A sprained ankle has far-reaching effects that personal trainers need to understand to help clients heal and regain mobility.

A sprain tears one of the ligaments that stabilize the ankle. It's one of the most common musculoskeletal injuries (Doherty et al. 2014), causing pain and other problems that can restrain mobility for up to 2 years (Anandacoomarasamy & Barnsley 2005). As the body compensates to protect the injured ankle, musculoskeletal imbalances can arise that pile on more pain and dysfunction throughout the body (Price & Bratcher 2010).

All this underscores why personal trainers need to know what causes ankle sprains, how they affect the musculoskeletal system, and how to help clients heal from a sprain and prevent the next one (see sidebars).

Ankle Sprain—Prone Activities/Exercises

Sports that require quick deceleration of the ankle (and body) as it moves from side to side—such as basketball, field hockey, racquetball, volleyball, squash and tennis—are more likely to injure the ankles (Hertel 2002). Furthermore, dynamic gym-based and sports-performance exercises that challenge side-to-side motion—for example, lateral hopping and ladder drills—can also set up exercisers for an ankle sprain, especially if they are unprepared for these activities.

Ankle sprains come in two varieties: inversion sprains (more common), where the ankle rolls to the outside (Hertel 2002), and eversion sprains, where it rolls to the inside. Eversion sprains are less common (in part) because the foot arch below the injured ankle and the placement of the other foot on the ground help decelerate stress to the inside of the ankle.

How Do Ankle SprainsAffect the Body?

When you sprain your ankle, the body initiates a variety of healing responses depending on the severity of the injury. Typically the joint swells, the surrounding soft tissues become inflamed, muscles in the foot and lower leg tighten, and the nervous system limits movement to protect the joint (Lynch 2002). Although side-to-side movement usually causes ankle sprains, the resulting joint dysfunction affects the forward, backward and rotational movements of the ankle.

Think about the biomechanics of walking or running: When one foot contacts the ground, the ankle must be able to internally and externally rotate, flex, extend and move from side to side (Cook 2010). If an injury impedes these movements, then other structures in the foot/ankle complex have to compensate.

For example, a recent sprain that is causing pain and immobility of the ankle joint may restrict movement of the heel and hind foot. Over time, this can irritate the soft-tissue structures of the foot, leading to plantar fasciitis and other painful foot issues (Chinn & Hertel 2010).

Ankle pain and dysfunction can cause problems all the way up the kinetic chain:

  • The ankle connects the foot to the shin bone (tibia) and calf bone (fibula), which form the lower portion of the knee joint. Hence, a sprained ankle affects knee functioning.
  • The remainder of the knee joint forms where the tibia and fibula meet the thighbone (femur). As a result, immobility in the ankle also affects the upper leg and hip, where the thighbone meets the pelvis.
  • Movement of the hip affects functioning of the pelvis and sacroiliac joint, where the pelvis meets the spine.
  • These areas, in turn, affect the position and movement of the spine and consequently the shoulder girdle, head and neck (Price & Bratcher 2010).

Therefore, ankle restrictions in any plane of motion—forward, backward, side to side or rotational—can hinder weight-bearing movements in the entire body (Kendall et al. 2005).

Scope of Practice

Identifying, diagnosing and treating an ankle sprain—or any medical condition for that matter—is the job of a licensed medical professional, not a fitness professional (Price 2015). However, a corrective-exercise specialist or fitness professional with proper skills can effectively bridge the gap for clients transitioning from physical therapy/remedial exercise to more dynamic and fun athletic/gym-based activities.

Indeed, a personal trainer's unique understanding of muscles and movement can help safeguard a client's ankles from injury in the first place, ensuring that the client can continue to exercise regularly (ACE 2010).

The sample postrehab/strengthening program outlined in this column can assist in achieving these exercise objectives. The first program helps clients transition from physical therapy after an ankle injury, and the second can strengthen a client's ankles to protect against future injury.


