Ankle Sprain Injury Prevention
THE
SINGLE GREATEST EXERCISE FEW PEOPLE KNOW
Rob
Woodside MPT, CSCS
Ankle sprains
plague not only athletes (statistically it is the most common
injury sustained by athletes), but also people simply engaging
in everyday activities. Fortunately, research in the past 10
to 15 years has shed enormous light on how to prevent ankle
sprains.
First and
foremost, we understand now that ankle sprains reoccur not merely
because of failures in ankle flexibility or strength, but moreso
due to the loss of balance and control (1-6) in the entire leg.
Normally,
as you get close to "rolling" your ankle, little receptors
in the ligaments of the ankle sense this and send a message
upstairs to the central nervous system (CNS). The CNS then reacts
by contracting the correct muscles in an effort to prevent a
sprain. In the chronically sprained ankle however, that system
of protection is disrupted, and the time it takes for those
muscles to react and protect is diminished. Therefore, the
ligaments get stressed and re-tear (or sprain) again and again.
Secondly,
we now understand that by retraining balance in someone who
suffers from chronic ankle sprains, we can speed that protective
mechanism back up, and subsequently decrease the chances of
re-injury (2-7).
Third, we
now understand that by specialized balance training, we can
also improve the internal protective response to an ankle sprain
in uninjured people as well (4,5).
So how do
we most effectively train balance? Often, ankle rehab begins
with relearning to balance just on one leg. For people with
a history of ankle sprains or with a recent ankle injury, this
can actually be very challenging.
For those
beyond that point, the following exercise offers a way for even
high-level athletes to condition the ankle to resist spraining.
Stand on one
foot. Now reach with the opposite leg outward in all directions,
forward, sideways, backwards, diagonally, etc. Reach out as far
as possible and hold for three to five seconds.
Each direction offers a different challenge to your balance and
trains the receptors of the ankle, knee, and hip. The farther
you reach the harder the balance leg is working. Start small and
work your way up. You can also reach with your arms, as this challenges
your balance differently.
Your
body's protective response to an ankle sprain involves adjustments
at not only the ankle but also at the knee, hip and spine. Research
has shown that people with a history of an ankle sprain have
a delayed response in the muscles surrounding the hip as well
as the ankle (8-10). The above exercise involves not only the
ankle balance receptors, but also the hips, making it extraordinarily
effective.
The
best time to do this is while watching television for 15-30
minutes (because this isn't the most exciting exercise in the
world). To increase the difficulty level, try the exercises
standing on a pillow, or with your eyes closed. The more creative
you are the better chance of simulating all activities that
will challenge your body.
REFERENCES:
1. Garrick
JG, Requa RK: The epidemiology of foot and ankle injuries in sports.
Clin Sports Med 1988;7(1):29-36.
2. Richie DH Jr: Functional instability of the ankle and the role
of neuromuscular control: a comprehensive review. J Foot Ankle
Surg 2001 Jul-Aug;40(4):240-51.
3. Osborne MD, Chou LS, Laskowski ER, et al: The effect of ankle
disk training on muscle reaction time in subjects with a history
of ankle sprain. Am J Sports Med 2001 Sep-Oct;29(5):627-32.
4. Sheth P, Yu B, Laskowski ER, An KN: Ankle disk training influences
reaction times of selected muscles in a simulated ankle sprain.
Am J Sports Med 1997 Jul-Aug;25(4):538-43.
5. Aydin T, Yildiz Y, Yildiz C, et al: Proprioception of the ankle:
a comparison between female teenaged gymnasts and controls. Foot
Ankle Int 2002 Feb;23(2):123-9.
6. Junge A, et al: Prevention of soccer injuries: A prospective
intervention study in youth amateur players. Am J Sports Med 2002;
30(5): 652-9.
7. Tropp H, et al: Prevention of ankle sprains. Am J Sports Med
1985 (13): 259-62.
8. Bullock-Saxton JE, Janda V, Bullock MI: The influence of ankle
sprain injury on muscle activation during hip extension. Int J
Sports Med 1994 Aug;15(6):330-4.
9. Bullock-Saxton JE: Local sensation changes and altered hip
muscle function following severe ankle sprain. Phys Ther 1994
Jan;74(1):17-28; discussion 28-31.
10. Beckman SM, Buchanan TS: Ankle inversion injury and hypermobility:
effect on hip and ankle muscle electromyography onset latency.
Arch Phys Med Rehabil 1995 Dec;76(12):1138-43. 
