Stabilize that ankle. It’s Not Always About Mobility

Many of us are stuck on always mobilizing to improve performance and decrease pain and injury.  It is true that mobility is a very important element to performance and injury prevention.  However, for many joints in our body, the same mobility that makes it possible to perform certain movements also contributes to its vulnerability.  Joint stability is also a key component to performance and decreasing injury. In this case we will use the ankle for example and the importance of ankle stability, especially for those with reoccurring ankle injuries.

Chronic ankle instability can be caused from ankle injury, including ankle sprain or fracture, as well as footwear.  When we wear footwear with added cushion or support it causes the intrinsic muscles in our feet and lower leg to not have to work as hard, leading to a decrease in strength and stability.  This does not mean you should throw out your old shoes and go out and buy a new pair of minimalist shoes overnight.  Doing so may only lead to further injury as the body tries to adapt to the change.   However, what we can do is practice and train our feet how to build strength, balance, and proprioception with safe exercises.

Lateral ankle sprains account for 85% of all ankle sprains.  Typically this occurs with inversion of a plantar-flexed foot. Studies have shown that history of ankle sprain is the most common predisposing factor to the occurrence of ankle sprains.  In fact, an article in Journal of Orthopaedic & Sports Physical Therapy states that more than 70% of people who sprain their ankles continue to have problems with them, and 80% will sprain their ankles again.  Evidence suggests use of ankle support DURING sporting events to decrease risk of injury, however, in practice or off-season training should be done to improve the body’s ability to protect on its own.

In addition to the 3 major ligaments on the lateral portion of the ankle, the muscles around the joint, especially the peroneals provide added stability.  The biggest problem after a sprain is instability of the ankle and decreased proprioceptive awareness.   Proprioception is the body’s awareness of itself in space.  When nerve receptors sense the ankle is in a vulnerable position it sends a message to the brain.  The brain then responds a message to the peroneals to contract to stabilize the ankle.  This decrease in proprioception delays the stability response and puts the ankle at increased risk of re-injury.

A combination of factors may contribute to chronic ankle instability including diminished neuromuscular control, proprioception and postural control deficits, muscle weakness, and ligament laxity.  A recent study demonstrates balance and proprioceptive deficits in patients with chronic ankle instability.  Exercises as well as neuromuscular and balance interventions appeared to be effective in addressing these deficits.

Therefore the focus of rehab and injury prevention for the ankle should be increasing strength, balance, and proprioception.  Doing exercises bare foot is a great way to ensure proper proprioception as it increases sensory awareness and allows the intrinsic foot muscles to aid in the stability.  In today’s video Dr. Megan Hersh shows us some of the progressions of barefoot balance drills that can be used as essential great warm up drills.

References

Lin, Chung-Wei Christine, Claire E Hiller, and Rob A de Bie. “Evidence-Based Treatment for Ankle Injuries: A Clinical Perspective.” The Journal of Manual & Manipulative Therapy 18.1 (2010): 22–28. PMC. Web. 31 Mar. 2015.

“Ankle Sprains: Combination of Manual Therapy and Supervised Exercise Leads to Better Recovery.” J Orthop Sports Phys Ther. 2013;43(7):456-456