Ankle sprains are among the most common risks your clients face. Knowing how to restore ankle mobility and strength—and transition injured clients back into a program of regular exercise—is one way to cement your reputation as a professional who can meet the needs of people with muscle and joint pain.


Research on the connections between footwear and ankle injuries is wide, varied and rife with conflicting data (Doherty et al. 2014).

How come? Part of the reason is that people who walk, run and exercise injury-free are more likely to do things barefoot without thinking about whether wearing shoes is an issue. However, when people injure a foot or ankle (especially if they have disposable income), then they typically search for remedies such as orthotics, arch supports, supportive shoes and so on. This reactive behavior skews research, suggesting that people who go barefoot are less likely to injure their ankles, while people who wear supportive shoes/orthotics/arch supports are more susceptible to injury.

However, research does support the notion that wearing more supportive footwear may be beneficial after an ankle injury until the ankle complex becomes mobile again and strong enough to deal with greater ranges of motion. Once range of motion and function are restored, less-supportive shoes and barefoot activities can be reintroduced (Chinn & Hertel 2010; Price 2014).






ACE (American Council on Exercise). 2010. ACE Personal Trainer Manual (4th ed.). San Diego: ACE.

Anandacoomarasamy, A., & Barnsley, L. 2005. Long term outcomes of inversion ankle injuries. British Journal of Sports Medicine, 39 (3), e14.

Chinn, L., & Hertel, J. 2010. Rehabilitation of ankle and foot injuries in athletes. Clinics in Sports Medicine, 29 (1), 157—67.

Cook, G. 2010. Movement: Functional Movement Systems: Screening, Assessment and Corrective Strategies. Aptos, CA: On Target.

Doherty, C., et al. 2014. The incidence and prevalence of ankle sprain injury: A systematic review and meta–analysis of prospective epidemiological studies. Sports Medicine, 44 (1), 123—40.

Hertel, J. 2002. Functional anatomy, pathomechanics, and pathophysiology of lateral ankle instability. Journal of Athletic Training, 37 (4), 364—75.

Kendall, F.P., et al. 2005. Muscles Testing and Function with Posture and Pain (5th ed.). Baltimore: Lippincott Williams & Wilkins.

LaBella, C.R., et al. 2011. Effect of neuromuscular warm–up on injuries in female soccer and basketball athletes in urban public high schools: Cluster randomized controlled trial. Archives of Pediatric and Adolescent Medicine, 165 (11), 1033—40.

Lynch, S. 2002. Assessment of the injured ankle in the athlete. Journal of Athletic Training, 37 (4), 406—12.

Price, J. 2013. The Amazing Tennis Ball Back Pain Cure. San Diego: The BioMechanics Press.

Price, J. 2014. How to choose the right training shoe. Australian Fitness Network. Accessed Aug. 12, 2016. www.fitnessnetwork.com.au/resources-library/choose-training-shoe

Price, J. 2015. Enhancing your professional reputation. PTontheNet. Accessed Aug. 12, 2016. www.ptonthenet.com/articles/enhancing-your-professional-reputation-3959.

Price, J., & Bratcher, M. 2010. The BioMechanics Method. San Diego: The BioMechanics Press.

Justin Price, MA

Justin Price is the creator of The BioMechanics Method® Corrective Exercise Specialist (TBMM-CES) program, the fitness industry’s highest-rated specialty certification. There are trained TBMM specialists in over 70 countries helping people alleviate pain and reach their performance goals. He is also the author of several books including the esteemed academic textbook The BioMechanics Method for Corrective Exercise. Justin is a former IDEA Personal Trainer of the Year, founding author of PTA Global, and a subject matter expert for The American Council on Exercise, PTontheNET, TRX, BOSU, Arthritis Today, BBC, Discovery Health, Los Angeles Times, Men's Health, MSNBC, New York Times, Newsweek, Time, Wall Street Journal, WebMD and Tennis Magazine. Learn more about The BioMechanics Method®

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