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Phil in Kent, England asks:
"Since a young age I have always had weak ankles due to repeated sprains. This problem seems to have persisted. What sort of excercise can I do to strengthen the ankles?"
Marc Bernier at the Alabama Sports Medicine and Orthopaedic Center (ASMOC), replies:
"Contrary to popular belief, ankle sprains are not necessarily 'minor' injuries. While it is true that most athletes recover relatively quickly from these injuries, it is not uncommon for them to turn into chronic pathologies that result in significant residual physical deficits. Proper rehabilitation is required to ensure that all physical deficiencies are addressed, especially in athletes with a history of multiple injuries.
"The traditional treatment of ankle sprains, as with most other injuries, has focused on the following objectives:
"In many instances, the strengthening programs that were implemented involved resistive exercises using surgical tubing and calf raises using either the athlete's body weight or weight machines. Once an athlete was able to progress through these exercises, a return to play ensued.
"In recent years, more attention has focused on the benefits of functional, sports related strengthening of the entire lower extremity in the treatment of ankle injuries. During these types of programs, more emphasis is placed on single leg balance activities and exercises that force the athlete to stabilize the involved lower extremity against some form of external resistance.
"In performing these types of exercises, the athlete is simulating movements and body positions that he will encounter while playing (additional benefits include re-training some of the neuromuscular pathways that are disrupted after injury, but are beyond the scope of this article). Functional strengthening is much more challenging to the muscular system, and helps to resolve the residual deficits that can lead to chronic injuries.
"The initial phase of strengthening will still involve the use of surgical tubing for resistive exercise (Figure 1). This is performed in all planes of movement, with the most important being the inside and outside (inversion and eversion) planes. Calf raises are also performed, starting from a standing position and progressing to weight machines which allow additional external resistance.
"The next phase involves single leg balancing activities. Initially, these are performed with the foot flat on the floor, and progress to a 'heel raised' position (Figure 2). The 'heel raised' position forces all of the stabilizing musculature of the ankle to become activated simultaneously to avoid either rolling the ankle over or the athlete falling down. Once this is mastered, the same exercises are performed with the athlete standing on an unstable surface such as foam or a balance disc (Figures 3-4).
"The next progression incorporates some form of sport-specific skill into the exercise program. For instance, soccer players will perform volleying while standing on an unstable surface (Figure 5); basketball players will catch and pass a ball.
"The final progression introduces plyometric exercise to the program. This is accomplished via single leg hops or jumps in multiple planes. Initial emphasis is on the ability to "stick the landing" after a jump, with subsequent emphasis on endurance."