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What can I do to prevent an ankle sprain?

Ms. Karena Wu
Physical Therapy

Do ankle eversion exercises to strengthen the peroneal muscles, the muscles on the outside of the calf.  These muscles mimic the same function of the ligament(s) that were torn on the outside of the ankle (if you had an inversion sprain). The exercises can be done with a Theraband or with a cuff weight around the foot.  The movement is pulling the pinky toes out to the side and then returning to a neutral position. Do not let the rest of the leg move.

Closed kinetic chain and proprioceptive exercises are important to prevent re-injury. That means hip, knee and ankle exercises, both strengthening and endurance. Balance and agility drills help the joint receptors work so that the muscles around the joint perform in a reflexive way.

Yusuf Boyd, NASM Elite Trainer
Athletic Training
Preventing ankle sprains encompasses a few different tasks. You can start with balance exercises beginning on a flat surface like the floor and progressing to a more proprioceptively enriched environment like balance pads, half foam rolls, and dyna discs along with your usual inversion (moving ankle in) and eversion (moving ankle out) strengthening exercises. But as Dr. Clark stated above, you cannot neglect your hips because they are key. I see a ton of ankle sprains in my daily clinic and one of the main things I focus on in addition to increasing proprioception is hip strength by having the individual perform lateral band walks to keep the glutes active as well as bridges and body weight squats. Remember that every thing in the body is connected at some point so what happens at one place affects another. Muscles work interdependently, not independently.
To avoid ankle sprains, maintain good strength, muscle balance, and flexibility. Warm up before engaging in sport activities, and wear proper footwear. Pay attention to your body’s warning signs, and slow down when you feel pain or fatigue. (This answer provided for NATA by the Weber State University Athletic Training Education Program.)
Edward Phillips
Physical Therapy
Here's how to do an inversion and eversion exercise for ankles:

Reps: 10
Sets: 1-3
Intensity: Moderate
Tempo: 3-1-3
Rest: 30-90 seconds between sets

Starting position: Sit on a mat with your legs extended. Bend your right knee and put the foot flat on the floor. Lift the toes toward the ceiling and place the loop of the resistance band around the ball of your right foot. Hold the band in your right hand, keeping tension on it.

Movement: This is a two-step exercise with a side-to-side movement. Step 1: Slowly turn your right foot inward. Pause, then return to center. Finish all reps. Step 2: Hold the band in your left hand, keeping tension on it. Slowly turn your right foot outward. Pause, then return to center. Finish all reps. Then repeat both steps with the loop on your left foot. This completes one set.

Tips and techniques:
  • Keep tension on the band at all times to create resistance.
  • Keep your heel on the floor throughout both steps.
  • Maintain neutral posture with your shoulders down and back.
Too hard? Sit against a wall and use a lighter resistance band.

Too easy? Use a heavier resistance band.
There are three areas that help promote ankle stability and health. These are flexibility, strength and something called proprioception. Most of us are familiar with flexibility, but some people are lacking the normal range of ankle motion. There are some that even have inequalities in flexibility from side to side. Achieving normal and symmetric flexibility and range of motion makes it possible for our ankles to keep us upright despite changes in direction or irregularities in the surface we are on. In addition, flexible muscles function better and are less likely to be injured. 
Muscle strength for ankle stability sounds obvious, but how many of us actually do something about it. The most important muscles are the lateral stabilizing muscles that keep us from rolling the ankle in either direction. In addition to strength, muscular endurance is important as our muscles begin to get tired. 

Proprioception is our ability to know where our body parts are in space and how that position relates to other body parts. The brain and nervous system is responsible for proprioception. This sense works in concert with balance in helping to keep ourselves upright. This is also an area that can be improved upon. To learn about these exercises in detail, consult a health care professional.

There are also a variety of braces that can be used if you have already sprained an ankle in the past. Taping is also used, but has not been as effective as bracing in research studies.

I believe that the best way to prevent and ankle sprain is to focus on what I'll call 'preventative maintenance'. Ankle sprains are extremely common, especially in sports. Here are a couple of things to focus on to help keep your ankles sprain free:

- Focus on mobility and range of motion in the ankle joint.

- Strengthen the muscles that surround and cross the joint.

- Keep those muscles, tendons and ligaments healthy by stretching.

- Wear shoes that support the ankle in the event of it rolling to the inside or outside.

- Tape your ankle or wear a brace to add support (I don't recommend doing this for a long period of time because it will cause the ankle joint to lose its ability to brace and support itself sufficiently, causing the ankle to become more susceptible to a sprain).

- Tailor your training to include balance, proprioception and exercises that work the ankle though all planes of motion.

- Focus on using proper form during your leg exercises.

- Make sure to keep your leg muscles balanced and in proportion to each other. Muscle imbalances lead to dysfunctional movements which cause postural deviations. If the ankle joint isn't functioning correctly, it is at higher risk for injury.

Hopefully some of these tips will help you avoid ankle sprains!

Dr. Mike Clark, DPT
Fitness
While many individuals might think that to prevent ankle sprains, you should focus on the muscles surrounding the ankle, in truth, that is only one area you should condition. Your hips are the other. Research has shown that when you sprain your ankle, you make your ankle ligaments loose and less responsive for support. Further research indicates that ankle sprains shuts down the muscles of your upper and outer hip, so when you sprain your ankle, you develop a lack of ligament support and decreased balance, increasing your risk of injury. The hip muscles become less active and do not help protect the ankle, which produces a nasty cycle of injury, making you more prone to further ankle sprains among other ailments. The best way to retrain your ankles is by activating key hip muscles with exercises like the floor bridge and side to side tube walking. Also, you should be doing progressively more challenging balance exercises on a single leg. For example, you can start on a single leg standing on a stable floor. You can progress to standing on a towel, and further progress that to standing on a pillow cushion. When your balance is looking good and you can balance successfully in different environments, add increased challenges by bending at the hip and knee of the balance leg performing single-leg squats or single leg deadlifts.

There are many simple things that can be done to prevent an ankle sprain. Make sure your strength, flexibility, and endurance are appropriate for the type of sport you will be playing. Select footwear that fits well and is tailored for the activity in which you will be participating. Incorporating activities into your training routine that challenge your balance can also help reduce your risk of future ankle sprain. Examples of these activities include standing on one leg with your eyes open or closed. These activities should be modified by including single leg balancing on an unstable surface and eventually incorporating tasks that involve strength and power while balancing on an unstable surface. If you participate in a sport, be sure to incorporate plyometric drills on a regular basis with a special focus on proper biomechanics and balance.

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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.