The frustration and pain of spraining an ankle is very personal to me. I’ve sprained each ankle at least 20 times (I kid you not). Since becoming a Doctor of Physical Therapy, it’s been my mission to figure out the root causes of ankle sprains and how to eliminate them.
I’ve pinpointed three major drivers of ankle sprains—an impaired vestibular system, an impaired proprioceptive system, and weak foot eversion muscles.
To address each of these in a practical manner, I created a methodical three-minute routine with progressions and regressions. It’s a routine I now perform every day, and I haven’t sprained my ankle in over a year, even while playing basketball, soccer and football consistently, and in low-tops, at that (that’s a whole other discussion).
Before we dive into the routine, let’s break down the three biggest reasons people suffer ankle sprains.
1. An Impaired Vestibular System
The vestibular system, located inside your inner ear, is your body’s main balance apparatus. Every time you move your head, whether it’s side to side, up and down, or any other motion, the vestibular system unconsciously sends feedback to your brain regarding motion, equilibrium and spatial orientation.
This “vestibular apparatus” consists of the utricle, saccule and semicircular canals, all housed in your inner ear. The basic anatomy of the vestibular apparatus can be seen above.
An impaired vestibular system is associated with a loss of balance, and balance deficits have been linked to an increased risk for ankle sprains. Therefore, it’s crucial to ensure the vestibular system is functioning properly.
2. An Impaired Proprioceptive System
The proprioceptive system is an unconscious sensory feedback system that informs the brain about joint position and where your body parts are in space. It’s often referred to as the “sixth sense.” Based on this feedback, the brain activates muscles and makes micro-adjustments to keep your positioning optimal.
An easy way to understand the importance of proprioception is to imagine if you didn’t have it. Try this: Close your eyes and move your hands and fingers around. If it wasn’t for the proprioception system, you would have no idea what your hands and fingers were doing!
The system relies on receptors in the muscles that monitor length, tension, pressure and painful stimuli. When your ankle starts to roll inward, these receptors alert your brain that it’s about to happen. When an ankle sprain does occur, these receptors get stretched out and impaired, and reaction times decrease, leading to a higher risk of future ankle sprains, increased proprioceptive deficits and so on. It’s a vicious cycle. Therefore, it’s critical that we train this system.
3. Weak Foot Eversion Muscles
The ankle evertor muscles—mainly the peroneals which run on the outside of your lower leg and ankle joint—act to evert the foot. When these muscles are weak, your ability to evert the foot is greatly reduced.
Inversion sprains are the most common type, making up roughly 85 percent of all ankle sprains. When your ankle inverts (turns inward), it’s these evertor muscles that have to be strong enough to counteract that force and evert the ankle (turn it outward) so it doesn’t continue to roll inward and cause a sprain.
That being said, the evidence for eversion strengthening in preventing ankle sprains is still up for debate. However, addressing and strengthening them may help, and surely won’t make anything worse so there’s no drawback.
The 3-Minute Ankle Saving Routine
Think of your vestibular and proprioceptive systems as the managers—they are responsible for recognizing when there’s a problem, “Oh no, I placed my foot in a high-risk position! Oh no, the ankle is turning inward!” and the foot eversion muscles as the workers responsible for moving the ankle back into a safe position.
To prevent ankle sprains, all three must work together and have to be up to par. I created this routine as an easy daily warm-up. You can do it multiple times throughout the day or, at the least, prior to activity. Progress to the next level only after you’re able to complete the current level easily.
1. Vestibular and Proprioceptive Training
Complete 1 minute on each side. Once that is easy, move to the next level. Here’s the full progression:
- Feet in tandem (tandem), no head movement
- Single leg (SL), no head movement
- Tandem with head turns
- Single leg with head turns
- Tandem with head turns and head nods (30 seconds each of head turns and head nods)
- Single leg with head turns and head nods
- The same progression as 1-6, with eyes closed
- The same progression as 1-6, on an unstable surface (like a foam pad or pillow)
- The same progression as 1-6, with eyes closed on an unstable surface
2. Foot Eversion Strengthening
Complete 30 seconds on each foot. Once you can do that with ease, move to the next level. Here’s the full progression:
- Isometric hold against hand resistance
- Active motion with controlled eccentric against hand resistance
- Isometric hold against banded resistance
- Active motion with controlled eccentric against banded resistance
If you stay patient and consistent, I’m confident this routine will clear-up your ankle sprain problems and greatly aid in preventing future sprains. That means less time nursing injuries and more time to play and train!
Photo Credit: sciencestock/iStock, ueuaphoto/iStock, KittisakJirasiitichai/iStock