Why Do SO MANY Ankle Sprains Reoccur. 

Without getting caught up in stats it should be enough to tell you that research conducted on over 300 Chinese professional athletes has shown that a shocking number suffer with long term pain, weakness and relapses after ankle sprain injury. The research in question concluded that stubborn pain, persisting weakness and re-occurrence of sprained ankles was a major issue affecting the athletic careers of those studied. 

Sprained ankles are far and away the most frequent of all sports injuries. To say that sprained ankles that need treatment are common would be a massive understatement! Sprains on the lateral (outside) of the ankle result in more treatment by professionals than all of the other sports injuries out there put together. The human machine with its bipedal design is a reasonably extreme piece of evolution and it obviously is not without its weaknesses. 

Image depicting ankle anatomy.

The ankle joint has a surprising lack of muscle considering the amount of weight bearing it does.

The ankle is prone to sprains because of the shocking amount of stress it absorbs day to day, the relative instability of the joint design and the surprising lack of supporting muscle surrounding the joint. The ankle sustains your whole body weight moving at speed millions of times each year. Amazingly the ankle does this job with a fraction of the muscle support found at the knee, the hip or even the shoulder which doesn’t weight bear. 

Despite all the reasons we have for being prone to ankle sprains and potentially suffer with re-occurrence of sprained ankle episodes I believe that we do have the capacity to effectively prevent or at least fully heal sprained ankles. 

I believe that the overriding factors that lead to all those nasty sprained ankles and their tendency’s to reoccur are our environment and our lifestyle. 

Even amongst elite athletes our lifestyles are generally far less active than our hunter gatherer ancestors. Basically we move less than we did when we lived in the outdoors and needed to find food, find water and make our own shelter. This lack of activity means that our muscle and soft tissue is nowhere near as strong and conditioned as nature intended. Tissues that are not as strong as nature intended are prone to sprains and strains, particularly in tissues like the ankle that bear so much weight.

What I believe to be a more significant cause of stubborn recurrent sprained ankles than any other is however environment. Our ancestors walked with their bare feet ‘in the mud’ for a million years before we invented concrete, paving, tarmac and hardwood flooring. The natural surfaces we evolved and adapted to walk on have shock absorption due to their softness, constant muscle stimulation due to their unevenness, and arch support due to their flexibility. 

Set aside for a moment the amount of preventative benefit inferred by all that shock absorption and extra muscles activation there is built into a life spent outdoors. Imagine for a moment how different life is for a sprained ankle that lives outdoors and moves barefooted  between forest and woodland compared to a sprained ankle that lives in a city. If you sprain your ankle i

Image depicting patient suffering from acute ankle sprain.

Ankle sprains are a frustrating but manageable part of life.

n the big outdoors the amount and type of work that it does to get through the day is dramatically different. Even professional athletes are on hard flat ground for most of their lives, this exposes them to sprained ankles just as much as it does us mere mortals. 

I believe that if you spent 2 months outside in bare feet after your sprained ankle occurred , having to navigate fallen trees, constantly shifting slopes and inclines, rock formations and vegetation you would end up with yotu ankle in a very strong and fully rehabilitated state. Instead you more than likely sit for a large part of each day and move almost solely on extremely hard flat surfaces that put a lot of stress in the ankle joint without asking much from its supporting muscles. The connective tissue sustains unnatural strain and the muscle tissue doesn’t do much work. 

Whether I am right or not about the cause of all these problems we already know what the solutions are. Extended periods of rehabilitation after ankle sprains which take time to carefully target motor control of the ankle, break up scar tissue and strengthen muscles improve long term outcomes across the board. It just so happens that the need for these tools fits quite neatly with the theory on the table. 


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