Ankle sprains are the most common injury in sports and physical activity, estimated to be about 25% of all injuries across sports. Of all ankle injuries, 85% involve the lateral ankle ligaments. There is strong evidence suggesting you increase the risk of re-spraining your ankle two-fold within the first year of spraining your ankle. Every year in the US, lateral ankle sprain affects 2.15 of every 1,000 people which results in $2 billion of healthcare costs (1). All these costs are primarily from non-invasive treatment. We know that athletes today benefit from the best available rehab techniques and here is a statistic that proves my point: in the NBA there are approximately 100 ankle sprains per season, and in the last 11 years there have only been 4 that require surgical intervention. With the high incidence of ankle sprains and the associated economic burden and negative chronic consequences, this calls for better preventative measures. In this article, you will learn the best ankle sprain prevention exercises and how you can incorporate prehab in efforts to reduce the risk of ankle injuries!

 

Ankle Sprain Prevention Exercises: Can We Actually Prevent Ankle Sprain Injuries?

First and foremost, this is a heavy topic that we discuss in detail in this article, but the answer is no, we cannot prevent 100% of ankle sprain injuries. If we could by now we wouldn’t be writing about this topic and creating a blog post about it! We still don’t have all the answers, and honestly, the verdict is still out if we can actually prevent first-time ankle sprain injuries. However, there is evidence to suggest we can decrease the risk of repeat ankle sprains. But the sad reality is ankle sprain reinjury rates are the highest of any lower-body injury, why?! More often than not we can point the finger at inadequate rehab and going back to doing too much too soon.

The point of this discussion is how we can avoid this narrative of injury and re-injury. Is there something we can do now to decrease the risk for an ankle sprain? Well, guess what, we are optimists and we are going to suggest yes, absolutely! Below you will find our favorite ankle sprain prevention exercises as well as prehab education designed to help you assess and manage and ankle sprain risk factors you may be dealing with!

 

Ankle Sprain Prevention Exercises: Learn More About Our Program

Ankle sprains can be challenging and frustrating due to also having the highest reinjury rate among any lower-body injury. This high reinjury rate is likely because the ankle sprain wasn’t properly managed in the first place. It’s time to change the narrative with [P]rehab! This program will help you recover from an ankle sprain and protect your ankle from another sprain as you get back to your normal life. Click here to learn more about our program!

 

Balance Training

It has been shown that postural control deficits are a huge risk factor for lateral ankle sprains (2). How do we improve this? By improving neuromuscular control and ankle proprioception! Proprioception is a form of kinesthetic awareness whereby you know and understand where your body is placed in 3-dimensional space.

Often times we see people focus excessively on improving mobility in their ankles with thoughts that it will decrease their risk of injury. However, mobility without adequate stability will lead you down a bad road. Ankle disk training will work on improving your joint’s ability to detect where you are in space and improve reaction time, which will translate into improved postural stability by correcting excessive ankle motion. It is imperative to correct excessive motion because it may lead to excessive reliance on passive structures, such as ligaments, for stability, which could lead to a sprain.

Exercises that work on stabilizing the ankle joint will work on improving active stability via the muscles and in turn, your body will have to rely less on passive stability, your ligaments! There is some evidence out there that suggests new shoes, bracing, and taping will help prevent ankle injuries. However, exercises that focus on improving neuromuscular control, proprioception, addressing sensorimotor and/or mechanical stability deficits, and balance training have been shown to be most effective in preventing ankle injuries (1-3).

Here I demonstrate using an ankle disc and progressing the challenge of the exercise in various ways! The goal of balance training is to improve proprioception & neuromuscular control so that your ankle will improve its muscle reflex activation, leading to more control and protection!

Looking For More Ankle Sprain Content? Watch This!

 

An Ankle Sprain Makes Your Balance Worse

Sample Ankle Sprain [P]rehab Program Education Video

Ligaments are passive structures and are meant to keep joints from moving excessively. When a ligament is sprained, proprioception is often impaired, which may result in instability due to damage of the mechanoreceptors within the ligaments. (Solomononow, 2006). Without intervention, the primary re-injury window is over a 1-2 year period post-injury until the individual is back at baseline.

Below you will find progressively challenging balance exercises! It is extremely important to work on tri-planar balance exercises, not just forward and back motion like you see with walking!

READ: WHAT YOU NEED TO KNOW ABOUT TISSUE HEALING

 

Single Leg Balance – Kettlebell Hand Off

 

Improve Ankle Dorsiflexion Mobility

As mentioned before, the balance between mobility and stability is key! With that being said, limited ankle dorsiflexion mobility is a significantly common external risk factor for lateral ankle sprains. Calf stiffness is common in athletes and this needs to be addressed with their regular training routine or else ankle mobility limitations can sneak by (4,5).

