Advertisement

How can I prevent repeat ankle sprain injury?

Jaspal R. Singh, MD
Physical Medicine & Rehabilitation
You should always have physical therapy (rehabilitation) for any type of ankle sprain, even one that is not severe.  Often minor ankle sprains can become chronic problems. A physical therapist can teach you how to strengthen the ligaments around the ankle using a balance and wobble board and single leg balance exercises. This can help prevent further injury.
Ms. Karena Wu
Physical Therapy
Isolated ankle joint strengthening exercises, especially of the peroneal muscles, are crucial.  Then, ankle/knee/hip exercises (closed kinetic chain exercises) are a must to make sure the leg joints properly work together.  You will train for strength and endurance.  Stability and proprioceptive (body awareness) activities are performed so that the joint receptors are trained to communicate well with the muscles to prevent re-injury. A balanced program of all of the above exercises will help prevent repeat ankle sprains.

The first question is how do you keep spraining them? Is the activity you are completing hazardous to your health? Do you have supportive shoes? And do you rest enough following the injury?

A great way to help strength your ankles will be through calf raise. When you complete a calf raise, you will be flexing through your ankle and this will help build proper strength. Beyond this, take the appropriate time to rest and be sure to answer those questions above. From there, we can figure out a more direct plan of action to assist you.

Unfortunately ankle sprains are very common, up to 25,000 a day in the United States of America. More people are having such severe ankle sprains that they might end up going to the emergency room for them. You can look at strengthening the muscles around the ankle for sure, but we do want to take the bigger picture into mind and many times after there is an ankle sprain the muscles around the front of the hip and calve get very tight. Specifically, the hip flexor and the IT band get very tight and then the glutes get weak, so you probably need some flexibility techniques there and around the ankle and the calves. Whether that is self-massage or stretching, you will also need to do some core stability work for the abdominals and glutes. Single-leg balance can be quite helpful as well to stimulate the receptors around the foot and the ankle can work right to help hold the ankle and foot in good alignment. It is not just about strengthening the ankle, although there is some point in strengthening the muscles around the ankle, but it is getting the receptors in the foot to work with the muscles, to align the bones, so the entire body can work in a coordinated fashion. Ankle sprains can be tricky, they can have cascading effects up throughout the rest of the body and if they are not treated correctly, can lead to other injuries later on.
Dr. Mike Clark, DPT
Fitness

While it is common to think that to prevent ankle sprains you should focus solely on strengthening the muscles around your ankles, in fact – and maybe more importantly – you must also concentrate your efforts on improving the strength of the muscles around your hips. Research demonstrates that when you sprain an ankle, not only do the connective tissues that support it become loose and less responsive but it also shuts down the butt muscles – decreasing the ability to maintain balance and proper lower body alignment. As a result, the lack of ligament support and decreased balance increases the risk of reinjuring your ankle. Without proper reconditioning, over time the hip muscles become less and less active and do not help protect the ankle, making you more susceptible to further ankle sprains and other injuries.

The most effective way to recondition your ankles and prevent future sprains is by doing exercises that wake-up and strengthen key muscles around the hips – i.e. butt muscles – as well as those that challenge your ability to balance on one leg and maintain proper alignment.

Incorporate the following exercises into the beginning of your exercise routine as part of your warm-up, performing 3 sets of 10-15 repetitions for each:

  • Ball Bridge

[media id="DEV__4c7e461d338df5_68981546" title="Ball Bridge"] 

  • Tube Walking Side to Side

[media id="DEV__4c8243e12c37a2_66045881" title="Tube Walking Side to Side"]

  • Single Leg Balance with Reach (progress from standing on the floor, to standing on a towel, to standing on a pillow cushion to enhance difficulty and challenge to the muscles around the ankle and hip)

David Hogarth
Physical Therapy

It's challenging to prevent repeat ankle sprains - but it is possible. Unfortunately, with each occurrence it gets more likely it will happen again. The tendency increases because the passive stability structures, the ligaments, become loose. The key then is to optimize the other stability structures.

Sprains typically happen in a side to side direction. The first step is to make sure that you have the best possible motion in the front to back direction. Stretch the calves and Achilles tendon to make sure you have good dorsiflexion (toes up towards knees). 

Next, work on balance activity to get the muscles around the ankle working as well as possible. Start with simple single leg balance with the foot in a good position with eyes open then eyes closed.

But this won't be quite enough. To finalize the process, you will need to progress the stabilization exercises to include the hip muscles and movements which the ankle decelerates movements in multiple directions. This is where the skilled advice of a corrective exercise specialist will become necessary.

