Updated: Feb 15
Ankle injuries are one of the most common musculoskeletal sports injuries, and recurring ankle sprains – also referred to as chronic lateral ankle instability or chronic ankle instability – can come back again and again to frustrate runners and other sportspeople. This article explains how you can avoid suffering from recurrent ankle sprains. It is also something that one of our team of online sports physios can help you with via a video consultation.
You may also find these articles useful:
- Should I go to A&E with a sprained ankle?
- How to treat a sprain – an update on the latest research
In this article:
Why are recurrent ankle sprains so persistent?
When you sprain your ankle it usually causes a tear in one of the ligaments. It can be a partial tear or a full tear. Your ligaments hold your ankle joint together, so if you tear them, then you are actually causing that joint to be temporarily unstable, if not longer.
If someone were to tear a ligament in, say, their knee, most people would go, ‘Oh, gosh! You must get that better before you go back to playing!’ And really, the same thing should be said about your ankle. However, because ankle sprains are so common, people don't really take them as seriously as they should, and they often don't rehab them to the right level before they go back to running or playing sport. In these cases, the injury can either happen again or the ankle can still give you problems, because it is not stable enough for a return to the level of activity you were at before the injury.
How to fix chronic ankle instability
To prevent or fix recurrent ankle sprains, you should check whether one or more of the following issues need attention.
Swelling in the ankle
The first thing you might want to consider after you've injured your ankle and you've gone through your initial acute soft tissue management is whether there is still some swelling. If so, firstly, swelling can affect the sensory motor control of the muscles around your ankle, and that can affect your balance, which will predispose you to going over on your ankle again. Secondly, if you go back to playing sport or running with a swollen ankle, the swelling tends to cause some pinching at the top front of your ankle, called impingement, and that can cause problems down the line.
So, if you’ve still got swelling in your ankle, the best thing is to say, ‘Actually, is it really ready to be going back to all the things I want to be doing, or does it need a little bit longer to just settle down?’
Range of movement
After a sprain, sometimes your ankle can be a bit stiff in dorsiflexion, which is when you pull your toes up towards your chest or when you go into a squatting position. As you can imagine, this movement is also required of your ankle when you are running.
Dorsiflexion is easily tested by seeing how far from a wall you can place your foot flat on the floor while your knee is touching the wall. (You can check our video below to see how this is done.) You should compare your recently injured ankle to the other one to see if there's much difference. Quite often after a sprain, this will be stiff and might need some work to get it better so that your biomechanics are right.
Steph demonstrates these movements and some of the rehab exercises mentioned lower down in this video about recurrent ankle sprains:
Strength exercises for chronic ankle sprain rehab
Ankle strength is also important, because if the muscles that control your ankle aren't as strong as they used to be, then they can't control your ankle so well. Examples of strength exercises that you may want to be doing include heel raises and TheraBand work (see the video for a demo).
Sometimes you might have problems where you're also not as springy as you used to be. Perhaps when you hop on one foot, you're nice and springy, whereas on the other one, where you injured your ankle, it's all flat-footed, which obviously affects your ability to run quickly. So, you need to not only make sure that your ankle strength is good in all directions - to properly prepare your ankle for sport, you also have to include plyometric exercises that can restore the springiness in your ankle.
There's also some research that shows that hip and core strength can make a difference for people with chronic ankle instability, mainly because if you don't have very good hip control, then your biomechanics might not be as good as someone who's nice and steady in their core and around their glutes.
Static and dynamic balance exercises for recurring ankle sprains
Sometimes when you sprain your ankle, you disrupt the sensory receptors in your ligaments and around the soft tissue that tell your brain what your ankle is doing and help you to balance. This is also known as position sense or proprioception.
Static balance is nice and easy to test. Stand on one leg with your eyes shut and compare it to how well you can do it on the other leg. Sometimes, people with a recently sprained ankle will find that their balance is not quite as good. This is another reason why people might sprain their ankle again, because they haven't rehabbed their static balance.
However, when you're playing sport, you're not just staying still, so you also have to look at what we call dynamic balance. This may involve reaching in different directions with one leg while you're maintaining your balance with the other, or it might be something more dynamic, like hopping and skipping sideways, forwards, and backwards. That's the next level of balance-type exercises that you need to be able to do to try and reduce the risk of spraining your ankle again.
How quickly your ankle muscles can react to unstable surfaces or running over uneven ground can also be a good test to see how it can cope with the sort of mechanism that might injure it and how quickly your muscles can stop it from happening.
The way that you walk or run can also tell us some things about your ankle. Sometimes people don't push off the way they do on their other leg, and that is an indication that you need more strength around your ankle. Sometimes, it's just something about the way you're running in general that actually predisposes you biomechanically to going over on your ankle. We can observe this during our consultations by getting you to perform test movements or asking you to film yourself while running on a treadmill. This can usually be fixed by improving the hip and core strength that I mentioned earlier.
Other options for fixing chronic ankle instability
You could consider getting scans and investigate taking the surgical route to fix recurring ankle instability. However, if you haven't done any of the rehab mentioned in this article to the very top level that you need it – and that depends on what physical activity that you are trying to get back to doing – then I suggest you do a rehab program for chronic ankle sprains first. Give it at least three to six months and try and get it as good as you can get it before you think about whether or not you need any scans or orthopaedic opinions.
Need more help?
If you need help with such a programme, that's the sort of thing we do all the time, so take a look at our website and then, if you want an individual assessment, please do book in, and we'll compile a bespoke ankle sprain treatment plan for you to get your ankle as strong as it can be.
We're all UK Chartered Physiotherapists with Master’s Degrees related to Sports & Exercise Medicine. But at Sports Injury Physio we don't just value qualifications; all of us also have a wealth of experience working with athletes across a broad variety of sports, ranging from recreationally active people to professional athletes. You can meet the team here.
About the Author
Steph is a chartered physiotherapist with more than 15 years' experience and a Master’s Degree in Sports and Exercise Medicine. You can read more about her here, and she's also on LinkedIn.
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Lephart, S. M., Pincivero, D. M., & Rozzi, S. L. (1998). Proprioception of the ankle and knee. Sports Medicine, 25(3), 149-155.
Vuurberg, G., et al. (2018). "Diagnosis, treatment and prevention of ankle sprains: update of an evidence-based clinical guideline." British Journal of Sports Medicine 52(15): 956-956.