In a 2010 study that looked at every injury sustained in the NBA over 17 years. The most common injury was lateral ankle sprains at over 13% of all injuries. If the world’s best are not immune from this injury then neither are you. Thankfully, science and research shows us that targeted strategies are highly effective at reducing the likelihood of sustaining a lateral ankle sprain! In the NBA there are approximately 100 ankle sprains per season, and in the last 11 years there have only been 4 that required surgical intervention. With high incidence of ankle sprains and the associated economic burden/negative chronic consequences, this calls for PREVENTITIVE measures.As they say, an ounce of prevention is worth a pound of cure.
For successful development of preventive measures, it is essential to have a sound understanding of the injury mechanism. With that being said, here is how to sprain your ankle.
The ankle gets the majority of its motion from two different joints: 1) talocrural joint and 2) subtalar joint. Together these joints allow our foot to move in every plane of motion so we can have excellent ground contact during dynamic movements. Ligaments connect bone to bone and therefore provide passive stablity to our ankle joints. Arguably, even more importantly, they also provide sensorimotor feedback to our central nervous system for adequate coordination and muscle recruitment. The three primary ligaments involved during a lateral ankle sprain are the
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Anterior talo-fibular ligament (ATFL)
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Calcaneo-fibular ligament
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Posterior talo-fibular ligaments.
These ligaments are stretched beyond their capacity when the foot is fixed to the ground and the ankle rolls outward as the toes turn inward. The exact biomechanics include rapid inversion with subsequent internal rotation that may or may not include plantar flexion at the ankle as well as altered kinematics at the pelvis, hip, and knee.
Grade 1: Mild- Ligaments are stretched but not torn Grade 2: Moderate-Partial tearing of one or more ligaments Grade 3: Severe-Complete tear of one or more ligaments
I could walk you through what the rehab process may look like but this is all about preventative measures. If I haven’t convinced you enough yet to begin your prehab journey today I will provide you with this:
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4/10 ankle injuries results in chronic instability
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1-4 people DO NOT return to their prior level of sport function after an ankle sprain event.
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Increases sprains increase your incidence to sustain another ankle injury by 50%
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Lateral ankle sprain injuries have the highest reinjury rate of all lower limb musculoskeletal injuries.
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See Stephen Curry’s missed game history and performance.
5 AREAS TO ADDRESS FOR ANKLE HEALTH
Before beginning an injury prevention program we have to assess what risk factors exist and can those risk factors be modified. For simplicity we will break it down into 5 key areas, all of which are modifiable.
Before beginning these exercises you consent to not holding Performance Project responsible for any injury, pain, or damage sustained during these exercises. I represent and warrant that I have no medical condition that would prevent my participation in the program. I agree to assume full responsibility for any risks, injuries or damage known or unknown which I might incur as a result of participating in the program.
Disclaimer: This is not meant to serve as a replacement for consulting a licensed medical provider. Pain can be and is very complex therefore if you are having pain beyond what is considered normal, seek help. Do your homework and seek someone who understands your movement goals and demands of your activity/sport. Seek someone who is current in his or her knowledge. I’m biased but I suggest starting with a physical therapist as they are irreplaceable in and the most cost effective in treating the musculoskeletal system.
In no event shall Performance Project be liable for any personal injury sustained during or after implementation of this program.
1)ANKLE STRENGTH
Strength, alone, is always a useful strategy when employing injury prevention tactics. Based on the extant literature, it appears there may be no substitute for greater muscular strength when it comes to improving an individual’s performance across a wide range of both general and sport specific skills while simultaneously reducing their risk of injury when performing these skills. A stronger muscle can only produce more force but it can also withstand more force.
Banded Monster Walks
Goal: Create a coordinated lower kinetic chain by synchronizing the hips, knee, and ankle to move and work together.
How: Begin by placing a small band around for forefoot (just behind where your toes begin). Keep your hip, knee, and ankle stacked as you take a small step in either direction. Be sure to keep your toes pointed forward at all times. Lead with your knee and not your ankle. As you begin to step you will feel muscles in your foot and ankle begin to activate. Once that foot is planted firmly into the ground step with the opposite leg in the same direction.
Application: Take 12-15 steps each direction for 1-2 rounds
and perform 1-2x per week.
Physio Ball Ankle Bridges
Goal: Create a stable base on an unstable surface. Without proper stability in the ankle this exercise becomes increasingly difficulty.
How: By laying on your back and place one foot firmly on a physio ball. Keep that foot flat through the entire movement. Press into the ball and lift your butt off the surface into a bridged position. Begin pulling through your heel to roll the ball toward your butt and control the ball away from your butt. Once your knee is extended lower yourself back down to the start position.
Application: Perform 2-3 sets on each leg for 8-10 reps.
Perform 1-2x per week.
Soleus Squats
Goal: Strengthen the most forgotten ankle stabilizer in the
entire lower extremity.
