Ankle injuries, and specifically ankle sprains, are the most common injury seen in youth sports. Over 300,000 ankle sprains occur yearly in high school athletes alone, with data showing that the rate of ankle sprains is increasing yearly, particularly in non-contact sports.
As a foot and ankle specialist, the most common issues I see that lead to ankle sprains, especially in athletes that have a history of ankle sprains, are hypermobility and a lack of strength.
Hypermobility refers to a joint having excess motion beyond what is needed for normal function, which comes from past damage to the tendons and ligaments around the joint, or a genetically abnormally loose joint. This extra motion at the joint makes it much more difficult for an athlete to maintain proper positioning of their foot and ankle during athletic movements which leads to ankle sprains.
Athletes are incredibly strong, but they don’t always have strength in the areas that they need it. For example, most athletes develop the muscles of their thighs (the quads and hamstrings) but they could overlook the muscles in their calves, shins, and feet. Many also lack strength in their hips, which is a major risk factor for ankle sprains.
Pre-Season Base Exercises
There are exercises that every athlete should be doing to prepare for an athletic season. These exercises will address strength, stability, explosiveness and agility.
Strength and Stability:
- Heel and Toe Raises: Heel and toe raises are both good places to start in building foot and ankle strength. A good standard to strive for is 20 single-leg heel raises from a step, with a one second pause in the bottom position.
- Bulgarian Split Squats: To improve ankle stability, A great exercise is the Bulgarian split squat with no heel support. This variation of the split squat is great for developing stability in the ankle. It forces the soleus to work isometrically to keep the heel elevated and also works the deep flexor muscles of the foot to grip ground. This can be performed a number of ways at home; with the forefoot on a step and the rear leg on a chair placed behind you, or even with the forefoot on the spine of a thick book and the rear leg supported on a couch behind you.
Plyometric Exercise:
Plyometrics are exercises that are designed to improve the output and absorption of high amounts of force in short periods of time. Examples of plyometrics include sprinting, cutting, jumping, in short, all the movements that athletes do on a daily basis. My emphasis is on the absorption of the high amount of force that is produced during these activities. While sprinting, 4-5 times your body weight is produced, meaning that your feet and ankles are absorbing 4 to 5 times your body weight with every step.
Athletes should be doing some amount of plyometric exercise year-round to keep their body conditioned to absorb this amount of force, but at the very least you should begin performing plyometrics a few weeks before the start of your season to prepare.
- Hopping: A great starting point that I use with most athletes are hopping exercises, as shown in the video below. Hopping strengthens the feet and ankles to increase the amount of force that they can absorb, and it’s important to perform them in all 3 planes of motion as shown. Many athletes get strong moving forwards and backwards, but neglect side to side and rotational movements.
- Sprinting: Athletes need to be performing sprints on a weekly basis, especially in the offseason. It doesn’t have to be much- 5 to 10 all out sprints of 20-60 yards one to two times per week is sufficient to maintain a base level of conditioning.
Agility:
The final component of a good training program is agility, the ability to change the direction or velocity of your movement in response to a stimulus. Most like to use agility ladders to train their agility, but there are two major flaws with ladder drills: your center of gravity doesn’t actually move very much, and there is no reaction component involved.
True agility training should involve your center of gravity moving well outside your base of support in response to visual stimulus. This happens in sport on virtually every play- athletes have to change their direction or speed of movement in response to how the defense plays them.
- Mirror Drill: A great drill to truly work on agility is called the mirror drill, as shown below. Find a partner and set a timer for 30 to 60 seconds. Taking turns, one partner will be the leader and the other is the follower. The leader wants to keep as much separation between themselves and the follower, while the follower is reacting to the leader’s movements and trying to keep up.
Physical Therapy for Pre-Season Athletes
It is important to keep in mind that these exercises are starting points and do not form a complete program. A physical therapist will be able to start with exercises that match an athlete’s current level of conditioning and progress them to more difficult variations as their body adapts.
It’s also important for an athlete to start preparing several weeks in advance. Strength adaptations take at least 2-4 weeks to develop, with actual progressions in muscle size taking 6 weeks to be noticeable. It takes time to get into shape, and many athletes I see in the clinic end up injured to due lack of preparation. They are too inactive during the offseason and get injured early in the season because their body is not ready for all the sprinting, cutting and jumping that is required.
There are a variety of risk factors that are correlated with an increased risk of ankle sprains, which is why athletes should see a Physical Therapist prior to the start of their main athletic season, preferably 1-2 months before the season starts. A PT will be able to screen for the relevant risk factors for ankle sprains, evaluate how the foot and ankle is functioning, and address any issues in strength, stability or mobility to make sure that they are ready for the rigors of practice and competition.
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