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Strengthening a sprained ankle – Proprioception

Sprained your ankle recently? Or do you have a weak ankle that is always troubling you? In this guide, we will design a program to aid you in getting back to your sport.

A study was done by Ergen and Ulkar (2008), and they stated that proprioceptive-coordination training can be used for prevention and rehabilitation of ankle sprains. Proprioception is the capacity of the body to determine where all of its parts are positioned at any given time, and it plays an important role in the world of sports. As a proprioception exercise is a proven method that can help to strengthen the ankle, I will recommend it for the injured athlete.

*SAFETY: Get medical clearance before commencing*

Proprioception

Proprioception refers to one’s own senses of the relative position of the body and strength of effort being employed in movement. It is a broad concept that consists of balance, coordination and postural control with visual and vestibular contributions, position sense, joint kinesthesia and muscle reaction time.

Sue Falsone, vice president of performance physical therapy and team sports at Athletes’ Performance says that proprioception is vital when rehabbing an injury. The good news for athletes and exercisers is that it’s similar to flexibility and strength in that if you work on it, it can get better. Regarding the risk of reinjury, several studies of the ankle found that reinjury wasn’t necessarily due to a lack of strength, but to a lack of proprioception.”

Proprioceptive training can be done in the absence of equipment to simplify the exercises. Some examples will be the calf-raises, hip abduction/adduction, one leg balance, toe walking, heel walking, forward-backward leg swings with flexed knee and cross-body leg swings.

There are various types of specific equipment that are designed for proprioception training. Examples are the exercise ball, the balancing board and the Both Sides Utilized (BOSU) balance trainer or sometimes called the BOSU ball which we will be using it. The BOSU balance trainer is equipment that combines a plastic base with inflatable bladder which looks like a halved Swiss ball.

*SAFETY: When doing a single leg balance, it will be advisable to start with the dominant side before moving on to the non-dominant side*

Program

I will recommend a program 3 times per week, lasting 6-8 weeks for the athlete.

Stage 1:

Begin the first 2 weeks of proprioceptive training at somewhat static position and without equipment as it will allow the athlete to achieve the correct technique of each individual exercise due to the more stable platform that they are doing on. As mentioned, exercises that can be done are the one leg balance, toe walking, heel walking, forward-backward leg swings with flexed knee and cross-body leg swings. Do each exercise for 30 seconds with good balance. Upon accomplishing this, we can further challenge the athlete by closing the eyes while maintaining the same position and stand still for another 30 seconds. Closing the eyes takes away the strong, balance-enhancing input from the visual system and forces the nervous system to depend more heavily on the somatosensory and vestibular systems to give balance.

Stage 2:

Proprioceptive training for the next 2-3 weeks will still be in relatively static position but be done with the equipment mentioned. Similar exercises as the first 2 weeks but now with an unstable ground. When the athlete is comfortable and is able to complete the movements with great coordination, we can further challenge them by positioning the athlete in sport-specific positions. In this case, get a tennis player to stand on the BOSU ball to practice his/her forehand, backhand and even serves using a racket.

Stage 3:

The final phase to complete the rehabilitation process before getting back to full sports will last approximately 2-3 weeks. Dynamic exercises such as vertical jumps, running figure-8 patterns, crossover walking & change of direction movement will help to bring about a connection between nerves and muscles.

These training will have to be done progressively and in the event of pain during exercises, STOP! Advancement from one stage to another varies from each individual and progression should be carried out when one is able to execute the exercises with balance and confidence.

*SAFETY: STOP in the event of pain*

 

Example of a proprioception program

Duration/Reps Exercises
Stage 1 20 times

20 times

20 times

30s

30s

30s

·         calf-raises

·         hip abduction/adduction

·         forward-backward leg swings

·         one leg balance

·         toe walking

·         heel walking

Stage 2

 

(with BOSU)

20 times

20 times

20 times

30s

30s

30s

20 times

 

·         calf-raises

·         hip abduction/adduction

·         forward-backward leg swings

·         one leg balance

·         toe walking

·         heel walking

·         Forehand/Backhand/Service swing

Stage 3 20 times

30s

30s

30s

·         Vertical jumps

·         Running figure-8 patterns

·         Crossover walking

·         Change of direction movement

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