How: Feel free to use a physio ball if needed. Begin by placing your back against a wall and squat down until your thighs are parallel with the floor. Maintain the parallel position and then perform a calf raise. Use a tempo of 3-1-1-0 (lowering portion-pause at the bottom of movement-raising portion-pause at top of movement). Is that confusing? Lift your heels off the floor (1 second). Pause at the top of the movement (1 second). Lower your heels back down slowly (3 seconds). Pause at the bottom with foot flat (1 second).
Application:Perform 1-2 sets of 12-15 reps. Perform 1-2x per
week.
2)DYNAMIC BALANCE
Balance is the combination of voluntary and reflexive control of the center of gravity (COG) and base of support (BOS) to maintain relative position and postural stability against intrinsic and extrinsic forces. Most understand that we can train our muscles to grow, develop more force, and endure longer periods of training; but there is a component of training that is forgotten. Our joints, connective tissue, and muscles have sensory fibers that give us important internal and external feedback for optimal stability. By biasing single leg movements we can optimize these mechanoreceptors to our advantage.
1)Single Leg Hinge into High Knee
Goal: Develop necessary single leg balance and rock hard ankle stability with the most fundamental movement pattern-the hip hinge.
How: Begin a single leg position with slight knee bend. The movement starts by hinging in your hips. (you must have proper hip hinge pattern with 2 legs before you can with one leg). Push your hips back while maintaining good back position. The knee and ankle should not change from its starting position. Once your reach your end range drive your hips through as you drive the opposite knee towards your chest. This is one repetition. Slow and controlled is the goal here.
Application: Perform 8-10 reps of 1-2 sets on each leg. Perform 2-3x per week.
2)Y-Balance
Goal: Develop multi-planar ankle stabilization and lower extremity neuromuscular control.
How: You reach will be three different direction in reference to the stance leg. You will reach anterior (forward), posterior-lateral (behind and away from the stance leg), posterior-medial (behind and towards your stance leg). Begin in the single position with slight knee bend. Your weight must stay on the stance leg at all times. Reach in all three directions without shifting your weight to the reach leg.You reach will be three different direction in reference to the stance leg. You will reach anterior (forward), posterior-lateral (behind and away from the stance leg), posterior-medial (behind and towards your stance leg). Begin in the single position with slight knee bend. Your weight must stay on the stance leg at all times. Reach in all three directions without shifting your weight to the reach leg.
Application: One rep is completed after you reach in all three directions. Perform 3-5 reps for 1-2 sets on each leg. Perform 1-2x per week.
3)KB Pass
Goal: Develop single leg reactive neuromuscular control. By using the KB to change the demands of the balance task your body must react accordingly to maintain rigid stability.
How: Begin in a single leg stance. Use a lighter dumbbell (under 20 pounds). Pass the dumbell from one arm to the other and lift the KB away from your body. Do not lift the KB any height than Mid-Chest height. Develop a rhythm as you controllably pass the KB side to side.
Application: Perform 10-12 reps for 1-2 sets. Perform 1-2x
per week.
3) TISSUE TOLERANCE
Injuries occur when the amount of force exceeds the tissues (muscle, ligament, tendon) capacity to absorb or withstand that force. This is certainly an unorthodox approach to injury prevention, but recent application has forced rehab professionals to think outside the box and consider the application of these interventions. There is a huge misunderstanding of what the human body is capable of and how truly adaptable it is. After all, the goal of training is promote and create positive adaptation. How do we adapt? By applying stress in the form of load to our body which then forces the body to adapt to that stress. After greater exposure to the stress our tissues become resilient to that stress in the future. Nobody ever got stronger by avoiding certain positions. We must explore our range of motion, specifically end range of
motion.
Build strong, capable, and more resilient joints and then you will create more movement potential.
Inverted Ankle Squats
This movement starts in a hyper-supinated position (foot rolled outward onto your lateral border). By loaded this position you will stress the tissues on the lateral ankle greater than standing in a traditional foot flat position.
Goal: Increase your foot’s tolerance to loaded inversion and supination so that in the event you do roll your ankle your tissues can better withstand that stress.
How: Begin standing in a squat width stance. Roll your feet outward so that the inside of your foot begins to arch upward. Begin lowering down into a squat as you maintain that same position and return to upright. This is meant to be challenging, awkward, and require a level of motor control that takes time to perfect.
Application: Perform 1-2x per week for 2-3sets of 10-12 reps.
Calf Walks
This movement demands endurance from your calf musculature and ankle stabilizers. By walking on your toes your have less ground contact which will increase the force through the foot.
Goal: Increase your foot’s tolerance to loaded plantarflexion.
How: Perform a calf raise and maintain that forefoot load bearing position. Keep your quads and glutes engaged for added stability and begin tip toeing. This can be modified by carrying Kettlebells, Dumbbells, or using a Barbell for more resistance.