Gastroc-Soleus Complex Stretching

First I demonstrate this stretch with the knee in a flexed position, which biases the soleus, due to the gastrocnemius being put on slack. Then I demonstrate the stretch with the knee in extension, which biases the gastrocnemius. The slant board will bias your foot into more dorsiflexion meaning a bigger stretch!

 

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Improve Ankle Strength & Stability

Remember, there is active stability and passive stability. Active stability structures are muscles that have contractile tissue whereas passive structures like ligaments do not have contractile tissue. In order to improve dynamic ankle stability and give our best efforts in trying to prevent a lateral ankle sprain, we have to improve ankle strength!

Some studies have shown ankle eversion to inversion strength ratios are often different in subjects with ankle instability when compared to subjects without a history of ankle injuries. While there is some contradicting evidence on which side is often impaired post ankle sprain, it seems like the majority of evidence suggests an emphasis on strengthening the ankle evertors like the peroneals as weakness here has to lead to a recurrence of ankle sprains (6).

With that being said, the best preventative measure would be to strengthen your peroneals now and increase their baseline capacity! Remember, you want to give your ankle the best fighting chance to avoid an injury, right?!

LISTEN: [P]REHAB DISCUSSES ANKLE DORSIFLEXION

 

Ankle Strengthening Exercises Targeting The Peroneals

The peroneals are typically weak and impaired after an ankle sprain because the mechanism of injury into inversion induces overstretching of the passive structures as well as the active structures. When muscles get overstretched, just like any other structure, they become weakened. Both exercises shown here demonstrate non-weight bearing positions to strengthen the peroneals. The second exercise will bias the peroneals more due to the active plantarflexion component of the ankle during the eversion.

 

Ankle Sprain Prevention Exercises: Stability Exercises

We know balance is commonly impaired post ankle sprain, with reduced time in single leg stance when compared to the uninjured leg (7,8). The research found a deficit in ankle position/proprioception to be associated with a history of ankle sprains, which results in a delay of activation of muscles across the ankle joint—especially the evertors (9,10). This results in a failure to re-correct excessive ankle position. This decreased sensory input from the joint receptors puts you at great risk to reinjure the ankle.

We also know poor balance is a risk factor for ankle sprains because poor balance can affect dynamic ankle stability! The type of training shown here will improve your joint’s proprioception and reaction time, which will translate into improved postural stability.

For the first exercise shown above, find a good resistance then stand on the foot you desire to train. To progress this exercise, stand on your toes, as this will increase peroneal activation. This increased peroneal activation occurs for 2 reasons. 1) Peroneals are a plantar flexor and evertor of the ankle and going up on your toes requires plantarflexion strength. 2) Going on your toes will decrease your base of support, thus increasing the demand for all of the ankle stabilizers to be working, peroneals included. In the second exercise, I use a wobble board both bilaterally and unilaterally in multiple planes.

 

Progressive Ankle Sprain Prevention Exercises Focused On Stabilization

Quick support drills, dynamic landings, and cutting drills are examples of exercises that demand high levels of ankle proprioception, similar to the demands of popular sports! Here are multiple ways in which you can improve the proprioception of the ankle in a more challenging manner (11).

First I perform a forward lunge onto the center of the blue side of the Bosu ball. Then I begin to step slightly lateral of midline. This will increase the demand of the evertor muscles. Be very careful not to deviate too far from the midline. The last thing you want to do is tweak your ankle! Then shown is training the ankle in another plane, the frontal plane, which is done by performing a lateral step onto the Bosu ball.

The final exercise here is jumping onto the Bosu ball. Notice how I begin very close to the Bosu ball. With each repetition, I start to increase my jump distance and velocity, which will increase the demand of my ankle stabilizers to stick the landing. A common mistake is a lack of variability and challenge for the individual. Make sure to vary the speed and intensity of this exercise to keep it challenging.

 

Challenging Your Postural Control

Our postural control depends on 3 factors: our visual feedback, our proprioception, and our vestibular system (inner ear). Furthermore, our body receives input from our central nervous system, and interprets that input to allow for controlled posture. In order to maximize dynamic postural control, it is important to train all three of these systems. Our vision is what gives us the most feedback for postural control, and usually is a good first step to take away. For instance, by standing on one leg with your eyes closed, you now are solely focusing on challenging your proprioception and vestibular system. Based on what deficits an individual has and which component of postural control is most impaired, that will guide treatment as to which specific exercises to focus on. We highlight some examples below!

