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Strengthening the Ankle After Injury

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.

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 Sprains Affect 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 as well.

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 programs outlined on these pages 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.

For two sample programs plus a full reference list, please see “Ankle Sprains: What Can Personal Trainers Do to Help?” in the online IDEA Library or in the November 2016 issue of IDEA Fitness Journal. If you cannot access the full article and would like to, please contact the IDEA Inspired Service Team at 800-999-4332, ext. 7.



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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