Ankle Sprains

by Chere A Schoffstall Date Released : 23 Jul 2002 Click here to comment on this article Question: I have a 15 year old client who plays football and baseball. He is forever spraining his ankles. Are there specific exercises for the ankles? If so, what are they? Answer: Addressing flexibility is definitely important. I would first do an overhead squat assessment to locate specific muscle imbalances. An ankle sprain could definitely be attributed to flexibility problems around the foot/ankle complex, but you will also want to address the hips. Weak glutes contribute to faulty movement patterns that can affect the ankle complex. By looking at the whole kinetic chain, you can address the problem more thoroughly. Here are a few tips to help address your client's needs. Basic Squat Assessment: Have your client stand with his feet shoulder width apart and arms held overhead by his ears. Ask him to squat down to where he feels comfortable and return to his standing position. Have him do a few reps, so you can get a good look at what his body is doing. Here are some things to notice: ABNORMAL MOVEMENT TIGHT MUSCLES WEAK MUSCLES Foot and Ankle Complex Feet Flatten Feet Externally Rotate Knees Knees Adduct Lumbo-Pelvic-Hip Complex Asymmetrical Weight Shifting Adductors, Iliotibial Band Gluteus Medius, Gluteus Maximus Gastrocnemius, Peroneals Soleus, Biceps Femoris, Piriformis Gluteus Medius, Anterior Tibialis, Posterior Tribialis Gluteus Medius,

Increased Lumbar Extension

Gastrocnemius, Soleus, Biceps Femoris, Adductors, Iliotibial band, Iliopsoas, Piriformis Iliopsoas, Rectus Femoris Erector Spinae, Latissimus Dorsi

Gluteus Medius, Gluteus Maximus, Transversus Abdominis, Multifidi Gluteus Maximus/Medius, Lumbo-Pelvic-Hip Complex Stabilization Mechanism

Shoulder Complex Arms Fall Forward (when Latissimus dorsi, Pectoralis Middle/Lower Trapezius overhead) or Lumbar Major Spine Hyperextends NOTE: For a more detailed description of the above, see Lenny Parracinos article "Overhead Squat: Total Body Profile." Here is an example program with exercise recommendations to help address your clients needs: Warm Up: 1. Self myofascial release (SMR) tight muscles (see above)

o Hold each tender spot for 20 to 30 seconds FLEXIBILITY (SMR, static stretches) Muscles SMR Peroneals Hold tender spots for 20-30 sec. Gastrocnemius/soleus Same as above Bicep femoris Same as above Piriformis Same as above Adductors Same as above IT band Hold tender spots 20-30 sec. Latissimus Dorsi Hold tender spots 20-30 sec. *STABILIZATION TRAINING (core, balance and reactive training)

Static None Hold 20-30s Same as above Same as above Same as above Same as above Same as above

Exercise Ball bridges* Floor prone cobra Tube walking side-side Single leg balance

Sets 1-3 1-3 1-3 1-3

Single leg squat 1-3 30-60 seconds Multi-planar hops w/ 1-3 30-60 seconds stabilization Horizontal jump ups w/ 1-3 8-10 30-60 seconds stabilization *Please remember to choose only one to two exercises for core, balance and reactive, each workout, STRENGTH TRAINING (circuit training format) Exercise Sets Reps Rest Period Ball DB chest press 1-3 12-15 Go to the next exercise Standing cable row 1-3 12-15 Go to the next exercise Standing overhead DB 1-3 12-15 Go to the next exercise press Step-up to balance 1-3 12-15 Rest 30-60 seconds Cool Down: SMR/Static stretch tight musculature worked in program. As with any client, you will want to address flexibility and strengthening the whole kinetic chain. With a client with persistent ankle problems, you will definitely want to address the foot/ankle complex by stretching the gastroc/soleus to allow for more dorsiflexion. Loss of dorsiflexion results in frontal and transverse plane compensations in the tibia, femur and lumbo-pelvic-hip complex. Increased femoral internal rotation results in increased eccentric overload to the gluteus medius/maximus, piriformis and bicep femoris. This can lead to synergistic dominance of the TFL, adductor complex, quadratus lumborum and glute minimus. This alters neuromuscular control of the lumbo-pelvic-hip complex and control of the lower extremities, which can perpetuate ankle sprains. Proper flexibility, using the right techniques, increases range of motion for proper joint movement Stabilization exercises target weak structures of the core and provides a solid foundation for the limbs to move from. In other words, it makes you more sturdy. The strength exercises increase the ability of the core muscles to work together with the prime movers. This helps ensure that the entire body has proper range of motion and strength. Make sure your exercises are safe and progressive. Only place your client in an unstable environment if he can safely handle it! * These exercises can be viewed in the PTN Exercise Library.

Reps 10-12 10-12 10-12 Hold for 10-30 seconds on each leg 8-10 10-12 (5-6 on each leg)

Rest Period 30-60 seconds 30-60 seconds 30-60 seconds 30-60 seconds