Most ankle injuries happen from a sudden twisting of the joint inward. Depending on the angle of the force, and how much the ankle twists, you can tear any one of/or all four of the ligaments that protect the outside of the joint. Many doctors calculate the number of weeks to return to activity by the number of ligaments damaged. This will give you a rough estimate. In reality, the damage will not completely heal for 4-6 weeks. It is during this time that the joint can be most vulnerable to further injury.
The stability of the ankle, as with all joints, comes from the shape of the bones, the length of the ligaments, and the strength of the muscles. You can’t change the shape of the bones without surgery. Once ligaments have been stretched out they cannot be shortened. The strength of the muscles that cross the ankle joint (internal support) and providing bracing outside the joint (external support) are the only two factors than an athlete has control over.
The stronger an athlete is going into an injury, the quicker they will return. The stronger the muscles are, the less likely the joint will be re-injured. If the ankle does get injured, the severity of injury will be less. Since nobody plans to get injured, it is best to include regular strengthening exercises for the ankle into your strength and conditioning program. An ounce of prevention is a lot less painful than getting injured and going through 4-6 weeks of therapy.
There are four (4) things an athlete can do to protect themselves from injury to their ankles.
- Strengthen all the muscles that move the ankle
- Externally brace the ankle
- Wear high top shoes
- Tape the ankle
The foot and ankle are able to move in four primary directions: up, down, in, and out. In addition the joint can move in combination of directions: up & in, up & out, down & in, down & out, and in circles. Exercises to strengthen all the muscles of the ankle can be done using body weight, free weights, machines, towels, and exercise bands. As with all strengthening programs, increases in sets, repetitions, and resistance need to be regular and adjusted based on performance. Doing the same exercises each day without any changes in difficulty will not get you stronger.
EXAMPLE OF PROGRESSIVE EXERCISES:
- 3 sets – 10 repetitions with one pound
- 4 sets – 10 repetitions with one pound
- 3 sets – 15 repetitions with one pound
- 3 sets – 20 repetitions with one pound
- 3 sets – 10 repetitions with two pounds
- 4 sets – 10 repetitions with two pounds
- 3 sets – 15 repetitions . . .
Keep in mind that most of the muscles that cross the ankle joint cannot handle a lot of weight. For exercises to be effective the resistance should be enough to challenge the muscle but not be so much that the joint is not able to work through the full range of motion.
There are many braces to choose from that will do a good job to support the ankle. The most effective braces are adjustable to fit your foot and ankle. Laces that adjust how tight the brace fits and non-elastic straps that prevent the ankle from turning inward will provide the best protection. Straps and laces can also be easily adjusted during activity to give the best support needed. Elastic braces and sleeves may be more comfortable but will not provide the adjustments for a good fit or restrict movement to prevent injury.
Almost all athletic activities depend on the feet. Shoes that do not fit properly or are worn out can contribute significantly to injuries. Wearing the right type of shoe for the activity is also very important; i.e. playing basketball in basketball shoes, running in running shoes. A high top shoe can be helpful in protecting the ankle joint if:
- the top of the shoe is at least 3 inches above the ankle bone
- the shoe is laced tightly all the way up
- the shoe is correctly fit to the foot in length and width
Unfortunately not all sports have the option of wearing high top shoes, but you may want to use that option if at all possible to prevent injury.
Using tape to support a joint is common practice in athletics. Advantages include a thin, lightweight support that can be tailored to fit an individuals needs. Disadvantages include the possibility of skin irritation from the adhesive, time required to apply it, tape is difficult to apply effectively to yourself, cost, and it loosens up significantly within an hour of application. Many people think that wearing tape on the ankles will make them weaker. My thoughts are that not doing exercises to strengthen the muscles will make them weaker. Tape may be the most popular tool used to prevent ankle injuries, but it is not the best.
Ankle injuries are seldom a one-time occurrence. More times than not they become a chronic re-occurring event that if it does not stop you from playing, will slow you down. You are only fooling yourself by ignoring the problem. Thinking that, “it is all better now, I haven’t hurt it since last year” will surely lead to another injury without taking steps to prevent injury. Those that are lucky enough to have never hurt their ankle should include regular exercises to keep that area of the body strong.
As you progress from one level of competition to the next, the physical demands become greater: more practices, contests, longer hours, increased intensity, etc. If you ignore these demands and rest on your natural ability, someday, somewhere, somebody is going to beat you. Hopefully it won’t be in the form of an ankle sprain that you could have prevented through strength and conditioning, bracing, high top shoes, and/or taping.