Ankle Sprain/Ankle Injury Prevention & Rehabilitation Training
So we have written and vlogged before that the number one predictor of future injury is previous injury. Now, you can't prevent every ankle injury. Sometimes you just get unlucky, just end up in the wrong spot. But there's a lot you can do to prevent future injuries, and here's how.
#1 Dopey Ankle Syndrome
There's three little muscles on the outside of your calf called the Peroneals. They have one real job - and that's to protect and stabilize your ankle and to stop it rolling in.
Peroneus Longus, one of three peroneal muscles
What happens after an ankle sprain, or if you wear heavy bulky shoes all the time, is those peroneals become sleepy and inhibited, so instead of being sharp and alert, ready to work, they are kind of dopey and switched off. What happens is, when you hit the ground, instead of those peroneals bouncing you off the uneven surface, the pothole, or the foot that you land on, what they do is, they are late to engage, you start rolling, and by the time the peroneals have reacted, it's too late - you’re already into your ankle roll. This leaves you with worse balance, worse control through the foot, and also ruins your agility and your reactivity too.
The answer? balance training, both static and dynamic.
The first thing to do is basically some static balance. So, shoes off. Standing on one leg, hands on your hips, and, then, eyes closed. The eyes closed bit is important, because what we're working on here is your proprioception, which is your ability for your nervous system to know where your limbs are in space without using vision.
By closing your eyes, you're forcing those peroneals and the nerves that control them, to stabilize the ankle joint, as opposed to relying on your vision to keep your balance.
Working from the floor is usually a better option than using unstable surfaces such as a Bosu or wobble board, although they do have some benefit in rehab settings.
Now that you've done with your static balance, you're going to work on your dynamic balance. Agility hops, low and agile to the ground, no pigeon toes, keep your feet straight, you want to stay flat through the mid-foot, barely enough space to slide a credit card under the heel. So, it's clockwise, counter-clockwise, double diagonal, double diagonal.
#2 Calf Strength.
This one's pretty straight forward. If you spent any time on crutches, in a boot, or even limping, that calf is going to be weaker as a result. If you don't directly address this weakness problem, then you carry that into sport. Weakness leads to fatigue, which puts you in poor positions, making you more susceptible to future injury, and, also, just making you lesser of an athlete as well.
Two things you want to work on here. First is standing calf raises. Every second day, can just be from flat, off a step, it doesn't really matter. The end of training, first thing in the morning, while you're brushing the teeth. It's a super-easy thing that's going to help those calves be nice and strong, which not only going to prevent and help you recover from any ankle injuries, it's also going to make you better as an athlete, because you're going to be springer, and more explosive.
Start double leg, probably three sets every second day, you want to build your way up to about 30 repetitions. Once you get to 30 for three sets of double leg, then progress to single leg. Same thing - work your way up to 30.
And then second, if you have access to it, some sort of a seated calf raise is going to be really good. This will help isolate your soleus and your tibialis posterior, which don't quite get worked as well in the standing version.
If you don't have access to a seated calf raise, you can just do a bent leg standing version, which will do a good job isolating that soleus as well. The biggest mistake with all your calf raise work is people who go too fast, and they bounce out of the top and the bottom. Control down, little pause, and then drive up from there.
#3 Range of Motion.
Just like with calf strength, if you don't directly work on your range of motion in that ankle, and correct the asymmetry level to the uninjured leg, then you are going to be more susceptible to a future ankle sprain, but also to other problems along the kinetic chain, whether it be the knees, the hips, or even the lower back. The best thing you can do to fix that is the knee-to-wall dorsiflexion test, but just do it as a stretch. What you are looking for here is a minimum of 10 centimetres, and make sure that the difference between the sides is less than two centrimetres. Hit that stretch for 30 seconds every single day, looking to increase the range - just a little bit every time you do it.
#4 Glute and Core Strength.
We have spoken about glutes before, but glute and hip strength is really important when it comes to stabilising the entire lower limb. Poor glute and core strength not only ruins your ability to control the knee and keep it out of the valgus, but it also ruins the stability and balance through the ankle joint.