When Chris Peterson sprained his ankle playing football in high school, he wrote it off as a minor injury. His ankle hurt for a couple of days, but no one suggested that he see a doctor and he soon felt better. “I got back to playing as soon as I could,” said Dr. Peterson, now a physical therapist at Washington University in St. Louis. However, even though his ankle didn’t hurt, he wasn’t the same afterward.
“I had a bad footing and my ankle just wasn’t there,” which often led to falls, he said.
Ankle sprains are among the most common musculoskeletal injuries. Official estimates are that two million people in the US sprain their ankle each year, but the true number is likely to be much higher, as many people never seek care for their injury.
Although a sprained ankle may seem like a minor injury, sustaining one leads to a much higher chance of doing it again. In a study of military cadets, those with a history of ankle sprains were 3.4 times more likely to sprain their ankle during the course of the study, compared to those with no history of ankle sprains. For about 40 percent of people, an ankle sprain can lead to chronic ankle instability, which is characterized by repeated rocking of the ankle, a general feeling of instability and instability, and occasional pain, tenderness, or swelling.
If you’ve sprained your ankle in the past, that doesn’t mean you’re destined to spend your life with a sore, wobbly joint, dreading the moment it gives way. Experts recommend a series of exercises to strengthen the ankles, which in turn reduce the chances of suffering a sprain, whether for the first time or for the tenth time.
Why don’t many ankle injuries heal completely?
“The main reason people get recurrent ankle sprains is that they never do rehab,” said Dr. Michael Fredericson, a sports physician at Stanford University.
The ankle is a complicated mosaic of bones and ligaments sewn together, connecting the tibia and fibula of the lower leg to the delicate bones of the foot. It has to do a lot of work, supporting the entire weight of the body while bending and flexing in many directions. It is this versatility, coupled with a constant workload, that makes full recovery from an ankle injury so difficult and critical, as it is so easy to re-injure an ankle. “There’s not a lot of room for error, especially if you play sports,” Dr. Fredericson said.
The key is exercise. In a recent meta-analysis of 14 randomized controlled trials, exercise-based interventions were more effective in reducing the risk of recurrent sprains than usual care, which often consists of rest, ice, compression, and elevation.
“We know that exercise therapy works,” said Jente Wagemans, a graduate student at the University of Antwerp and lead author of the study. “We know that it is effective for the prevention of a secondary injury.”
Even in the first few days after a sprain, it can help to move your ankle. Dr. Alysia Robichau, a sports physician at Houston Methodist Hospital, often recommends a very light, non-weight-bearing activity, such as tracing the alphabet with your foot, in the days after a sprain. “That helps with smooth range of motion,” she said.
Slowly strengthening the ankle
Once the ligament has started to heal, which is in the first few weeks after a sprain, the next step is weight-bearing exercise. Like bones and muscles, Mr. Wagemans explained, ligaments become stronger when an increasing amount of force is applied.
Unlike the bones, the ligaments of the ankle must be strengthened in multiple directions, because the joint is very mobile. A simple exercise to strengthen your ankle is to wrap a resistance band around your foot and attach it to something heavy, like a table leg. Then flex your foot forward, backward, and sideways, aiming for three sets of 15 reps each.
If you’re trying to prevent ankle injuries, these exercises should be done three to four times a week. If you are recovering from a recent ankle sprain, all exercises should be performed under the supervision of a physical therapist, who will adapt them to the injury.
The risk of nerve damage
Every time you step on an uneven surface or have to place your foot quickly, the tiny nerves in your ankle automatically help keep you steady instead of rolling or twisting. Think of them like the lane-assist feature in some cars, which makes small steering corrections to avoid drifting, Dr. Peterson said, except nerves cause your ankle to return to a neutral position. One of the main causes of wobbly ankles is when sprains also damage these corrective nerves.
“Without that feedback system, you’re more likely to sprain your ankle again,” said Jeff Harvath, a physical therapist at Washington University in St. Louis.
Single leg balance to retrain your nerves
If your ankle feels wobbly or unstable or has a habit of rolling, you need to retrain the nerves in that area. “It’s about teaching the muscles and ligaments to coordinate in the right way,” said Dr. Robichau.
One of the best ways to do this is a single leg balance exercise. To start, balance on one leg, extending your arms in different directions, aiming for one set of 20 reps. It’s important to use lots of varied movements, such as reaching with your hands, shifting your weight, closing your eyes, or even standing on one leg while brushing your teeth. “The more real it seems, the more it transfers” into daily life, Dr. Peterson said.
Once you’re comfortable with this, add an element of instability by balancing on a couch cushion, foam balance pad, or Bosu ball. For an extra challenge, add a light weight or medicine ball. Another variation is the star touch with the standing leg. Balance on one foot and extend the other foot straight out, forward, sideways, and back, clockwise, aiming for two sets of 15 reps.
Strong muscles to support the ankles.
The muscles of the legs, ankles, and feet also play an important role in ankle stability, so it’s important to strengthen them. Any time the ankle joint is pulled in the wrong direction, the ankle and calf muscles help pull it backwards. “We don’t want to rely on ligaments for everything,” said Dr. Harvath.
This includes the muscles in the lower legs, which tilt the foot in, out, up, and down. Strengthening these muscles can help compensate for weaknesses in the ankle ligaments. Dr. Harvath recommended launching yourself on an unstable surface, such as a couch cushion, foam balance pad, or Bosu ball. He recommended two sets of 15 repetitions for each leg.
Another exercise for the calves and ankles is the standing heel raise, which can be done with one leg or with both legs. Stand with your feet shoulder-width apart. Simply rise up on your toes, then lower your heels to the ground. Aim for three sets of 10 reps.
If done regularly, these exercises can prevent and help you recover from injury. As for Dr. Peterson, his ankle instability forced him to stop playing football and persisted for about 10 years. It was only when he went to school for physical therapy that he began his own exercise routine to strengthen his ankles.
To this day, although the ankle ligament is still damaged, it has been able to compensate and create the stability it needs. He does all his favorite activities, like running marathons and rock climbing, without worrying about his ankle moving. For many of the patients he sees, regaining strength and stability in the ankles is a matter of learning what exercises to do. “It’s often very simple,” she said.
Rachel Fairbank is a freelance science writer based in Texas.