The Dreaded Ankle Sprain
By Chris Carlsen
The Dreaded Ankle Sprain and How to Restore Gait Pattern and Ankle Stability
The high ankle sprain was practically unknown thirty years ago, but today, this injury has become more pervasive. Part of the problem can be attributed to footwear that over-stabilizes the ankle (such as high top sneakers) and shoes with big, cushy heels. In addition, the general lack of youth strength training, which builds strong feet, has led to dramatic increases in ankle injuries. Aside from hip and core strength, one of the most glaring weaknesses I see in working with my young athletes lies in their feet. In addition to shoddy sneakers, the paucity of walking today contributes to weak ankles. As a child, my parents did not drive, so I walked everywhere (which was not uncommon for growing up in NYC). From when I was four years old, my mother and I trekked three miles, twice per week, to my grandparents’ house and back. I feel my ankles have remained healthy, even through years of playing football and other sports, due to this fact.
When young athletes are led to believe that they must rely on high top sneakers for ankle support, or shoes with large heels for stabilization, their proprioception (the body’s sensory awareness of itself in space) and stabilization muscles shut off and become weak. This can, for instance, lead to ankle sprains in basketball players; a sport that is a leading cause of anterior knee pain. The ankle’s primary role is to stabilize the knee. When athletes lose ankle mobility, it follows that they lose knee stability. Interestingly enough, soccer players (who wear flat footwear) "have few ankle or patella-femoral problems, yet [they] use a low-cut, lightweight shoe on grass. Training with less artificial stability at the ankle joint probably protects the ankle and knee".[i] Thus, modifying an athlete’s choice of footwear can have vast implications for their ankle and knee health.
Incurring an ankle sprain is devastating. Not only are athletes or clients unable to perform in events, the compensation pattern adopted can lead to many more problems that do not necessarily trace back to the ankle. With an ankle injury (as with other injuries), the waist muscles opposite to the injury tighten out of the need to both compensate and lighten the load placed on the injured area until the body heals. Even after the injury heals, the compensation pattern can sometimes remains dominant. This will leave athletes with more pressure on one side of their body and can lead to improper leg length, uneven gait and possibly a lowered shoulder. These deficiencies also constitute the new resting length of their muscles, and will follow them onto the squat rack, bench, powerlifting platform and even the court or field. Athletes aside, most individuals will incur trauma in their lives, and although proper training and conditioning can help decrease the probability of getting hurt, there are still too many variables to completely avoid injury (fatigue for one). One way to help restore gait and pelvic rhythm for someone who has had an ankle sprain is by adopting somatic training, which focuses on restoring primal movement patterns (fitness and somatics). The more my students can connect to a feeling and rhythm the more they can feel the compensations patterns. This restoration will also allow them to go into their training session in a more optimal postural alignment. The two most beneficial somatic exercises for improving ankle issues and correcting one’s gait, or their style of walking, are the human X and the wash cloth.
In Move Without Pain, Martha Peterson described how the human X pattern promotes awareness of the waist muscles by getting one’s hips to move up and down, alternately lengthening and shortening the muscles. This is important for increasing flexibility in the pelvis, which in turn promotes smoother, easier walking.The wash cloth mimics the motion of walking, in that when one leg reaches down, the opposite side of the waist contracts. Martha wrote that if the center of the body is tight, the pelvis won't relax and rock, and the movement pattern will be compromised. These exercises are quite advantageous for those recovering from ankle sprains because they reintegrate fundamental walking patterns that are ruptured after an injury.
* I follow this up with walking and paying close attention to rhythm of the pelvis.
From there, I will work on strengthening the ankle by first focusing on the hand. The hands are tantamount to the feet of the upper-body. The feet and hands both spread over a surface, grip it and send sensory messages about it to the rest of the muscles, telling them how much strength to apply. Since the hand is closer to the brain, there is greater control over it and explains why it is easier to spread and wiggle each finger independently as opposed to doing so with the toes (the fingers are also used more frequently, making this easier). I then try to recreate this feeling within the athlete or client’s foot. As they spread their fingers and push to the outside of the hand, gripping hard with the big thumb, they are creating a balanced force couple, which renders the hand neutral. Notice the arch created in the hand and how the muscles of the palm light up. This must be created in a neutral foot. Athletes and clients should be able to separate the toes, spread the floor and grip with the big toe, lighting up the muscles of foot and creating an arch of support. My colleague, massage therapist Devin Mcgilvery, frequently reports that many of his clients’ toes are stuck together and that their range of motion is therefore limited. Focusing on strengthening the feet has significant implications for every client, even if they have not incurred an injury.
After clients learn to create a neutral foot, they must master standing on one leg while spreading and gripping the floor. The toes need to be straight ahead and one should be able to maintain that position for 30 to 60 seconds before progressing. It is imperative not to skip this step. Doing so would be like trying to do an advanced core exercise without first learning how to master the plank; one will never sense a lack of neutrality. Joel Seedman recently wrote an insightful piece about barefoot training, which provides some advanced progressions beyond standing on one foot :https://www.t-nation.com/training/truth-about-barefoot-training.
* After mastering standing on one leg, we will progress to the static-lunge. We want to be able to stabilize the ankle in a more dynamic environment. In the video above, my student likes to pronate when he fatigues, I use the band to give him resistance and feedback to fight pronation.
Ankle health cannot be overlooked in building strong athletes and clients. For further information about promoting strength or mobility in the ankles, or if you are interested in hosting a workshop at your facility, feel free to send our team an email at Info@IronLionPerformance.com, or leave a comment below.
[i] Boyle, Michael, Advances in Function Training. On Target Publications, 2010 (pg. 66)