Exercises To Decrease Risk Of Common Soccer Injuries: Ankle Sprains

An ankle sprain occurs when the ligaments of the ankle are overstretched as the ankle is rolled, twisted, or turned in an awkward or unexpected way.  Ligaments are connective tissue of the body that connect one bone to another bone and provide support through a joint.  Lateral ankle sprains, or sprains to the outer ligaments of the ankle, are the most common forms of ankle sprains in soccer players due to the movements required of the sport.

Ankle sprains are assigned a grade (grade 1, 2, or 3) based on the extent of injury to the ligaments.  The recovery time from an ankle sprain is typically longer with higher grade sprains.

Soccer players may have an increased risk of ankle injury if they have any of the following:

• Weakness through the muscles of the calf and ankle 

• Poor balance and control of the ankle or foot with dynamic activities

• Tight calf muscles

• A history of previous ankle sprain or injury 

Our joints and tendons contain sensory receptors called proprioceptors that respond to the movement and position of the body.  Proprioceptors communicate information to our brain and muscles and help us maintain or change our body position.

Research studies suggest that regular participation in a lower extremity strengthening program that includes proprioceptive training may help decrease the risk of having an ankle injury during soccer activities.  A lower extremity strengthening program should also include exercises that address strength and mobility impairments in the ankle in addition to building proprioception. 

Check out the video below for dynamic balance exercises to improve ankle proprioception:

Questions? CLICK HERE to contact the author of this article, Sean Tyler, DPT.

"Move Better" Series: The Importance of Ankle Dorsiflexion Mobility

WHAT IS ANKLE DORSIFLEXION?

Dorsiflexion is a motion that occurs at the ankle and involves the movement of the top part of the foot toward the tibia (shin) bone.  The same movement occurs when your feet are planted on the ground and you bring your tibia forward over the foot, like when you squat or crouch.  

WHY IS ANKLE DORSIFLEXION IMPORTANT? 

Restricted ankle dorsiflexion has been found to  impact many functional movement patterns including the squat, single-leg squat, step down, and landing from a jump.  This may impact a person’s ability to perform sport specific movements as well as normal daily activities.  Someone with impairments in ankle dorsiflexion mobility may have difficulty going down stairs, squatting to lift an object off of the ground, standing up from a low chair, or walking on inclines and uneven surfaces.  

Limitations in ankle dorsiflexion during squatting, lunging, and jumping activities is also correlated with an increase in dynamic knee valgus during these movements.  Dynamic knee valgus is when the knee moves or collapses inward while under load.  This increase in dynamic knee valgus may increase someone’s risk for knee injury and knee pain with sports and movement.  

Adequate dorsiflexion range of motion is also important for running and sprinting.  During running and sprinting, ankle dorsiflexion range of motion can affect the swing speed of the forward moving leg and alter the foot position and amount of pronation during impact with the ground.  

HOW CAN I ASSESS MY ANKLE DORSIFLEXION MOBILITY?

See our previous blog post titled “MOVE BETTER" SERIES: KNEE-TO-WALL TEST to watch a video on how to perform a simple dorsiflexion mobility assessment at home. 

WHAT CAUSES POOR ANKLE DORSIFLEXION MOBILITY?

Ankle dorsiflexion mobility can be impaired due to tight calf musculature or a prior ankle injury or surgery.  These injuries and surgeries may include ankle fractures, tendon and ligament repairs, and ankle sprains.  These injuries often result in periods of immobility and possible tissue scarring that can impair ankle dorsiflexion mobility.  They may also alter the alignment and biomechanics of the ankle joint.  Both significant and minor ankle injuries may affect ankle mobility, however in most cases the ankle joint can regain full range of motion and function over time.      

HOW MUCH ANKLE DORSIFLEXION IS NORMAL? 

Normal ankle dorsiflexion range of motion is 20 degrees according to most research and orthopedic organizations, however there is some variability in the research literature.  Studies have found that walking requires 10-20 degrees of ankle dorsiflexion, while studies examining squatting have found that more than 20 degrees may be necessary to get into deep squatting positions.     

To measure your ankle dorsiflexion, see our previous blog post titled “MOVE BETTER” SERIES: KNEE-TO-WALL TEST.

HOW CAN I IMPROVE MY ANKLE DORSIFLEXION?

In most cases, ankle mobility can be improved with consistent stretching and joint mobility exercises.  See our recent blog post “MOVE BETTER” SERIES: EXERCISES TO IMPROVE ANKLE DORSIFLEXION MOBILITY for exercise examples.

-Sean Tyler, DPT

An Ounce of Prevention: Reducing the Risk of Ankle Sprains

A running joke in Seattle is that summer doesn’t start until July 5th, which therefore means prime hiking season is now upon us. Exploring the mountains and alpine lakes of the Pacific Northwest can be an excellent form of exercise, bringing with it numerous benefits to your musculoskeletal and cardiovascular systems. But with those benefits also comes the risk of injury, with ankle sprains being a common culprit. In fact, ankle sprains make up approximately 45% of all sports-related injuries in the United States. While most ankle sprains will heal over the course of 2-8 weeks, 73% of individuals who have sustained an ankle sprain once are likely to sustain another ankle sprain in the future. Fortunately, the risk of ankle sprains can be reduced via injury prevention programs. In fact, those who have sustained an ankle sprain in the past benefit even more from these injury prevention programs, experiencing a greater reduction in risk than those who have never sprained an ankle. However, the overall risk of ankle sprains is still higher in individuals who have a history of an ankle sprain. The best predictor of a future injury is a past injury. We cannot change the past, but we can alter the future by performing targeted exercises at the ankle joint.

So what do these injury prevention programs look like? The primary goal is to improve ankle stability via balance/proprioceptive exercises, which are the gold standard for reducing the risk of ankle sprains. Standing on one foot with your eyes open on flat ground is a solid baseline, for which you should be able to balance for 60 seconds without having to catch yourself. If you can do this without much of a challenge, a simple progression is to close your eyes, which will make the exercise significantly more difficult. Our vision is one of three systems to contribute to our sense of balance and typically the one we rely on most. So, when we close our eyes we are down to two systems and are therefore less efficient at maintaining our balance. Once this is mastered, one could advance to performing single leg balance with motion on the opposite side of our body, further challenging our limits of stability. Here is an example:

Single Leg Balance Progression Video

Balance exercises like these can be performed every day in order to reduce the risk of ankle sprains when hiking, backpacking, or trail running. Perform balance exercises barefoot in order to make them more challenging. As always, all exercises should be pain free and you should get approval from a healthcare provider before beginning a new exercise program following an injury. Once cleared, find a safe and quiet place to stand on one leg and test your limits of stability.

-Grant Hennington, DPT