Chances are if you’ve spent much time in the world of sports, you’ve heard the phrases, “I’ve got terrible ankles,” “I sprained my ankle again,” or my personal favourite, “oh it’s just an ankle sprain.” Have you ever wondered how one of the most common injuries in sport has come to be, or why they rarely seem to be taken seriously?
To better understand injuries around the ankle, it’s important to understand the anatomy of the area and what makes the ankle so injury prone.
In the foot and ankle, there are 26 bones, plus the two bones that make up the shin that helps form the ankle joint. These 28 moving parts need to pack together nicely to avoid injury. With these many bones, it means lots of joints between them, even with more ligaments and muscles/tendons to hold it all in place. This all contributes to a very mobile and often injury-prone part of the body.
For the sake of this article, let’s simplify the huge array of foot and ankle injuries and talk about the “typical” ankle sprain. Here, I’m referring to those recurrent and nagging lateral ankle injuries, (ie. rolling over the outside of the foot). These injuries can happen in game 7 of the NBA championship or stepping off of a curb carrying groceries on a Sunday afternoon. An ankle sprain can affect anyone from a gangly teenager who runs like Bambi on ice, to an efficient triathlete.
There are many reasons as to why some sprain their ankles and others don’t.
Some are born with an inherent looseness or laxity of their joints and ligaments, while others have ankles like bricks. Some have a certain clumsiness about them that may be genetic, and some simply may have terrible luck. There are certain sports or activities that can place you at higher risks based on the demands, which can be altered by wearing braces or tape. Often, you’ll hear people describe themselves as having “weak” ankles or “poor balance.” This can certainly contribute to injury, but fear not, these are what I’d call modifiable factors – things that you can change for the better.
The first thing I do when rehabilitating a patient is assuring them that change can be made with proper knowledge and training. The good news is that ankles are trainable. Balance is trainable. Strength is trainable. Proprioception (body awareness) is trainable.
This means that the foot and ankle, and all of its moving parts, can become more resilient and can help to improve performance rather than being the reason for sitting on the bench or avoiding certain activities.
While there is no one-size-fits-all approach to eliminating these injuries, incorporating a unique recipe of the following can help lower one’s risk.
1) Basic Balance/Proprioception – Begin to train the brain-foot connection. From single leg holds on the ground, to working on unstable/soft surfaces, or closing your eyes and spelling the alphabet with your foot on a soccer ball. These exercises will lay the groundwork for more to come.
2) Foot/Ankle Strength – Makes sense right? Strengthen the muscles around the joint you wish to stabilize. This will improve the ankle’s capacity to absorb and produce force, react strongly to changes in direction, and physically strengthen the tissue that is required to hold things in place. Start with foot positioning/arch control drills, heel raises, and band resisted ins and outs with the foot.
3) Lower Body Strengthening – Hip, knee and torso strengthening will better improve the ability to push and absorb forces that transmit through the foot and ankle. A stronger and more stable lower body/trunk will improve the body’s overall ability to limit injury. Focus on weight-bearing activities like squats, lunges, lateral lunges, and step-ups.
4) Advanced Balance/Proprioception (Perturbations) – Once the groundwork is laid, begin to mimic real life with movement. If these injuries occur when one gets off balance, then you better train to maintain balance when life tries to pull you off. Hop and land on one foot, balance in challenging positions while performing various movements, or have someone distract/perturb you during a movement.
5) Dynamic Strengthening – Let’s get bouncy. I love targeted two-leg or single-leg hopping patterns to teach the brain and ankle how to control and stabilize through fatigue (which is when many of these injuries can occur). These movements challenge the dynamic structures of the lower body to strengthen the foot/ankle. Box jumps, landing from heights, side shuffles and plants – all great ways to incorporate all of the above categories in sport-specific patterns.
The above list is no means an exhaustive list or one scientifically proven method to prevent ankle injuries. Rather, use the list as a general blueprint to strengthen and stabilize ankles. Growing research indicates that these types of balance and stability training programs can decrease re-injury rates, and may even help to avoid getting into trouble in the first place.
Thanks for reading,
Schiftan, G, Ross L, Hahne A (2015). The effectiveness of proprioceptive training in preventing ankle sprains in sporting populations: A systematic review and meta-analysis. Journal of Science and Medicine in Sport.18:3, 238-244.