Preventing Progressive Ankle injury

This is a sponsored post from CSC sponsor Bluegrass Orthopaedics.

Ankle injuries are one the most common lower extremity injuries in sport, with more than 2 million occurring each year. The medical term is ankle sprain/strain. The most common type is an inversion injury (the foot rolls or turns inward) resulting in injury to the structures on the outside of the ankle. Sprain denotes injury to the supporting ligaments while strain denotes injury to the muscles supporting the ankle. The initial reaction of the body to the injury is an increase in ankle swelling, bruising, and protective pain which necessitates relative rest (use of crutches).

Often, the swelling, pain, and functional limitations resolve within a few days to a week with rest and ice. However, recurrent injury is common, up to 60%, often with progressive damage and prolonged recovery time leading to a chronic condition. After several re-injuries, surgery may be required to stabilize the joint.

Many factors contribute to re-injury. The most important is insufficient balance retraining. When the pain and swelling goes away most people think it is safe to return to previously normal activities (including sports)! They often discontinue physical therapy due to the lack of symptoms. However, we know that following injury functional deficits persist even though the ankle may look and feel normal. The most common residual deficit is a loss or reduction in “balance ability”, medically termed proprioception.

A common history is a traumatic ankle sprain during a sporting event that is followed by recurrent injuries with less and less time in between injuries and requiring less and less force or trauma to cause the injury. In the end, just stepping off a curb or stepping onto a small rock or in a small hole results in an ankle sprain. The ankle is basically an unstable joint with the weight of the body balancing on it.

The ankle muscles are responsible for keeping the balancing act in tact. The muscles respond by getting input from the joint, ligament, and muscle receptors. These receptors “tell” the ankle what is happening and how to react (which muscles to contract and which to relax) in order to perform a task like running or jumping and landing safely. Just because the pain has gone away doesn’t mean that the receptors are functioning normally. Research has proven that joint, ligament, and muscle receptors are slow to react following an ankle sprain, placing the ankle at a high risk for re-injury.

Fortunately, this problem is easily fixed by completing some simple, progressive balance exercises. A simple progression of balance retraining exercises completed over 3-5 weeks has been shown to significantly decrease the risk of re-injury (by up to 60%). However, these exercises must be done before structural damage is done to the joint or ligaments to prevent chronic pain. So if you or someone you know has suffered an ankle injury make sure that they complete the appropriate rehabilitation before it is too late.

A simple exercise progression is outlined below:

Stage I:

  • Standing Gastroc/Soleus Stretches
  • 2 foot toe raises
  • 1 foot toe raises
  • Standing on 1 foot, balancing for 30 seconds

Stage II:

  • One leg stance with theraband (4 directions)
  • ball toss (one leg)

Stage III:

  • One foot hop (vertical only)
  • One foot hop (multi-directional, but straight planes)
  • One foot hop (multi-directional, in all planes)

Stage IV:

  • Sport Specific Activities

Each exercise in each stage should be pain free and easily completed without losing your balance before progressing to the next stage.

If you are having ankle pain or feel like your ankle is unstable please contact the physical therapy department at Bluegrass Orthopaedics for help.


Robert Pruden, PT


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