A high school basketball player enters into a game for the first time after taking a number of weeks off after she sprained her ankle in practice. She spent hours working with her athletic trainer doing everything she could so that she could play again – icing, crutches, taping, and exercises, exercises and more exercises. She is excited to finally be back playing. However, in her first game back, she jumped and landed on an opponent’s foot, falling to the court clutching her ankle yet again. This athlete is not alone as ankles sprains are one of the most common injuries amongst not only basketball players, but football, volleyball, and soccer athletes as well.
Basically, a sprain is an excessive stretch, partial tear, or full tear of ligaments, the tissues that connect bones together. As a physical therapy student and sports enthusiast, I have been asked more than once about methods of preventing ankle sprains by athletes and their families as well as my own friends and family. I have witnessed frustrated athletes deal with ankle sprain after ankle sprain. These athletes and their parents all ask the same question – is there anything that can be done to prevent this from happening again? Should he be wearing an ankle brace or maybe taping his ankle? Is there a certain type of shoe that she should wear on the field or court to prevent these events? Is there a specific exercise that he should be doing and for what length of time does he have to do this for?
Well, I wish I had the magic, guaranteed-to-work, straightforward answers. If I did, I would probably be traveling the world and retired at the age of twenty-five. A significant amount of research has been done regarding ankle sprains in athletes over the years and a lot of the findings do not give a clear-cut answer regarding these questions. But let’s take a look:
Ankle braces. Should an athlete wear one on the injured side when returning to play?
In general, it is probably a good idea to wear some sort of brace on the injured ankle when getting back to sports. In a couple of studies, basketball and football players that wore a lace-up type brace had significantly fewer ankle sprains than players that did not, however, the severity of ankle sprains did not depend upon if a brace was worn. Another study showed that a semi-rigid brace also decreased the frequency of ankle injuries in basketball, but again, not severity. Furthermore, soccer players with a history of ankle sprains that wore a stirrup-type brace were less likely to re-sprain their ankle than players without the brace.
What about ankle taping? Is this more effective than wearing a brace?
Ankle taping also seems to be helpful in avoiding ankle sprains; however, the evidence is muddy in terms of whether taping or bracing is more effective. A review of several studies found that the use of ankle braces and ankle tape both reduced the frequency of ankle sprains in athletes by 69% and 71%, respectively. So, if you sprain your ankle and you are returning to sports, taping it or wearing a brace probably is a good idea, at least temporarily.
Are there certain shoes that seem to help prevent ankle sprains?
Not really. One may think that wearing high-top shoes versus low-top shoes is better for preventing ankle sprains, however, there is no research which supports that. Evidence is inconclusive as to whether air-cells in the heels of shoes contribute to ankle sprains. When shoe shopping, I recommend trying different shoes on, spend a little time walking or running in them if possible, and then purchasing the shoes that you feel are the most comfortable and that will work best for you.
What kinds of exercises should a person do following an ankle sprain?
Soon after an ankle sprain, gentle range of motion, stretching, and strengthening exercises are the focus combined with elevation, compression, and icing. However, as the athlete gets further out from the time of injury and is able to better walk on the ankle, exercises that challenge his or her balance should become the focus. For example, standing on one leg is a great balance exercise and can be made more challenging by standing on a pillow, closing the eyes, or tossing a ball back and forth with a teammate. My personal favorite is gently pushing an athlete at the shoulders at random intervals while he or she stands on one leg. Utilizing equipment such as balance disks or wobble boards can be advantageous as well. An athlete can then progress to hopping exercises. For example, hopping forwards to backward and side-to-side on one foot and hopping at diagonals. Different variations of lunges and box jumps can also be used in rehabilitation. It is also important to incorporate agility and sports-specific drills into the late stages of rehabilitation such as cutting, turning, shuffling and backward running.
When is it okay to stop ankle rehabilitation exercises?
Probably never. Yeah, you probably are not too happy with that answer. There have been studies that have shown that people can demonstrate instability in a sprained ankle even three years after injury. Really, in my mind, I think balance exercises that challenge the ligaments and stabilizing structures of the ankle joint should be a regular part of almost every athlete’s regular exercise routine. The good news is that just by participating in sport, athletes are challenging the ankle joints in ways that make it stronger and more stable – jumping up for a rebound, running on a grass field, cutting to get open for a pass – all of these movements inherently challenge the ankle. However, this doesn’t mean that just practicing or playing in games or matches is enough, especially if an athlete is wearing a brace or taping his or her ankle. Taking time to do balance exercises for the purposes of increasing the stability in the ankles can reveal weaknesses or asymmetries that may not be addressed in day-to-day play.
Well, there you have it. Hopefully, this helps to answer some questions. Like I said, answers are not totally clear in most cases. Perhaps there will be future research that provides more clarity. In the meantime, have fun doing those balance exercises!
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