03/06/2023
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. We commonly think of this injury in sports like basketball, football, volleyball, and soccer, but these also occur during running, jumping, and hiking activities.
Ankle sprains occur an estimated 20,000+ times a day in the US. They most commonly occur in sports that require quick changes in direction and/or speed. An ankle sprain involves an excessive stretch, partial tear, or full tear of ligaments, the tissues that connect bones together. Once sprained, stability of these ligaments does not occur until at least 6-12 weeks. Many athletes that sprain their ankle return to their sports within a week. Unfortunately, some of these will repeat the injury like in the scenario above. Repeated or severe ankle sprains can lead to chronic ankle instability. As a physical therapist, athlete, and sports enthusiast, I have been asked about methods of preventing ankle sprains. Athletes and their parents all ask the same questions: Is there anything that can be done to prevent this from happening again? Should they be wearing an ankle brace or maybe taping the ankle? Is there a certain type of shoe they should wear? Is there a specific exercise they should be doing?
Unfortunately, there aren’t simple answers to these questions. A significant amount of research has been done regarding ankle sprains in athletes over the years, so let’s discuss some of these findings further:
Should an athlete wear an ankle brace 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. Several studies have shown decreased rates of re-injury with bracing. This is especially important if athletes are rushing back to their sport within weeks, as ankle sprains take 6-12 weeks to heal. Braces provide external support while the ligaments, tendons, and muscles heal.
What about ankle taping? Is this more effective than wearing a brace?
Ankle taping also seems to be helpful in avoiding ankle sprains. Most studies suggest that bracing and taping are effective, but bracing may be more helpful for long duration due to several factors. Tape can be more expensive in the long run since it needs to be replaced more frequently. Tape is also somewhat less reliable than a brace (i.e. can fall off with sweat, be applied incorrectly, or lose supportiveness due to elasticity breakdown). Taping is still a better solution than no support, and it can be less restrictive & bulky compared to bracing for sports like gymnastics.
Are there certain shoes that seem to help prevent ankle sprains?
Not really. There is minimal evidence that high-top shoes decrease risk of ankle sprains vs low-top shoes. If your doctor or therapist notices high arches or flat feet, orthotics may be helpful to improve foot and ankle alignment. 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. There are shoes that increase your risk of ankle sprain, though: flip flops. Cheap flip flops that have no support around the foot and ankle should not be worn when recovering from an ankle injury (or ever, but that’s a lesson for another day).
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 can 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 towel or pillow, closing the eyes, or passing a ball back and forth with a teammate. 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 later stages of rehabilitation such as cutting, turning, shuffling and backward running.
When is it okay to stop ankle rehabilitation exercises?
Probably never. Maybe not the answer you were hoping for, but many studies that have shown that people can demonstrate instability even years after injury. Balance exercises that challenge the ligaments and stabilizing structures of the ankle joint should be a regular part of almost every athlete’s 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 uneven trails, 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.
Check out our foot and ankle page for more on common conditions and treatments, or give us a call at (402) 609-1750 to learn more.
