Chronic Ankle Instability: Why am I always rolling my ankles?!

Ever feel like you have weak ankles? Do you tend to “roll” your ankles? Well, you are not alone! You may relate to a term we call “chronic ankle instability.” In other words, having an extensive history or increased propensity for ankle sprains. As with almost anything, there are several factors contributing to this condition. The important takeaway from this blog is understanding how muscular strength plays a key role in improving ankle stability.

A little anatomy and mechanics behind ankle instability

As it turns out, there are a few different ways one can roll their ankle. However, the most people commonly twist their ankle by rolling it inwards, also known as an inversion ankle sprain. This occurs when the bottom of your foot turns inward during the roll, or your ankle “inverts”. As a result, there is injury to the ankle ligaments on the outside of your ankle as they get over-stretched during the forced and unexpected twist. After one acute roll, or after repeated rolls, these ligaments become weakened by the excessive lengthening, further contributing to your chances of another sprain. Ugh!

In fact, there is only so much that can be done for the over-stretched ligament itself. The most important step immediately after an ankle sprain is to address the inflammation in the area with the well-known RICE method: rest, ice, compression, and elevation. After addressing the inflammation, you need to create stability. Outside of bracing the ankle for external support (which may be warranted in certain cases, or for short periods of time to allow safe mobility), strength and control allows for improved stability. Ideally, we want to create enough support through proper alignment and strength so that you do not have to rely on a brace. Your PT will usually decide if/when you need a brace.

Where do I need to gain strength and why?

Often, the ankles fall victim to weakness from your knees, hips or trunk. Strength deficits in your core and hips can trickle down, causing compensations throughout your lower extremities. Ultimately, this predisposes you to injury by altered mechanics. All of that to say, one must have central stability for distal mobility. The way your bones and tissues align does not change much with PT. However, physical therapists focus on FUNCTIONAL deficits, or the way your body has adapted over time that may lead to muscular weakness. When trained in the right way, you can alter these functional deficits to create a more stable and efficient system that results in better mobility and less risk for injury.

In most cases, it is useful to strengthen areas around the ankle. The muscles on the outside of your lower leg perform the action opposite of the common inversion ankle sprain. Strengthening these muscles encourages strength opposite the direction prone to injury. You also want to strengthen the muscles of the ankle/foot to provide better arch support and stability of the lower leg with weight bearing activities.

Here is a link to our YouTube channel providing exercises specific to strengthening your ankle and lower leg:  Ankle/Lower Leg Exercises: https://bit.ly/ankleinstability.

Don’t forget central stability!

As previously mentioned (and may be forgotten) is addressing core and hip strength. Specifically, the muscles on the outside of your hip (known as the hip abductors). These muscles play an important role in keeping you upright while walking. Your hip muscles, including your gluteus medius) help keep your hips level while standing on one leg. Furthermore, having good strength in these muscles allows for less compensations in your knee or ankle. Uneven surfaces will feel less daunting when you feel like you have control over your lower legs and more stability in your hips.

Gluteus medius: an important muscle for lower extremity stability:

What happens when your glute medius is not supporting your pelvis properly? You may see one hip drop down compared to the other when standing on one leg. This is called the Trendelenburg sign, indicating a lack of pelvic stability during single leg stance. In other words, your hips are unable to stay level when one foot is unweighted causing a drop in the pelvis. If this is happening every time you take a step, you can see how it may lead to compensations in your ankles.

Trendelenburg sign: weakness in glute medius; sign of needing some stabilization strength! Notice how the left hip drops with lifting the left foot off the floor; the pelvis should remain level.

Here are a few links to our YouTube channel demonstrating basic core/hip strength activities:

Core and Hip Exercises: Activating Core (TA), TA marches, TA heel slides, Quadruped Core, Hip Abduction

Balance activities tie it all together!

If you’ve recently experienced a sprain, you may not be able to tolerate these quite yet; however, as your central strength improves, it’s important to challenge the whole system with balance training.

Tandem and Single Leg Balance:   (need to add balance video links once they are on YouTube)

*As always, these exercises are just suggestions for the general public. For specific exercises and rep/set recommendations, please consult your provider or visit us at Atlanta PT!*