When Chris Peterson sprained his ankle playing football in high school, he treated it as a minor injury. His ankle hurt for a few days, but no one suggested he see a doctor. He soon felt better.
“I got back to playing as soon as I could,” said Peterson, now a physical therapist at Washington University in St. Louis, Missouri (United States). However, even though his ankle didn’t hurt, afterward it just wasn’t the same.
“I was stepping wrong, and my ankle just wouldn’t respond,” which often caused toppling, he said.
Sprained ankles are among the most common musculoskeletal injuries. According to official estimates, 2 million people in the US sprain their ankles every year, but the real number is likely much higher as many do not seek medical attention for this injury.
While an ankle sprain may seem like a minor injury, it leads to a much greater likelihood of it happening again. In a study of military cadets, those with a history of sprained ankles were 3.4 times more likely to sprain their ankles during the study, compared to those who had not suffered a sprain.
It is estimated that for 40% of people, a sprained ankle can lead to chronic instability characterized by repeated spraining of the joint, a general feeling of wobble and instability, and occasionally pain, tenderness, or swelling.
If you’ve sprained your ankle, it doesn’t mean you’re destined to go through life with a painful, shaky joint, dreading the moment when it will give way. Experts recommend a series of exercises to strengthen your ankles, which in turn reduce the chances of suffering a sprain, whether for the first or tenth time.
Why Many Ankle Injuries Don’t Fully Heal
“The biggest reason people get recurrent ankle sprains is that they don’t get rehab,” said Dr. Michael Fredericson, a sports physician at Stanford University.
The ankle is a complicated web of bones and ligaments that connect the tibia and fibula of the leg to the delicate bones of the foot. He has to do a lot of work, supporting his entire body weight while also bending and flexing in many directions.
It is this versatility, along with a constant workload, that makes it so difficult and critical to fully recover from an ankle injury, as it is so easy to re-injure the joint. “There’s not a lot of room for error, especially if you play sports,” said Dr. Fredericson.
The key is exercise. In a recent meta-analysis of 14 randomized controlled trials, exercise-based interventions were more effective at reducing the risk of recurrent sprains than usual care, which usually consists of rest, ice, compression, and elevation.
“We know that exercise therapy works,” said Jente Wagemans, a graduate student at the University of Antwerp (Belgium) and lead author of the study. “We know it’s effective in preventing a secondary injury.”
Even in the first few days after a sprain, therapy can help move the ankle. Dr. Alysia Robichau, a sports physician at Methodist Hospital in Houston, Texas, often recommends very light, weightless activities, such as tracing the alphabet with your foot, in the days after a sprain. “It helps with smooth range of motion,” she said.
Strengthening the ankle gradually
Once the ligament has started to heal, which happens in the first few weeks after a sprain, the next step is weight-bearing exercise. Like bones and muscles, Wagemans explained, ligaments get stronger when increasing amounts of force are applied.
Unlike bones, ankle ligaments need to be strengthened in several directions as the joint is very mobile. A simple ankle strengthening exercise is to put a resistance band around your foot and attach it to something heavy, like a table leg. Then flex your foot forward, backward, and to the sides, aiming for three sets of 15 reps each.
If you’re looking to avoid ankle injuries, these exercises should be done three to four times a week. If you are recovering from a recent ankle sprain, all exercises should be guided by a physical therapist, who will adapt them to the injury.
Risk of nerve damage
Every time you step on an uneven surface or have to land your foot quickly, tiny nerves in your ankle automatically help it stay steady rather than twisting or turning. Think of them as the feature on some cars that makes small steering corrections to avoid swerving — except the nerves bring the ankle back into neutral — Peterson said.
One of the main causes of unstable ankles is when sprains also damage these corrective nerves.
“Without that feedback system, you’re more likely to sprain your ankle again,” said Jeff Harvath, a physical therapist at Washington University in St. Louis.
Balance on one leg to retrain nerves
If your ankle feels wobbly, unstable, or has frequent sprains, you need to retrain the nerves in that area. “It’s about teaching the muscles and ligaments to coordinate properly,” said Dr. Robichau.
One of the best ways to do this is with the single leg balance exercise. To start, balance on one leg, extending your arms in different directions, aiming for a set of 20 repetitions.
It is important to use a lot of varied movements, such as reaching out to grab something, shifting your weight, closing your eyes, or even standing on one leg while brushing your teeth. “The more real it looks, the more it transfers” into everyday life, Peterson said.
Once you’re comfortable with this, incorporate an element of instability by balancing on a sofa cushion, foam balance cushion, or Bosu ball. For an added challenge, use a light weight or medicine ball.
Another variation is the star leg stretch. Balance on one foot and extend the other foot in a straight line, forward, sideways, and back clockwise, targeting two sets of 15 repetitions.
Strong muscles to support the ankles
The muscles in your legs, ankles, and feet also play an important role in ankle stability, so it’s important to strengthen them. Whenever the ankle joint is pulled in the wrong direction, the ankle and calf muscles help to pull it back. “We don’t want to rely on ligaments for everything,” said Dr. Harvath.
This includes the muscles in your lower legs, which tilt your feet inward, outward, up, and down. Strengthening these muscles can help compensate for weaknesses in the ankle ligaments.
The Doctor. Harvath recommends lunges on an unstable surface such as a sofa cushion, foam balance cushion, or Bosu ball. He suggests two sets of 15 repetitions for each leg.
Another exercise for your calves and ankles is the standing heel raise, which can be done with a single leg or both. Stand with your feet shoulder-width apart. Simply stand on your toes and then lower your heels to the floor. Try doing three sets of 10 repetitions.
If done regularly, these exercises can prevent and help you recover from an injury.
As for Dr. Peterson, his ankle instability forced him to stop playing football and persisted for about ten years. It wasn’t until he entered physical therapy college that he started his own exercise routine to strengthen his ankle.
Today, although his ankle ligament is still damaged, he has managed to compensate and create the stability he needs. Do all your favorite activities like running marathons and rock climbing, without worrying about your ankle turning. For many patients Peterson sees, regaining strength and stability in the ankles is a matter of learning which exercises to do. “It’s usually very simple,” he said.
Translated by Luiz Roberto M. Gonçalves
Chad-98Weaver, a distinguished author at NewsBulletin247, excels in the craft of article writing. With a keen eye for detail and a penchant for storytelling, Chad delivers informative and engaging content that resonates with readers across various subjects. His contributions are a testament to his dedication and expertise in the field of journalism.
