Many of us have had an ankle sprain or two (or many more), but most us probably haven’t done any specific training to help regain full strength and control of the ankle.  The most common thing I hear in the clinic is “yeah, I just have bad ankles now. I sprain them a lot.” The sad thing is many people just accept this without thinking or knowing what they can do to make it better.
Though most people recover completely after a lateral inversion ankle injury (when the foot rolls inwards), a considerable percentage of people have persistent complaints as they’ll report that the ankle feels looser and that they are more prone to reinjury. However, many research studies have shown that a specific training program can help decrease pain, increase function, and decrease the odds for a recurrent ankle sprain.
First, make sure you don’t have anything more serious that may need more than conservative (exercise) care.  If you just recently sprained your ankle, make sure there is no pain prior to doing these exercises. Some people are also still walking around after a severe ankle sprain and may still benefit from surgery as they may have a ligament that has been fully ruptured.  These people can usually walk around, but they’ll notice that their ankle is a LOT more flexible and can invert more than the other foot.  If you think you just lack strength or control, than try the following exercises.
1) Single leg balancing exercises
First, make sure than when you stand, your foot is properly positioned.  You may have never thought about it, but you can probably pick up your arch.  Most people have been told whether or not they’re an “overpronator” (especially by the shoe salesman at the running shoe stores), but you can control how much your arch drops down, which may also influence how much your ankle, shin, and knee roll in.  For more on this, see my upcoming post on foot positioning.
First, try to stand on one leg with everything straight and the other knee in the air. Make sure you maintain a nice tall and erect posture.  Hold for 30 seconds
Second, try a single leg hip hinge, similar to Warrior 3 and try to hold that position.. Hold for 30 seconds.
Lastly, do a single leg squat and hold for 30 seconds.  These are my 3 basic positions for practicing your single leg balance. Once you feel this is easy and you are consistently still, master this with your eyes closed. In short, try this progression:
  • Hold each position for 30 seconds
  • Hold each position with eyes closed for 30 seconds
  • Hold each position for 30 seconds while standing on a soft, pliable surface to make things even harder (try a sofa cushion, bosu ball, dyna disc, etc)
  • Hold each position for 30 seconds while standing on a soft, pliable surface while playing catch with someone.
2) Strengthen your peroneal muscles
These are the muscles that support the outside of your foot.  The tendons of these muscles slide right behind your outside ankle bone.  My preference is do a heel raise with a bias for the peroneal muscles. Begin with the basic heel raise exercise by standing on one leg and lifting your heel up off the ground as high as possible.  Try to put more pressure on the medial forefoot (behind the big toe).
Option 1: use an elastic band to pull your ankle outwards. This will force you to use your peroneals more as you try to keep your foot and ankle straight
Peroneal biased heel raise
Option 2: if you don’t have a band, you can place a quarter underneath the inside forefoot right behind the big toe.  As you do the heel raise, make sure you maintain pressure on the quarter.
Goal: Perform 3 sets of 25
3) Strengthen your hip muscles
Hip muscles are just as critical to balance as your ankle and foot muscles.  Particularly the gluteus medius which helps with your standing alignment when you are on one leg.
Try this progression of exercises, and move onto the next one once you can perform the recommended parameters:
  • Clamshells: lay on your side with your knees bent. Make sure to not move your pelvis. Raise your knee up and down. 3 x 20
clamshell
  • Sidelying leg raises (hip abduction): lay on your side with your top leg straight.  Roll your pelvis slightly forward so that your belly button points to the floor.  Raise your leg up to the ceiling and keep it behind your pelvis.  3 x 20
hipabduction
  • Modified Sideplank: perform a sideplank with your knees bent. Hold for 10 seconds, then rest for 3 seconds. Repeat 10 x
sideplankmodified
  • Sideplank: Hold for 10 seconds, then rest for 3 seconds. Repeat 10 x
sideplank
  • Sideplank with clamshells and hip abduction: lastly, perform 3 x 20 clamshells or sidelying while holding the sideplank. You can also  try other variations of execises while holding the sideplanks as in the picture below.
sideplank with leg raisesideplank advanced
If you can do the last set of exercises, you should have sufficient strength with your hips to help with running and agility exercises.
4) Perform more single leg exercises
Modify your exercise routine to include more single leg exercises, which will change your balance and your hip and ankle muscles more.  Perform lunges, side lunges, single leg deadlifts, single leg squats, bulgarian split squats, etc
5) Perform agility exercises
Retrain your foot and ankle to not only be strong, but to help with speed and power. You should feel comfortable running and jumping laterally on your own before you start to do this when playing sports. Here are some suggestions:
Jumproping hops on one leg over a line (sideways, forwards and backwards, diagonals)
Ladder drills – there’s not a bad one. Do as many as you can think of!
Practice light cuts and then progress to making sharper and faster cuts
Longterm, make sure you have the hip and ankle strength so that you can optimally control your body when running, cutting, and playing sports.  By doing these exercises regularly, you’ll be able to increase the strength that you need in your legs and you’ll decrease the likelihood of respraining your ankles.
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