Once you sprain your ankle you are more likely to do it again. To strengthen your ankles do range-of-motion exercises. Try writing the alphabet with your ankle, so that you are moving the ankle in all directions. You can also get rubber strengthening-bands and perform the same exercises with resistance. Single leg-toe raises, where you go up on your tiptoes while standing on one leg might also help. You should be able to do this 10 times in a row without any problem. Physical therapy can also sometimes be helpful if you do not feel you are making progress on your own.
Brian Yee
Physical Medicine & Rehabilitation

It is important to improve ankle dorsiflexion after an ankle sprain. Research indicates a loss of ankle mobility with chronic ankle sufferers - primarily in ankle dorsiflexion - which is the motion you need to walk correctly. Reserach also indicates a change in muscle control patterns not only in the ankle but also up the kinetic chain, such as a loss of hip control.

Therefore:

1. Improve ankle dorsiflexion: calf stretching, seeing a Physical Therapist to mobilize your ankle and decrease swelling.

2. Ankle stability: ankle circles, resistance bands to strengthen lateral/medial ankle musculature/tendons.

3. Ankle proprioception: standing balance exercises as indicated

4. Hip stability: primarily with gluteus maximus and medius exercises. It is important to find a specialized Physical Therapist that can specifically help facilitate you gluteal muscle patterns.

5. Specific training for sports/function: proper footwork in your sports can help decrease you chance of ankle sprains as well.

When someone sprains their ankle, they damage the ligaments that surround the joint. The ankle joint is not as stable as it used to be, so it will be more susceptible to reinjury. Once the pain and swelling have decreased and you have full motion at the ankle, you should begin strengthening exercises. To help prevent reinjury, you can strengthen the muscles that are around the ankle joint. To strengthen the ankle, you can perform exercises with surgical tubing or exercise bands. The exercises are plantar flexion, dorsiflexion, eversion and inversion. These exercises correspond to moving the foot upward, downward, inward and outward.

To perform dorsiflexion, the band will be placed around the top of the foot and another person will hold the end of the band. Then pull your foot upward and slowly let it return downward. To perform plantar flexion exercise, the band needs to be placed around the bottom of the foot. Then hold the end of the band and push the foot down against the band as if pushing on a gas pedal. To perform the eversion strengthening exercise, the band needs to be placed on the lateral (outside) part of the foot, while holding the other end of the band at the other side. To perform the inversion exercise, place the band around the medial (inside) part of the foot and have someone hold the other end of the band at the other side. The person holding the end of the band needs to hold tight enough so that it applies resistance without too much tension. If the resistance becomes too easy, then you are ready to progress to the next resistance band strength level.

In addition, it is important to work on balancing on the injured ankle as well. Stand on your injured leg, with the knee slightly bent. Then balance on one leg for 30 seconds. Once you are able to balance easily on level ground for 30 seconds, have someone throw a ball for you to catch while balancing or close your eyes while balancing.

Should any of these exercises cause pain, seek medical attention from a physician. The physician may also refer you to an appropriate healthcare provider, such as an athletic trainer, to assist you with a progressive rehabilitation program.

(This answer provided for NATA by the King College Athletic Training Education Program.)

Continue Learning about Sprains and Strains

Don’t be a Turkey this Turkey Bowl Season
Don’t be a Turkey this Turkey Bowl Season
Dr. Mike’s Cleveland Clinic sees plenty; so does Dr. Oz’s New York Presbyterian Hospital -- emergency room visits for sprains, broken bones, contusion...
Read More
Weekend Warrior: Simple Self-Care for Minor Strains, Sprains and Bruises
Weekend Warrior: Simple Self-Care for Minor Strains, Sprains and Bruises
Whether you're an athlete or a semi-out-of-shape desk lounger who hasn't seen a gym in months, soft-tissue injuries (think strains, sprains, and bruis...
Read More
What causes skier's thumb?
Rachel Rohde, MDRachel Rohde, MD
Ligaments connect bones to each other across a joint; injury to a ligament often is called a “sprain...
More Answers
What is a midfoot sprain?
James P. Ioli, DPMJames P. Ioli, DPM
A foot sprain involves tearing a ligament, a fibrous structure that connects one bone to another...
More Answers

Important: This content reflects information from various individuals and organizations and may offer alternative or opposing points of view. It should not be used for medical advice, diagnosis or treatment. As always, you should consult with your healthcare provider about your specific health needs.