What is ankle instability?
Ankle sprains are by far, the most commonly sustained athletic injury. They are prevalent at all levels of running, with lateral sprains (spraining the ligaments on the outside of the ankle) accounting for 85% of all such injuries. The off road runner is more at risk due to the uneven surfaces than the road or pavement runner.
The biggest problem after an ankle sprain is the resulting instability (or recurrent sprains) of the ankle that can follow. Studies have shown that approximately 30% of athletes who suffer a lateral ankle sprain go on to suffer chronic ankle instability.
The severity of lateral ligament injuries at the ankle may be graded by a physiotherapist. Grade 1 is where there is no abnormal ligament laxity or looseness; Grade 2 injuries reveal some degree of laxity, however there is a firm end point; Grade 3 injuries show gross ligament laxity without a discernible end point on testing. All three grades are associated with pain and tenderness initially.
How to prevent or beat ankle instability:
Once the acute ankle sprain has been treated by the RICE regime (rest, ice, compression, elevation) along with physiotherapy to restore full ankle range of movement if necessary, then the focus is to prevent/beat ankle instability by increasing ankle strength, proprioception and balance. For ankle strengthening exercises, working the ankle sitting down against a resistance band is recommended. The ankle must be worked in 4 directions – moving the ankle outwards, inwards, upwards and downwards performing 2-3 sets of 12 repetitions in each direction. Whilst strengthening the ankle is important, the key factor in preventing or beating ankle instability is to improve the ankle “proprioception”. When a person suffers an ankle sprain, the sensory receptors in the ligament are also damaged. These receptors are responsible for proprioception, which is a function of our nervous system, and this helps a runner sense where their foot is in relation to the ground. Training to improve ankle proprioception will also improve balance.
Ankle bracing or taping to reduce ankle instability:
Research suggests that ankle bracing and taping are equally effective in reducing the risk of future ankle sprains, however bracing is easier to apply and doesn’t aggravate the skin as much. It must be remembered however, that both bracing and taping only support the ankle while the runner is wearing them. Retraining ankle strength, proprioception and balance targets the underlying impairments and once these components are improved, in most cases no further preventive measures such as bracing or taping should be needed. In moderate to severe cases of ankle instability we, here at Apex Clinic recommend bracing (usually over taping) for a few months until an intensive training program has been undertaken and has had time to become effective. Research has shown that an intensive program of ankle proprioception and balance training will be effective after between 4 to 10 weeks.
The key ingredient – exercises to improve ankle proprioception and balance:
Each of these exercises should be performed with your eyes open and then with your eyes closed, on 5- 6 days per week, for 15 to 20 minutes in total, once or twice daily.
1) Single leg balancing, clapping: Balance on the affected ankle, with a slightly bent knee, and clap your hands in front of you, behind you and above your head. This can be progressed to standing on a trampoline or firm cushion.
2) Single leg balancing, throwing and catching a ball: Balance on the affected ankle, throw and catch a ball, bending your knee slightly each time you catch the ball.
3) Single leg hops: Balance on the affected ankle, with hands on your hips. Hop slowly forwards for 10 hops then backwards, then out to each side.
4) The dot exercise: Mark out 4 dots on the ground, at each corner of a square and one dot in the middle with tape or chalk. Standing on the affected ankle, start at the central dot and hop to each corner dot and back again to the central dot each time. Repeat this exercise in a clockwise and then anti-clockwise direction.
5) Single leg squats: Balance on the affected ankle, with hands on your hips. Maintain your balance while performing a mini squat, such that your knee bends to 45 degrees and up again.
At Apex Clinic we also advice all trail runners to do these exercises, on both ankles, whether they have had an ankle injury or not, as prevention is better than cure. Ankle instability can be conquered in most cases, so take action now!