Application: Perform 2-3x per week for 2-3 walks of a maximum distance. Maximum being as far as you can while maintaining proper positioning and stability.
4) ANKLE DF MOBILITY
What the research tells us:
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“A smaller amount of ankle dorsiflexion displacement during landing is associated with less knee flexion displacement and greater ground reaction forces.”
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“If the absorption of forces does not occur at the distal joint, the forces will be translated to the next joint; possibly causing increased forces and compensatory motion at that joint.”
Limited ankle-dorsiflexion range of motion (ROM) after lateral ankle sprain has been considered a predisposing factor for recurrent ankle sprain because diminished dorsiflexion prevents the ankle from reaching its closed-pack position by holding the ankle in a hypersupinated position. Therefore, ensuring appropriate restoration of ankle dorsiflexion after ankle sprain has important clinical implications for restoring full functional abilities, ultimately leading to reduced risk of recurrent ankle sprain.
Banded Dorsiflexion Mobilization
Goal: Improve ankle dorsiflexion mobility by using a band to assist in gliding the joint as you move through active range of motion. This helps the sensorimotor system find and maintain new end ranges of motion to reduce perceived tightness or stiffness through the range of motion.
How: Attach a resistance band that is about 1-2 inches thick around a squat rack or rig. Place the band below your lateral ankle bone. Step away from the attachment point to give more tension through the band and make your way into a half kneeling position with the target ankle forward. Driveour knee over your toe as you maintain heel flat position. Make sure your knee tracks over your mid to lateral foot. Do not let your foot roll inward or allow your knee to travel inside your foot.
Application: Hold the end range position for 3-5 seconds and perform repeatedly for 1-2 minutes as needed 2-3x per week to get desired results.
Ankle Distraction with Calf Stretch
Goal: Reduce anterior joint pinching and posterior soft tissue joint tightness.
How: You will need one band and one strap for this. Begin by wrapping your band to a squat rag or a rig. Lay on the ground and place your heel inside the band and then criss cross the band over your ankle. Move further away from the attachment to put resistance in the band. You should feel some distraction in the ankle joint. Using the strap place this around your forefoot and pull back towards you. You should feel a cal stretch.
Application: Perform 10 rounds of 10 second holds at end range 1-2x per week.
5) PLYOMETRIC TRAINING
Basketball is a plyometric sport. Think of how many times your jump in one event (training session, practice, game)? Jumpshot, rebound, lay-up, dribble complexes)? Train your ankles and lower extremity how to absorb and react to ground reaction force the right way.
1)Low Box Drops
How: Using a low height box (less than 12’’), jump down and land with excellent control on one leg. Your cue to land like a ninja (very quietly). Make sure to absorb the force in the ankle, knee, and hip by using good flexion in those joints. Don’t land stiff.
2)Lox Drops with Lateral Jump
How: A progression of the prior exercise is now to absorb the force and use that for a counter movement. Upon landing on the single leg you now have to drive off that leg and move directly lateral. Upon landing in the lateral jump you will now land on the opposite leg you jumped off of. Landing control applies here as well. Keep your trunk stable and stacked over top your hip, knee, and ankle.
3)Low Box Quick Hops
How: Rapidly and repeatedly jump from the floor to the box and return down. This is more challenging than it looks so make it easier by using good control and focusing on the intent of the exercise.
Injury prevention is all about modifying what we can modify. There is always going to be a risk for injury with dynamic movements in the game of basketball or any sport. Research has proven that preventive exercises are effective at reducing your risk for injury. The biggest thing you can do for yourself is commit to being compliant with these exercises and program. I promise this will have carryover to other events in your life (performance, training, and injury prevention).
Be sure to understand the WHY when performing these movements and perform with INTENT. These exercises can be performed in as little as 15 minutes over the course of a day. You can use them as:
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Primers before practice, game, training session
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Stand alone exercises in your free time
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Incorporated in your strength and conditioning program
There is no one size fits all approach to training so use them in a way that you will receive the most benefit!
REFERENCES
Cressey EM, West CA, Tiberio DP, Kraemer WJ, Maresh CM. The effects of ten weeks of lower-body unstable surface training on markers of athletic performance. J Strength Cond Res. 2007;21(2):561-7
Delahunt E, Bleakley CM, Bossard DS, et al. Clinical assessment of acute lateral ankle sprain injuries (ROAST): 2019 consensus statement and recommendations of the International Ankle Consortium. Br J Sports Med. 2018;52(20):1304-1310
Fong CM, Blackburn JT, Norcross MF, Mcgrath M, Padua DA. Ankle-dorsiflexion range of motion and landing biomechanics. J Athl Train. 2011;46(1):5-10.
Vuurberg G, Hoorntje A, Wink LM, et al. Diagnosis, treatment and prevention of ankle sprains: update of an evidence-based clinical guideline. Br J Sports Med. 2018;52(15):956.
