Managing Your Ankles: From Injury to Prevention (Part 3)
This is Part 3 in a 3-part series: View Part 1 | View Part 2
By Nick Mong, PT, DPT, ATC.
While the advice below comes from a physical therapist and athletic trainer with nearly a decade of experience, no article can replace a thorough and individual examination by a qualified professional. If you have sustained a sports injury which is failing to heal in a timely manner, or you have tried to return to your sport and suffered the same injury, you should seek the help of your physical therapist or orthopedic physician for evaluation and guidance.
Once you’re back to playing form, you’re going to want to make sure that your acute injury doesn’t come back to plague you as a chronic injury. It’s easy to think that once your pain is gone, you’re back to exactly where you were previously, but that is very rarely the case.
This is due to the fact that during an injury, your brain “forgets” how to control the injured area as well as it did before, and you need to retrain it in a process known as neuromuscular re-education. Simply put, this means challenging your balance and control actively outside of practice or competition. Specifically making balance exercises a consistent part of your normal work-out routine will pay off in the long run in the form of improved performance and decreased injury rates.
A classic example of an excellent exercise for improving neuromuscular control is a single leg squat in front of a full-length mirror. Start by balancing on one leg with your stance knee bent to 90 degrees, then slowly lower your body weight downwards. With the mirror in front of you, you should be able to see your ankle, knee, hips and pelvis (i.e. your belt line). To perform a proper squat, your knee should stay directly in line 
with your ankle, and your belt line should stay entirely level with the ground as you lower down. If you see your knee dive inwards towards your other leg, or you notice that your opposite hip is dropping, you’ve lost proper form. If you see this, be thankful that you’re working on improving it, because having your knee dive inwards during any squatting motion has been shown to be a substantial risk factor for traumatic, non-contact knee injuries, particularly ACL ruptures. If you can’t seem to get it quite right, no matter how much you’re practicing, it could be that you’re simply too weak in some key areas to perform it correctly and need to begin to address those with specific exercises.
Two of the major muscles groups that tend to get ignored during typical strength workouts are the hip abductors and the hip external rotators, which both play a major roll in determining how well your knee is controlled. Both of these groups are small, so getting them stronger won’t really result much noticeable muscle bulk increase, but increased strength will help to improve your overall lower leg control during squatting, jumping, and cutting movements. A great, albeit challenging, exercise for your hip abductors is a combination of a side-plank and a leg lift. The specifics are a bit too boring to try to describe here, but (as of the time of this writing) if you enter “side plank with hip abduction” into Google image search, you’ll find a multitude of pictures detailing exactly what to do. Similarly, entering “side plank with hip clamshells” brings up a variant that will really help to improve your deep hip joint strength while working on improving your core stability at the same time. After working on these exercises daily for a week or two, try the single leg squat again and you’ll probably be surprised at how much easier it is to keep good control.
If you’re entirely new to strengthening exercises, or just find these ones a bit over your head, you can always consider hiring someone to instruct you in proper form and technique. I’m biased towards physical therapy, and if you’re still having occasional pain with exercise despite following your common sense and the tips provided in this series of articles, you should definitely consider finding a competent sports physical therapist to assess you and get you back to 100%. However if you’re not having pain but are just worried about recurrent injuries, a personal trainer may be a great fit for you. Unfortunately, personal trainers are not a licensed profession, which means that their education, experience, and competence levels can vary greatly. Word of mouth referral can be a great place to start to find a trainer who is right for you, but regardless of that make sure that any trainer you interview is educated in some sort of movement assessment program. A very well known and well-researched program is known as the FMS (Functional Movement Screen), and low scores on the FMS have been shown in a variety of research articles to correlate with increased injury risk from high school to professional level athletes. Going through the FMS screen can also help to identify any other flaws in your biomechanics as well.
I hope this short series of articles has been educational and helpful for the weekend warriors at PortlandSports.com, and that you’re all tearing it up on the field. If you’ve enjoyed reading through this and would like to see more, drop me any ideas for future articles in the comments.
