“Bulletproofing” the ankle
Duncan Ogilvie (MSc, CSCS, ASCC) – Director of DO Training
The ankle can be an Athletes worst nightmare, and is the main injury suffered in sports such as basketball, volleyball, and handball. It is rare to find an athlete that hasn’t had some type of history of ankle issues. With this is mind perhaps it’s wise to prepare for what some might say is an inevitable ankle sprain or strain, and “Bullet Proof” it.
The structure of the Ankle
The ankle is designed to be a mobile joint; this is something that is very important for efficient movement. Below are pictures of the bones, ligaments, tendons and muscles that make up the ankle.
Muscles of the Ankle
Ligaments of the Ankle
Tendons of the Ankle
As stated already, the ankle is a mobile joint. If mobility in the ankle is lacking, be it by a saggital blockage from previous injury or taping, strapping or braces, this can lead to problems. With a lack of mobility in the ankle, more range of motion will be needed by other joints further up the chain to compensate. As a result the knee often gets asked to take up the mobility slack. Not idea for a joint that is build for stability (1,2,3,4). The ankle is a complex structure and has many bones, ligaments, tendons and muscles that allow it to function optimally. I won’t go into detail about the structure of the ankle; if you want that there are some great resources out there that can give you all you need. However it’s important that you know the ankle is made up of 3 main bones, the Talus (foot), tibia and fibula (leg). The joint of the ankle is a synovial hinge allowing Plantar Flexion, Dorsi Flexion, Inversion and Eversion; there is movement through all 3 planes, making it a mobile joint. The most common ankle injury is a inversion sprain, and this most likely leads to damage to the Anterior Talo-Fibular Ligament (ATFL).
Common Injury prevention measures.
With such high instances of ankle injury in sport there are many preventative measures out there to help reduce the instances of them. These measures include such things as rigid and semi rigid braces, strapping and taping. Much research has been done of the success rate of these types of preventative measures, and has shown that the use of lace-up ankle braces reduced the incidence but not the severity of acute ankle injuries (5). However this research often fails to look at the effects of kinematic on other joints, and much research has stated as mentioned above that reducing the mobility of an ankle can increase likelihood of injury to the knee, hip, and lower back while also having a negative effect on power, speed and agility (6,7,8,9). While providing a quick fix for an unstable and weak ankle following injury, bracing in any form might not be the answer. Again we can look at the research that shows chronic bracing of the ankle can hinder and regress joint stability and strength.(10, 11) Resulting in a reliance on bracing, which would then give you all the negatives already stated.
There are limited studies that show the effects of chronic bracing, but you don’t need research to tell you this. Ask any athlete who has braced for a number of seasons in a row, and ask them to take off the braces. No chance…they will hold onto them like a mother does to a new born baby, proclaiming they can’t live without them. This is enough real world evidence for me to think that maybe braces and strapping are not the answer. One thing I am certain about and all the evidence and research backs it up it, and that is if you strengthen your ankle and its surrounding musculature as well maintaining adequate mobility it will definitely help you reduce the instances of injury to your ankle, and make it more resilient to further injury, or “bullet proofing” it.
STEP 1 – First and foremost, lose your shoes, strengthen your feet.
A sense of foot position in humans is precise when barefoot, but is distorted by athletic footwear, which accounts for the high frequency of ankle sprains in athletes. With all the shoes in our collections, high tops, low tops, boots, high heel for the women (or men if your into that) our feet get beaten up. Cushioned heels and arch support are all un-natural to the natural foot, and thus over time will change the software of our foot. Spend as much time (upto 80% of your time) barefoot or in minimalist shoes (some protection for the sole from sharp stuff is always a good thing). Why do I make such a statement, and I know what you’re thinking…no I’m not some bearded hippy naturalist.
Here is why -
Proprioception – A large number of our proprioceptive receptors in the body are in our feet. It makes sense right? Our foot is the first point on contact with the floor in movement. This feedback is essential for use to adjust and react to what we are experiencing while in motion. So why dumb down these receptors by thick soles and cushioned heels. You can’t engage the muscles of your feet, thus improving stability, if your brain can’t feel them.
Strength – Walking and working out barefoot will allow your feet to breath, your toes to move, and your arches to spread on impact, what they are designed to do. All this will allow you to strengthen your feet and make them more robust.
Mobility – Walking, running and working out barefoot or in minimalist shoes will allow your ankle to move through its full range during gait, improving your mobility at the ankle, (pretty sure your Nike high-tops that you hoops in don’t allow much ankle range of motion). We should know now what issue a lack of ankle mobility can cause.
