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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.
Return to Articles
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.
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