 

Feet Together on Foam – Eyes Closed

Sample Ankle Sprain [P]rehab Program Exercise

 

Closing Thoughts

The ankle joint as previously mentioned is highly susceptible to injury; however, we as individuals have the ability to maximize our bodies ability to prevent and control our injury risk. This article has given you strategies that you can implement into your exercise routine in order to strengthen your ankles as well as improve confidence in your body’s ability to tackle any environment!

 

Ensure You Don’t End Up With Recurrent Ankle Sprains

What do poor smelling cologne or perfume and ankle sprains have in common? They both can leave behind a lingering discomfort in the sensory system. The other commonality is that they can both be changed! Building up ankle stability, proprioception, strength, and power will both reduce the likelihood of ankle injuries or get rid of any lingering discomfort that may be present. As for the bad cologne or perfume, you know what to do here.

 

References

1. Kerkhoffs, G. M., Rowe, B. H., Assendelft, W. J., Kelly, K. D., Strujis, P. A., & Van Dijk, C. N. (2001). Immobilisation for acute ankle sprain. A systematic review. Archives of Orthopaedic and Trauma Surgery, 121(8), 462-471.
2. Verhagen, E. A., & Bay, K. (2010). Optimising ankle sprain prevention: A critical review and practical appraisal of the literature. British Journal of Sports Medicine, 44(15), 1082-1088. doi:10.1136/bjsm.2010.076406
3. Osborne, M. D., Chou, L., Laskowski, E. R., Smith, J., & Kaufman, K. R. (2001). The Effect of Ankle Disk Training on Muscle Reaction Time in Subjects with a History of Ankle Sprain. The American Journal of Sports Medicine, 29(5), 627-632. doi:10.1177/03635465010290051601
4. Fernandez, W. G., Yard, E. E., & Comstock, R. D. (2007). Epidemiology of Lower Extremity Injuries among U.S. High School Athletes. Academic Emergency Medicine, 14(7), 641-645. doi:10.1197/j.aem.2007.03.1354
5. Starkey, C. (n.d.). Injuries and illnesses in the national basketball association: A 10-year perspective. Journal of Athletic Training, 35(2), 161-167.
6. Wilkerson, G. B., Pinerola, J. J., & Caturano, R. W. (1997). Invertor Vs. Evertor Peak Torque and Power Deficiencies Associated With Lateral Ankle Ligament Injury. Journal of Orthopaedic & Sports Physical Therapy, 26(2), 78-86. doi:10.2519/jospt.1997.26.2.78

7. Beynnon, B. D., Renström, P. A., Alosa, D. M., Baumhauer, J. F., & Vacek, P. M. (2001). Ankle ligament injury risk factors: A prospective study of college athletes. Journal of Orthopaedic Research, 19(2), 213-220. doi:10.1016/s0736-0266(00)90004-4

8. Zoch, C., Fialka-Moser, V., & Quittan, M. (2003). Rehabilitation of ligamentous ankle injuries: A review of recent studies. British Journal of Sports Medicine, 37(4), 291-295.
9. Waddington, G., Adams, R., & Jones, A. (1999). Wobble board (ankle disc) training effects on the discrimination of inversion movements. Australian Journal of Physiotherapy, 45(2), 95-101. doi:10.1016/s0004-9514(14)60341-x
10. Karlsson, J., & Lansinger, O. (1993). Chronic Lateral Instability of the Ankle in Athletes. Sports Medicine, 16(5), 355-365. doi:10.2165/00007256-199316050-00006

11. Lephart, S. M., Pincivero, D. M., Giraido, J. L., & Fu, F. H. (1997). The Role of Proprioception in the Management and Rehabilitation of Athletic Injuries. The American Journal of Sports Medicine, 25(1), 130-137. doi:10.1177/036354659702500126

 

About The Author

Arash Maghsoodi, PT, DPT, CSCS

[P]rehab Co-Founder & Chief Marketing Officer

Arash Maghsoodi received his Doctorate in Physical Therapy from the University of Southern California. For his undergraduate studies, he attended San Diego State University and studied Kinesiology. After sustaining a career-ending ankle sprain while playing collegiate soccer, he realized how disabling and life-altering injuries can be. Arash currently resides in beautiful Santa Monica, California. His clinical experience is primarily in the orthopedic and sports setting. He has treated a wide variety of conditions ranging from the post-operative individual to the professional athlete. Arash is keeping the family legacy of becoming a physical therapist, as his mother is a practicing clinician of 30 years in the Orange County area.

 

 

 

 

 

 

DISCLAIMER – THE CONTENT HERE IS DESIGNED FOR INFORMATION & EDUCATION PURPOSES ONLY AND IS NOT INTENDED FOR MEDICAL ADVICE.