Bulletproof Ankles: Strength And Stability To Prevent Ankle Sprains
Ankle Injury Prevalence
According to current research, ankle sprain is the most common injury in sports, accounting for 45 percent of all athletic injuries. The risk of a recurrent ankle sprain doubles in the first year, following injury. Ankle injury can be precipitated by instability of the ankle.
Functional Vs. Mechanical Instability
Functional ankle instability (FAI) is characterized by an ankle that buckles or “gives way” in activity. The causes of FAI include muscle weakness, impaired balance control, delayed muscle reaction time and decrease joint proprioception. Joint proprioception is the joint’s ability to detect the position it is in (this is done by mechanoreceptors) and send that information back to the brain to make adjustments as needed.
Movement beyond the ankle’s normal range of motion is classified as mechanical ankle instability (MAI). This is caused by ligament laxity, anatomical abnormalities, degenerative and chronic inflammatory processes.
Although both forms of ankle instability have different causes, one may compound the effects of the other. Mechanoreceptors in the joints must adapt to the elongation of ligaments, and this will alter joint proprioception. If you feel that your ankles are unstable there is an easy test to determine your risk for ankle sprain.
How To Identify Risk Of Ankle Sprain
The single leg balance test has been proven to be a reliable and valid tool for assessing risk of ankle sprain. In this test, the athlete stands on one foot without shoes—the opposite knee is bent and not allowed to touch the weight bearing leg, hips remain level to the ground, eyes are open and fixed on a point on the wall, then the eyes are closed for 10 seconds. The athlete has failed the test if their bent leg touches the weight bearing leg, if their foot position changes on the floor, if the foot of their bent leg touches the ground, if their arms move from the original position, or if the athlete reports imbalance. If the athlete does not pass the first trial, a second trial is done with only the result of the second trial counting. Both feet must be tested and the athlete must be able to perform the task on both legs in order to avoid failing. If it’s too late for testing and you have sprained your ankle, it’s important to understand the phases of injury to determine when return to activity will be appropriate.
Phases Of Injury
Phase One: Starts at time of injury and ends when all signs of inflammation (pain, loss of function, swelling, redness, heat) have subsided. This phase generally lasts two to four days and is also characterized by scar tissue composition. Goals of treatment in this phase are to protect the injured ankle, control pain, limit swelling.
Phase Two: Repair and regeneration. Starts two to four days after injury and lasts through approximately the sixth week after injury.
Phase Three: Remodeling of tissue. Starts approximately three weeks after injury and lasts a minimum of 12 months to complete.4 Tensile strength of the healing ligament increases during this phase.4
Recovery After Injury
Within 12 weeks following the trauma, 60-90 percent of people will return to activity at their pre-trauma level. With that being said, 40 percent of ankle injuries result in chronic ankle instability and risk of recurrent ankle sprain increases after the first one. Up to 70 percent of patients report persistent residual symptoms
After completion of a proprioceptive training program with our innovative balance board trainer, recurrence of ankle sprain decreases by 50 percent. By just replacing your typical warm-up with a balance exercise board program, you can greatly reduce your risk of future ankle sprain.
How The TherRex Balance Board Can Help
Due to it’s patented shape, the TherRex balance board trainer allows you to exercise your ankle functionally in the plantarflexed and inverted position. Doing so activates the peroneal muscles at up to 100 percent of maximal muscle contraction. Insufficient strength of the peroneal muscles is associated with recurrent ankle sprain and chronic ankle instability—exercise should focus on conditioning these muscles. The principle of specificity dictates training be as closely simulated to the task or activity as possible. Functionally training the ankle in this position can prevent injury and keep you doing what you love. This makes TherRex balance board trainer the best balance board for ankle strengthening, rehabilitation, and injury prevention.
1. Lateral Movement
Rock the board side-to-side. Try to control the board and limit motion front to back.
Tilt the board front-to-back. Try to control the board and limit motion side-to-side.
3. Lateral Ankle Isolation
Rock the board to one side, then tilt the board front-to-back using foot on same side. This exercise can be progressed by gradually decreasing weight bearing through opposite foot.