The best solution for reducing ankle sprains in shod (foot wearing) athletes is the use of more advanced footwear (minimalist) to retain maximal tactile sensitivity, thereby maintaining an awareness of foot position comparable to that of the barefoot state or perhaps even improving on it.
STEP 2 – Strengthening your ankle
As mentioned already strength is important, conditioning the musculature of the lower leg will go a long way to getting you bulletproof. Resisted planter and dorsi flexion as well as inversion and eversion with a band is a great way to increase strength through your ankle’s range of motion.
Adding some calf raises, jump rope, and bunny jumps (small jumps with maximal plantar flexion), that can be added into the warm up is also a good way to condition and strengthen the ankle musculature.
STEP 3 – Balance (Propioception)
Balance in essential to maintain a healthy ankle. Most people with a previous ankle injury will struggle to maintain balance on 1 leg, due to reduced proprioception post injury, so this is a good place to start (remember go barefoot to not dumb down your receptors). Once balance can be maintained add movement to arms and the opposite leg, or close your eyes to challenge your balance even more. A good progression from this is 1 leg jump- lands. Make sure you stick the landing and maintaining your balance. I implement all these forms of balance into my warm ups with my athletes on a daily basis.
STEP 4 – Mobility and Flexibility.
By now you should be sold on the benefits of a mobile and flexible ankle joint. Getting out your shoes and staying away from saggital blockages such as taping and restrictive shoes will go a long way to improve this. Here are a couple of great stretches and mobility drills that you can do every day
Ankle Mob Touches - Ensure that the heel is kept down, push knee forward to touch the box/wall in front of you. To progress move your toes further away from the box/wall and repeat.
Downward Facing Dog – A popular yoga stretch, but great for ankle mobility and improving posterior chain flexibility. Start on all fours, drive ups up and back and aim to get your heels down flat onto the floor. Push your shoulders back and extend your thoracic spine.
Over-Head Squat – Quite possibly the king of all mobility exercises. It is great for spine, shoulder, hip and ankle mobility. A good depth of squat aiming to get your “ass to grass” while keeping your arms locked out and above and slightly behind your head, will give you great mobility through your ankles. Often the limiting factor in the overhead squat is ankle mobility. If you struggle with this try to raise your heel on a 1 inch block, and give it ago. Work to get the block thinner and thinner until you have no need for it and you can perform a great OH squat like little buddy below.
Take home message.
No athlete wants to get injured or enjoys injury but in reality, it’s part of sport. The best cure, however, is prevention. Following these 4 steps will help you get out of the braces and bullet proof your ankles. Give it a go and remember progression is the key, don’t just rip off your braces and forgo strapping and continue with your routine. Bulletproofing your ankle is a process that will take some time, adding these steps every day and doing them routinely with good progressions you are on the right track to playing without the braces and strapping, while they will help you reduce the instances of an ankle injury.
References
1.Santos MJ. Et al. (2004) “The effects of ankle bracing on motion of the knee and hip joint during trunk rotation tasks.” Clin Biomech. 19:964–971
2. Gardner JK. Et al. (2012) “Effect of ankle braces on lower extremity joint energetics in single-leg landings.” Med Sci Sports Exerc. 44(6):1116-22.
3.Teitz CC. et al (1987) “Evaluation of the use of braces to prevent injury to the knee in collegiate football players.” J Bone Joint Surg Am. 69:2-9.
4.Venesky K. (2006) “Prophylactic anklebraces and knee varus-valgus and internal-external rotation torque.” J Athl Train. 41(3):239-244.
5. McGuine TA. (2011). “The Effect of Lace-up Ankle Braces on Injury Rates in High School Basketball Players” Am J Sports Med. 39(9): 1840–1848.
6. Paris DL. (1992). “The Effects of the Swede-O, New Cross, and McDavid Ankle Braces and Adhesive Ankle Taping on Speed, Balance, Agility, and Vertical Jump” J Athl Train. 27(3): 253–256.
7. DiStefano LJ. (2008) “Lower Extremity Kinematics and Ground Reaction Forces After Prophylactic Lace-Up Ankle Bracing” J Athl Train. 43(3): 234–241.
8. MacKean LC. (1995). “Prophylactic ankle bracing vs. taping: effects on functional performance in female basketball players.” J Orthop Sports Phys Ther. 22(2):77-81
9. Shaw MY. (2008) “Ankle Bracing, Fatigue, and Time to Stabilization in Collegiate Volleyball Athletes” J Athl Train. 2008 Mar-Apr; 43(2): 164–171.
10. Gibble PA. (2010). “Bracing does not improve dynamic stability in chronic ankle instability subjects.” Phys Ther Sport. 11(1):3-7.
11. Robbins S. (1998) “Factors associated with ankle injuries. Preventive measures” Sports Med. 25(1):63-72.
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