Guest Columnist: Janet Caputo, PT, DPT, OCS
Why do athletes sprain their ankles? Ankle stability depends on two-way communication between the brain and the ankle joint including the associated muscles and ligaments. During competition, an athlete’s brain receives a great deal of information from the environment that it must process to make decisions which allow the athlete to react to changes in his environment. As competition increases, the decision making process becomes more complex because the athlete’s brain is required to process even more information, but faster. Also, during intense competition, some athletes experience stress and fear. Increased demands for attention, concentration, and reaction time coupled with feelings of anxiety reduce the athlete’s ability to process information. In addition, damage to joint receptors from an ankle sprain reduces the ankle’s ability to communicate with the brain. Decreased processing speed and impaired ankle joint sensation result in loss of coordination and errors in judgment that place the athlete at increased risk for injury.
Furthermore, after an ankle sprain damages the ligaments, the body repairs the injured area with scar tissue that is 30% weaker than the original tissue. The weakened ligament is more vulnerable to re-injury because of its decreased ability to withstand force.
Risk Factors: Research has identified several risk factors and divided them into two groups: modifiable and non-modifiable. Those individuals with risk factors that can be modified benefit most from injury prevention techniques while those with non-modifiable risk factors (those that cannot be changed) require a different approach.
Risk factors that can be modified or changed include: body weight, sport, level of competition, and neuromuscular control/postural stability. For example, overweight athletes sprain their ankles more frequently and athletes involved in basketball, soccer, and lacrosse incur the highest incidence of ankle sprains. Also, as the level of intensity in competition increases, so does the occurrence of ankle sprains. While lowering your body weight can often be accomplished, changing sports and lowering intensity may not be as easy if you are a competitive athlete. Maybe the most important risk factor that can be modified is diminished neuromuscular control. Diminished neuromuscular control and postural stability increases the likelihood of an ankle sprain. Neuromuscular control occurs when your joints and ligaments communicate with your brain, your brain processes this information, and then your brain tells your muscles how to react. If your ligaments and joints do not send the right information, if your brain does not process the information correctly,
and/or if your brain does not give the correct commands to your muscles, you will sprain your ankle! While this may sound a little “heady” it can be improved with exercises specifically designed to address this problem. Studies show that this may be the most important risk factor to improve.
Non-modifiable risk factors include: gender, age, and previous ankle sprain. Males between the ages of 15 and 24 and females over the age of 30 experience higher rates of ankle sprains then their opposite-sex counterparts. Individuals under 25 years of age sustain ankle sprains while engaging in athletic activity, while those over 50 sprain their ankle during normal daily activity. A previous ankle sprain places an individual at a considerably greater risk for a subsequent ankle sprain.
Regardless of what your risk factors are, almost everyone can improve their ankle strength, balance, and agility? Consider the following exercises:
1. Ankle Strengthening Exercise
Heel Walk: While wearing sneakers, walk on your heels. Perform as a timed activity, beginning with 15 seconds and advancing as tolerated to 1minute. Repeat 3 times and perform 2 sessions daily.
2. Ankle Balance Exercise
Single-leg Stance: Stand on one leg for 30 seconds. Repeat 3 times and perform 2 sessions daily. Performing this activity barefoot, standing on a foam cushion, with arms crossed and eyes closed increases your challenge.
3. Ankle Agility Exercise
Side Step Overs: Place several cones on the ground greater than shoulder width apart. While standing with your feet shoulder width apart, tie an elastic band between your ankles. As quickly as you can, step over the cones moving left to right and then right to left. Perform as a timed activity beginning with 15 seconds and advancing as tolerated to 1 minute. Repeat 3 times and perform 2 sessions daily.
For a more comprehensive program, consultation with an athletic trainer or sports physical therapist would be required.
How do you know if you have an unstable ankle? Go to: www.pitt.edu/~neurolab/publications/1999/RozziSL_1999_JOrthopSportsPhysTher_Balance%20training%20for%20persons%20with%20functionally%20unstable%20ankles.pdf.
Complete the Ankle Joint Functional Assessment Tool. A score of ≥ 26 indicates that you may have a functionally unstable ankle and you would benefit from an aggressive program specifically designed for your needs.
Guest Columnist: Janet Caputo, PT, DPT, OCS specializes in orthopedic and neurological rehabilitation. Dr. Caputo is clinic director at Mackarey & Mackarey Physical Therapy Consultants, LLC.
Read “Health & Exercise Forum” – Every Monday. This article is not intended as a substitute for medical treatment. If you have questions related to your medical condition, please contact your family physician. For further inquires related to this topic email: firstname.lastname@example.org.
Paul J. Mackarey PT, DHSc, OCS is a Doctor in Health Sciences specializing in orthopaedic and sports physical therapy. Dr. Mackarey is in private practice and is an affiliate faculty member at the University of Scranton, PT Dept.