ANKLE SPRAIN INJURY PREVENTION
Steve Daisey 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.