Working in the medical and fitness industries when it comes to ankle injuries, or any injury, two of the comments that I hear most often are “ankle injuries are just normal in sports”, or “my family has weak ankle” attributing the injury to some genetic predisposition.

They are in correct on both accounts. No injury is normal in sports. They may be common in sports but they are normal, otherwise, everyone would have them.

Secondly, injuries are not hereditary. It’s not hereditary or their gene pool that causes injury it’s actually dysfunctions and muscle imbalances from within their lifestyle that should be attributed to ankle and other injuries.

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Ankle injuries although common can be prevented and should an ankle injury occur the severity can be significantly minimized.

We will review the most common injuries to the ankle, and what can be done to prevent these from happening in the first place and how to prevent them from reoccurring. Here are a few terms for reference as we discuss ankle injuries.

Types of Injuries

– Sprain: injury to a ligament, (Ligaments attach bone to bone.)
– Strain: injury to a muscle or tendon, (Tendon attached muscle to bone.)
– Fracture: broken bone. Can range from stress fracture or micro breaks or disruption in the bone to incomplete fracture in which there is disruption and some separation within the bone to complete fracture in which there is disruption and complete separation through the bone.

Severity of Injury

– Grade I: fibers of the ligament, tendon or muscle are stretched but there is not disruption in the fibers or structural integrity.
– Grade II: a mild to moderate or tear or disruption of the fibers of the ligament, tendon or muscle occurs. Normal function inhibited.
– Grade III: complete tear and disruption of the fibers of the ligament, tendon, and muscle occurs. Significant decrease or loss in function.

Common Ankle Injuries

– Inversion Sprain of the ligaments to the outside of the ankle joint. (The most common injury.) These ligaments include the Anterior Talo-Fibular Ligament, (ATF), the Calcaneal-Fibular Ligament, (CFL), and the Posterior Talo-Fibular Ligament, (PTF). Foot and ankle “roll” or twist to the outside.

– Eversion Sprain of the ligaments, more so the Deltoid ligament on the inside of the ankle joint. Foot and ankle “roll” or twist to the inside.

– Strain of the Achilles’ Tendon on the posterior or backside of the ankle joint at or just above the area. Forceful flexion of the ankle causing increased tension in the Achilles’ tendon. Can also twist to a certain degree in and ankle sprain.

– Fracture, or break in the bone, more commonly to the lateral or outside bone the malleolus. Force or torque at the ligament attachment creates break within the bone or pulls a piece of bone off the ankle. Can also occur with impact such as in landing.
So, what causes ankles injuries to occur? Nothing happens without a reason. There is a cause and effect especially when it come to the human body and injuries.

Injuries occur from muscular imbalances and improper muscle position which create dysfunctions in how the body moves and works together. Once deficits are identified exercises can be performed to improve the body’s overall movement patterns and avoid injury.

Indicators of Muscular and Movement Pattern Deficits

ankle injuries_2

** If any of these or combination of these are present that individual is at risk of an ankle injury and other injuries.

– Everted Foot Position – in this position body weight is loading through the outside of the foot instead of equally through the middles if the foot. Here the arch of the foot is also decreased which decreases proper support and weight transfer through the foot and ankle predisposing the individual to an ankle sprain.

Proper position is to have the toes pointing forward with weight equally distributed on both feet and through the middle of the foot from toes to heel.                                         

– Everted Ankle Movement – stand in front of a mirror, raise up onto your tippy toes, if you see your ankles move outward as you move up and down on tippy toes this is an indication of muscular strength imbalance surrounding the ankle joint.

This movement outward is an indication of what the ankle is doing when you push off your toes when walking, jogging or having to move into toes to reach.

The proper movement pattern should be for the ankle joint to move in a straight line up and down without deviation to either side, as seen in the picture.

– Decreased Dorsi Flexion on Ankle – in standing, keeping body in a straight line from head to toe keep your heels on the ground as you raise your foot upward as in tapping your foot up and down but DO NOT move your weight onto your heels.

Tightness in the achilles’ tendon or calf will make this difficult to perform. You may find yourself compensating by moving your body behind your ankles. The picture shows the “Don’t” position.

Exercises to Prevent Ankle Injuries

– Band Exercises  these exercises use a resistance band or tubing to strengthen the muscles of the ankle by resisting the inward and outward movements of the ankle.

While these are good exercises, they are performed in a non-weight bearing position and provide a lower level of strengthening than exercises performed in weight bearing and performed in positions that promote proper movement patterns of the muscles.

Ankle Circles – these are excellent for strengthening and recruiting the muscles of the foot, ankle and lower leg. They also provide immediate feedback as to which muscles have decreased muscular strength and endurance. As you perform this exercise you may feel muscles that are burning from fatigue.

Those are the muscles that have been on vacation and are weaker or have less endurance than the others. You may also find the first couple of times you do this exercise that the circles look more like squiggly lines than circles. Another indication of muscle imbalance.

To perform, lie on you back with hip and knee at 90 degrees, hold behind the knee, moving only the foot and ankle rotate outward for 30 circles. Repeat to the opposite direction inward then perform on the opposite side. Progress repetitions as is tolerated.

– Feet Together Toe Raise – this exercise will help if your ankle move outward when on tippy toes as discussed above. Standing with feet, ankle and knees together perform calf raise but do not let feet, ankles or knees separate at any time during the exercise. Progress to 4 sets of 20 reps.

– Functional Side Stepping Band – place stretch band around the ball of the feet as shown in picture. In standing legs hip width apart with toes facing forward and knees slightly bent, keeping band taut (DO NOT bring the feet together.

Maintain hip distance between the feet.), step to the right for 10-15 steps then repeat to the left. Progress to 3-4 times each direction. You should feel this in the sides of the calves. If you feel in the hips you are compensating with the hips.

– Functional Calf Stretch – place the bottom of one foot up against a wall keeping heel on the ground. Using the opposite foot behind you raise yourself “up-and-over” the front foot.

This stretches the foot, ankle and calf without creating tightness in the ankle joint by compressing the joint as in the “Don’t” picture. Hold stretch for 30-60 seconds each side.

“Preferred”” Not Preferred”

– Gravity Drop – standing on edge of step keeping body in straight line from head to toe lower heels off the edge of the step. Keep toes facing forward and allow the weight of your body to load down through the heels. Progress to 3 minutes.

– Calf Raises in 3 Positions – standing on floor or edge of step perform calf raises by moving up and down onto tippy toes just touching heel to the floor during each set.

Do not rock back and forth on your feet. This exercise strengthening the calf and Achilles’ tendon. 3 positions are 1. Toes facing forward, 2. Toes slightly inward, 3. Toes slightly outward. Progress to 3-4 sets of 20 repetitions in one position. Perform 1-2 sets if performing all 3 positions.

– Shin Raises – sitting with heel on floor, hold 10# weight on top of foot, Tap foot up and down. This exercise strengthening the shin muscles to work in coordination with the other muscles of the lower leg for proper ankle mechanics. Progress to 3-4 sets of 20-25 repetitions.

As you see the exercises to avoid and prevent ankle injuries are pretty simply. The hardest thing is to continue to include these in any workout routine you have.

These can be done as a warm up to your current exercises or can be done throughout the day to promote strength and endurance of the ankle.

Follow these exercises and see how much better you feel when you walk and have an extra bounce in your step. If you are a female athlete, you might be interested in knowing how to deal with  athletic amenorrhea.

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