isometric strength exercises, and reintroducing weight-bearing as tolerated. Manual therapy and neuromuscular training also begin here to restore proper ankle biomechanics.

3. Strengthening Phase (6–10 weeks):

Progressive strengthening of the calf, foot, and ankle muscles is key. Proprioceptive and balance drills are advanced. AFL-specific movement patterns like single-leg hopping, cutting, and acceleration drills are gradually introduced (3).

4. Return to Play (10+ weeks):

In this final phase, sport-specific drills, sprint training, and full-contact simulation are performed. A player must demonstrate full strength, agility, and confidence in the ankle before being cleared to return to competitive AFL play.

TREATMENT FOR HIGH ANKLE SPRAINS

Evidence-based treatment for high ankle sprains includes manual therapy, functional rehabilitation, and sport-specific reconditioning. Here at Fortitude Chiropractic, we can assist with joint mobilisation, soft tissue therapy, and progressive loading. In cases of severe instability or ligament rupture, surgical intervention may be required (2). Long-term outcomes are best when rehab is structured and sport-specific, ensuring players return to the demands of AFL without re-injury (3).

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References:

• Nussbaum, E. D., Hosey, R. G., & Laskowski, E. R. (2003). Clinical diagnosis and treatment of ankle syndesmosis injuries in athletes. Mayo Clinic Proceedings, 78(2), 173–179. https://doi.org/10.4065/78.2.173

• Beumer, A., van Hemert, W. L. W., Niesing, R., Entius, C. A., Ginai, A. Z., & Swierstra, B. A. (2003). Radiographic measurement of the distal tibiofibular syndesmosis has limited use. Clinical Orthopaedics and Related Research, 411, 227–234. https://doi.org/10.1097/01.blo.0000069892.11032.d2

• Gerber, J. P., Williams, G. N., Scoville, C. R., Arciero, R. A., & Taylor, D. C. (1998). Persistent disability associated with ankle sprains: A prospective examination of an athletic population. Foot & Ankle International, 19(10), 653–660. https://doi.org/10.1177/107110079801901005

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