Ankle sprains have to be one of the most common injuries for young athletes.
It seems like every other week someone has sprained an ankle or is rocking a brand new brace.
This kind of injury is especially annoying for the athlete because everything is affected at the foot. Walking, running, and jumping are all going to be changed as a result of the injury.
Depending on the timing of the injury, some athletes may be tempted to play through it. This could be really dangerous in severe cases. The risk for re-injuring the ankle is also very high.
There should be no rush to get back to sport on a bad ankle.
When we are talking about returning to sport it is a little bit different than returning to function. Physical therapists are somewhat limited on what they can do by the insurance companies. Once an athlete has restored their ability to move and control the ankle, they are probably going to be cleared from PT.
At this point, the athlete is usually not ready to absorb and produce the force needed for their sport, from the ankle.
This is where solid post rehab training has to take over, in a safe and effective manner.
Ankle Range of Motion
The ankle joint is mobile. It is intended to move in multiple directions with a lot of range of motion.
Ankle braces and stability exercises are intended to reduce range of motion. These things are not inherently bad but once an athlete is able to return to function, ankle mobility must be trained.
The brace should really only serve as protection against uncontrollable factors. Speed, agility, and sport training are all somewhat unpredictable so the brace may be helpful. In the weight room or part of a warm up the brace can come off to establish ROM and control of the joint.
A strong set of glutes is important in control for the ankle.
The ankle is still a mobile joint as I just mentioned but the risk for injury goes up if there is bad alignment or a lack of control. This is where the glutes step in.
Take an athlete with wide hips. This causes the femurs to angle in and bring the knee joints close together. This misalignment at the ankle joint makes control a lot more difficult to achieve. A lack of control increases the risk for injury.
Having strong glutes gives the athlete the strength that they need to pull out of this alignment. The athlete also needs to be coached on running and jumping with good technique because the muscles don’t fix the problem themselves.
Improved glute strength is best accomplished with deadlifts, bridges, and single leg work.
Proper Loading and Landing Mechanics
Most ankle sprains happen when the foot rolls in and the ligaments on the outside of the foot get overstretched or damaged.
It is essential to teach the athletes how to load the body when we are coaching speed, agility, and jumping drills. It is not simply good enough to put some cones down and have athletes complete the drill. They have to know how to stop themselves.
Jumping is easier to monitor landing technique. As a good rule of thumb, the athlete should land in the same position that they jump from.
Agility drills are much more difficult to see but not impossible.
What to look for:
- The athlete should be balanced with the upper body being within their base of support
- No leg should get too far away from the rest of the body
- The athlete should be decelerating by lowering the hips and bending at the knees
- Hard pivots and change of direction should be avoided
- When stopping the athlete should not be falling over
Changing direction with good mechanics is going to help the athlete resist injury. Injuries are not preventable but we can give our athletes the best opportunity to build resiliency to them.
Prevention and rehabilitation both consist of the same principles. How far you progress for each will depend on the athlete.
Too often athletes are in such a hurry to return to the field that they forget about how important training is. This is not the best strategy for performing at a high level and re-injury risk is high.
I know everyone is dying to get their kid competing at an elite level but we sometimes have to think about the long term for athletes that cannot even drive yet.