Preventing Ankle Injuries in Sports
Strengthening Muscles to Prevent and Reduce Severity of Injury
Ankle injuries are one of the most common injuries seen in sports. Because of its structure, the ankle is particularly susceptible to inversion (turning inwards) ankle sprains.
Anatomy of the Ankle
The ankle joint consists of three bones including the tibia, fibula, and the talus. These three bones make up the ankle mortise. The structure is unique in that the distal ends of the tibia and fibula fit tightly over the top of the talus with the tibia extending down over the medial side of the talus and the fibula extending down over the lateral side of the talus.
Together the three bones form a tight articulation. However, the unique structural feature is that the fibula extends further on the lateral side of the talus than the tibia does on the medial side. This creates a boney block on the lateral side of the ankle preventing the foot from rolling towards the outside. This structure explains why the mechanism of injury for most ankle sprains is a rolling of the foot inwards.
There are three primary ligaments on the lateral side of the ankle. These ligaments are the anterior talofibular, calcaneofibular, and posterior talofibular. Of these three ligaments, the anterior talofibular ligament is most often injured in an inversion sprain.
Ligaments are made up of dense connective tissue with some elastic properties. This means that the ligament can stretch to a point. However, if the force is greater than the strength of the tissue, the ligament will tear. Once this type of tissue has torn, it will not return to its original length. This is an important physiological factor when returning from an ankle injury.
Proprioceptive Training for the Ankle
The key to preventing ankle injuries and/or returning from an ankle injury is to improve the proprioceptive feedback located within the ligaments and to strengthen the surrounding musculature. Retraining the neuromuscular system will help the muscles of the ankle contract more efficiently when they feel the ankle losing stability.
This type of training can be done through balance training and/or proprioceptive training using rehabilitation equipment such as a proprioceptive board, balance board, or dyna disc. The goal is to perform a single leg stand and maintain balance for a minimum of 30 seconds. The athlete can work on this for three to five minutes each day.
Strength Exercises for the Ankle
The goal of strength exercises is to strengthen the specific muscles surrounding the ankle so that the muscles are strong enough to right the ankle prior to incurring injury to one or more of the ligaments. The simplest and easiest tool to use is a theraband.
Therabands come in a variety of strengths (corresponding to specific colors). They come in rolls and can be cut into an appropriate length for ankle exercises. A good length would be three to four feet (depending on the size of the individual).
The middle of the band is wrapped around the foot and toes and the ends are held by the individual at a diagonal angle. The tighter the band is held, the higher the resistance. The exercises need to be performed in two directions.
The first direction is to start with the toes “up and in” and move towards a “down and out” position. The second position is to start with the toes “up and out” and move towards a “down and in”. The two directions form an “X” pattern. The toes should lead the way and need to be incorporated into the exercises.
The individual should perform three sets of ten exercises in each direction. These exercises can be done daily for the most benefit.
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