Apr 4, 2017Keeping Ankles Healthy
By Dr. Phillip Gribble
Phillip Gribble, PhD, ATC, FNATA, is an Associate Professor and Director of the Division of Athletic Training in the College of Health Sciences at the University of Kentucky. He serves as the Co-Director of the International Ankle Consortium and can be reached at: [email protected].
Ankle sprains are one of the most prevalent injuries athletic trainers see in the physically active and sport populations. They can also be one of the most difficult to treat effectively–lateral ankle sprains have a very high rate of recurrence, leading to a condition called “chronic ankle instability,” which involves lingering disability and dysfunction. Effective prevention strategies are an important aspect of tackling the ankle sprain health care burden.
Two types of prevention exist for lateral ankle sprains: 1) neuromuscular control exercises and 2) external ankle supports. Both have utility for prevention and can be implemented easily, but each has its own challenges related to compliance and cost that athletic trainers must strive to overcome.
In general, exercises that target neuromuscular and sensorimotor control are very effective at preparing an athlete for participation in physical activity. These exercises emphasize progression of dynamic and functional movements to challenge the base of support, while incorporating proper muscle firing patterns to create optimal coordinated actions. Some of the critical components should include:
• Balance: Emphasis on balance training consistently shows success in ankle sprain prevention. Start athletes with simple activities, such as standing on one foot with their eyes open. Then, progress to more difficult tasks, using combinations of eyes open and closed or introducing a challenging surface, such as a foam pad. Evidence also supports the use of wobble boards or similar equipment for successful ankle sprain prevention. Have the athlete balance on the board for shorter durations at first–10 to 15 seconds–and progress to 30- to 45-second intervals.
• Dynamic stability: Coordinating balance while holding a position statically is very important, but the athlete must prepare to challenge their base of support during dynamic tasks, as well. This can include standing while reaching to grab or catch an object. Exercises like the star excursion balance test or standing on one foot and catching a ball work well, too. Additionally, athletes must learn to move their base of support safely from one spot to another, as in hopping and landing. Therefore, exercises could start with forward/backward and lateral hopping, and progress to more challenging landing and change-of-direction work. Always emphasize the creation of a new stable base of support with each contact with the ground.
Providing the ankle with mechanical support through bracing or taping is another viable injury prevention strategy. Prophylactic ankle supports help to limit injurious motions during physical activity, potentially by slowing down the velocity of the motion as well as providing some preparatory neural activity that may contribute to improved sensorimotor control. Preventative ankle taping is also very common in athletic training practice, but bracing should be the first choice, as it likely provides more consistent support and may be more cost effective than the materials needed to tape an ankle daily.
While evidence is growing that preventative exercises emphasizing balance training and prophylactic ankle supports can reduce the rate of ankle sprains, athletic trainers can face challenges with implementing these strategies. Compliance by the primary stakeholders may be the biggest hurdle. Performing the preventative exercises can be performed with little to no fiscal cost, but there is a time investment that many coaches and athletes will not commit. Therefore, it is important to present a battery of exercises that can be performed efficiently to increase the likelihood of follow-through.
Furthermore, there can be some non-compliance issues with ankle supports. Athletes may find the braces or tapings to be uncomfortable, a coach might feel the supports somehow hinder the athlete’s performance, or budgetary limitations may restrict the athletic trainer from providing the desired supports. Under these circumstances, it is incumbent upon the athletic trainer to explain the need for compliance with the prevention exercises to the athletes and coaches and emphasize the importance of ankle supports in budgetary discussions.
Ankle sprains are rampant in physical activity and equate with time loss and activity restrictions that are larger than most realize. For this reason, it is vital for athletic trainers to implement viable prevention strategies, regardless of any concerns that limit compliance.