Sprained ankles are the most common sports injury by far. If you were a physiotherapist, osteopath or chiropractor just treating sports injuries and nothing else your days could easily be filled up, sprained ankle, after sprained ankle after sprained ankle. To make the situation even more predictable sprains or sprained ankles on the ‘outside’ of the ankle outnumber medial sprains (inside sprained ankles) more than 100-1.
On a human levels sprained ankles can be shockingly impactful to quality of life. That being said, the short term pain and frustration of injury recovery is something that most of us can handle pretty well. What is far more serious is finding that you are suffering from repeat ankle sprains and mobility problems related to progressive weakness in the ankle. This can impact our ability to connect with and enjoy many of the most basic activities that add up to a good quality of life. To some degree almost all of us define our enjoyment of life partly by our ability to be active and express our wellbeing through movement, this is a whole lot easier without pain and there threat of injury.
The classic moment in which the sprained ankle occurs involves the body weight and tibia bone tipping or rolling over the outside of the ankle joint. This rolling or tipping means that the entire downward force of your body weight moving at speed is now no longer loading through the ankle joint but through the 3 little ligaments on the outside of the ankle. During the process of rolling over a sprained ankle you go from having a firm base to hanging on by a thread. At that moment all the safety mechanisms in the system have failed and it comes down to the miserable mathematics of body weight + speed – ankle ligaments. But what were these safety mechanisms that failed??
Muscles & Nerves Prevents Ankle Sprains
I can speak as someone who has never sprained their ankle but who has come close to having a sprained ankle on many occasions. I had a particularly classic one of these ‘nearly a sprained ankle’ moments several months ago running on Mt Victoria in Wellington. I was coming down a steep slope covered in a harshly exposed tree routes and travelling at a reasonable but not completely reckless speed. Close to the bottom of the slope I slightly misjudged an angle on one of the many exposed roots and felt the alarming sharp ‘give’ of my ankle rolling. The next 3 strides I made on that same side felt slightly sharp in a way that you might almost call pain, I felt a small wave of relief and gratitude to still be in one piece and that was it. This is the first time I have thought about it since.
What happens in these split second corrections of those of us lucky enough to live an unsprained existence (touch wood) is a bewilderingly complex and high speed coordination of muscles and spinal nerve reflexes.
As the ankle ligaments stretch under the displaced tibia bone, microsecond nerve messages fire a distress signal from receptors in the ligament up to the spinal column. These messages travel along specially designed high speed data cables with superconductive sheaths made of ‘special stuff’ to the spinal cord. The spinal cord needs to receive and decode these messages in microns of a split nanosecond (or something like that), so that it can instruct all the right muscles to fire in a way that prevents a sprained ankle level ligament injury. One of the truly amazing things about the nervous system is that it has overrides.
Decisions that need to be made at injury prevention speeds happen at the spinal cord level. The brain just wouldn’t have time to process the information and send instructions back to the body. The solution is that the spinal cord intervenes, makes a decision and gives instruction back to the necessary muscles to save time. This is a lot like having managers who can make decisions for a in real time without having to go to the MD or CEO for ‘operational decisions’. High level, biological superconductive safety measures. This entire ‘nano-moment’ from the sudden stretch to the muscles activating to prevent a sprained ankle event is how the body prevents your full weight going through the ankle ligaments to prevent a sprain.
As complex as all this injury prevention is on a cellular and physiological level; the concept is as simple and elegant as a modern car that senses you have made a miscalculation and dabs the breaks on your behalf. Simple idea… complex execution.
Why are the Ankles Own Muscles Not Important Then?
The reason however that they are really not worth focusing on or specifically targeting is that they are only a very small part of the muscle action that prevents ankle sprains.
The muscle mechanism that prevents sprained ankles works from the back of the hip right down to the ankle bone and foot. The mechanism generates the most force and has the greatest effect in the gluteal & hip muscles and it’s power lessens as the size the muscles diminish toward the ankle. In other words the big strong hip muscles work harder to prevent sprained ankles than the small muscles at the ankle itself.
There is no question that the smaller muscles groups at the outer margin of the shin bone and ankle (peroneal muscles) are very important for preventing ‘inversion’ sprain movements but they are nowhere near powerful enough to take sole responsibility for sprained ankle prevention.
The great news is that in terms of strengthening and rehabilitation & prevention of sprained ankles the right exercises will take care of all the necessary muscles groups.
Weight bearing ‘functional’ exercises that challenge all the muscles involved in balance and body weight management automatically activate the necessary muscles groups exactly as nature intended. There are exercises that target sprained ankle prevention by isolating certain muscle groups, these aren’t as effective as exercises that target the entire muscles ‘mechanism’ from the hip down to the foot. Balance training activates everything from the glutes down to the small intrinsic muscles of the foot.
Research and extensive clinical observations by countless practitioners over the years have shown beyond a doubt that sprained ankles are a serious issue. A significant ankle sprain that is not effectively and diligently rehabilitated can profoundly affect the career of a sports person. Among mere mortals, ankle sprains and the muscle weakness that ride on their coat tails can be a serious threat to quality of life in the long term. This means that effective strength training for sprained ankle prevention is a serious issue and one that needs to be pursued in the most effective way possible. The most effective way without doubt it to target the strength of the entire leg and not just the muscles of the ankle itself.