McIlroy’s Ankle Injury Explained

By Eva Nugent MISCP

The Anterior Talofibular Ligament is big news this week because of world number 1 golf player Rory McIlroy’s injury sustained while having a football “kick about” with friends. McIlroy reports sustaining a “total rupture of his left ATFL and damage to the associated ankle joint capsule”. This unfortunate injury has put his golf season in doubt with the Open Championship starting just next week the 16th of July.

But what exactly is the ATFL? And what does the rehabilitation for this injury involve?

The Anterior Talofibular Ligament is one of three ligaments that make of the lateral ligament complex of the ankle joint. It originates at the fibular malleoulus of the lateral shin bone (fibula) and runs forward to and attaches to the Talus (ankle bone). The other two ligaments are the Posterior talofibular ligament (PTFL) and the Calcaneofibular ligament (CFL). The function of these ligaments is to provide stability and support to the ankle joint. The ATFL specifically prevents the anterior translation of the shin in relation to the foot/ankle. The ATFL is the most commonly injured ankle ligament and is most vulnerable when the foot is pointing downwards and inwards as the body’s centre of gravity rolls over the ankle (plantarflexed and inverted position). This is commonly described as “going over on your ankle”. It is commonly injured in sports like football or GAA where unpredictable fast turns or cutting movements are involved. This is referred to as an ankle sprain and results in damage to the fibres of the ligament as they are overstretched. Ligament sprains are classified as grade 1, grade 2 or grade 3.

Grade 1 / Mild Sprain Few Ligament fibres torn ; stability maintained Grade 2 / Moderate Sprain Partial rupture , increased laxity but no gross instability Grade 3 / Servere Sprain Complete rupture ; gross instability Rory McIlroy suffered a Grade 3 rupture of his ATFL which is the most severe type of ankle sprain. Depending on the severity of the damage and management of the injury complete rehabilitation of time can range from 6-12 weeks. The symptoms of the injury include swelling, bruising, ankle pain, deep bony pain and tenderness on palpation of ankle ligaments and the inability to bear weight. If not rehabilitated properly there is a high risk of re-injury or developing chronic ankle instability. Conservative management of ankle sprains is the most common choice of rehabilitation with Physiotherapy playing the main role. Surgery may be considered if the ankle is unstable and has not responded to conservative management.

Physiotherapy management

Management and rehabilitation of this injury will include different phases from time of injury to return to play. The phases are interlinked and cross over with time spent in each phase depending on severity of injury and compliance with the rehab program.

Phase 1 Focus on rest (no weight bearing), pain management and reducing the swelling Phase 2 Focus on regaining full range of motion (stretching, joint mobilisations, soft tissue massage) Phase 3 ; Focus on strengthening the muscles around the ankle, foot and lower limb to regain dynamic ankle stability and control Phase 4 Focus on balance and proprioception (the sense of joint position in space) are vital components of rehabilitation to develop stability and coordination of the muscles to help prevent recurrence of injury. Phase 5 Focus on sport specific exercises, agility and return to sport

Regaining strength and stability in the ankle will be vital for Rory Mc Ilroy to have a successful recovery as during a golf swing the ankle ligaments and musculature play a big role in stabilising the foot and ankle to prevent rolling over on it.