4. Full-Depth Heel Raises
Position one or both feet further back on the board, as shown. Raise your heels and tilt the board forward to increase range of motion.
5. Supinated Heel Raises
Position one foot at an angle to the center of the board, as shown. Raise your heel and tilt board forward to increase range of motion.
*This exercise will promote the natural motion of the ankle throughout the movement. It will also increase activation of the ankle everters, an important muscle group for lateral ankle stabilization.
Chad Franche, PT, DPT
Click here for a complete ankle sprain recovery program and get back to pain free activity!
Contact us today to learn more about how the TherRex Board can change the route to recovery and injury prevention for you, your clients, and all athletes.
Copyright © 2018 TherRex Innovations LLC. All Rights Reserved.
TherRex™ is your trusted source for the best researched and most accurate fitness and rehab information on the internet.
Kerkhoffs G, Bekerom M, Elders L, et al. Diagnosis, treatment and prevention of ankle sprains: an evidence-based clinical guideline. Br J Sports Med. 2012;46:854–860.
Doherty C, Bleakley C, Delahunt E, Holden S. Treatment and prevention of acute and recurrent ankle sprain: an overview of systematic reviews with meta-analysis. Br J Sports Med. 2016;0:1–17.
Trojian TH, McKeag DB. Single leg balance test to identify risk of ankle sprains. Br J Sports Med. 2006;40:610–613.
Hupperets MD, Verhagen EA, Mechelen WV. Effect of unsupervised home based proprioceptive training on recurrences of ankle sprain: randomised controlled trial. BMJ. 2009;339:b2684.
Verhagen E, Beek A, Twisk J, Bouter L, Behr R, Mechelen W. The Effect of a Proprioceptive Balance Board Training Program for the Prevention of Ankle Sprains A Prospective Controlled Trial. The American Journal of Sports Medicine. 2004; 32(6): 1385-1393.
Verhagen E, Bay K. Optimising ankle sprain prevention: a critical review and practical appraisal of the literature. Br J Sports Med. 2010;44:1082–1088.
Vriend I, Gouttebarge V, Mechelen W, Verhagen E. Neuromuscular training is effective to prevent ankle sprains in a sporting population: a meta-analysis translating evidence into optimal prevention strategies. BMJ. 2016;1:202–213.
Eils E, Schroter R, Schroder M, Gerss J, Rosenbaum D. Multistation Proprioceptive Exercise Program Prevents Ankle Injuries in Basketball. Official Journal of the American College of Sports Medicine. 2010; 2098-2105.
Kaminski T, Hertel J, Amendola N. National Athletic Trainers’ Association Position Statement: Conservative Management and Prevention of Ankle Sprains in Athletes. Journal of Athletic Training. 2013; 48(4): 528–545.
McGuine TA, Keene JS. The Effect of a Balance Training Program on the Risk of Ankle Sprains in High School Athletes. The American Journal of Sports Medicine. 2006;4(7): 1103-1111.
Hupperets MD, Verhagen EA, Mechelen MV. Effect of unsupervised home based proprioceptive training on recurrences of ankle sprain: randomised controlled trial. BMJ 2009; 339: b2684.
Van AG, Bierma_Zeinstra SM, Verhagen AP, de Bie RA, Luijsterburg PA, Koes BW. Comparison of Conventional Treatment and Supervised Rehabilitation for Treatment of Acute Lateral Ankle Sprains: A Systematic Review of the Literature. JOSPT. 2002;35(2): 95-105.
Mattacola CG, Dwyer MK. Rehabilitation of the Ankle After Acute Sprain or Chronic Instability. J Athl Train. 2002;37(4): 413–429.
Behm DG, Muehlbauer T, Kibele A, Granacher U. Effects of Strength Training Using Unstable Surfaces on Strength, Power and Balance Performance Across the Lifespan: A Systematic Review and Meta-analysis. Sports Med. 2015; 45; 1645-1669.
Loudon JK, Santos MJ, Franks L, Liu W. The Effectiveness of Active Exercise as an Intervention for Functional Ankle Instability A Systematic Review. Sports Med. 2008; 38(7): 553-563.