What Therapeutic Exercises Aid in Managing Ankle Instability?
Physical therapists are key in guiding patients through the recovery of ankle instability, prescribing targeted exercises tailored to individual needs. From a seasoned physical therapist's recommendation of strengthening exercises to additional answers like engaging in non-weight-bearing swimming, these therapeutic interventions are designed to restore stability and mobility. Here are seven effective exercises, including professional insights and additional therapeutic strategies, that have proven beneficial for patients grappling with ankle instability.
- Prescribe Ankle-Strengthening Exercises
- Incorporate Multi-Directional Slider Lunges
- Introduce Single-Leg Standing Variations
- Utilize Balance Board for Proprioception
- Implement Resisted Dorsiflexion with Therabands
- Add Controlled Toe Raises to Routine
- Engage in Dynamic Calf Stretches
- Strengthen with Non-Weight-Bearing Swimming
Prescribe Ankle-Strengthening Exercises
Ankle instability is due to weakness within the ankle musculature or laxity in the ligaments surrounding the ankle joint. Repeated ankle sprains (ligament) or strains (tendons/muscles) are the most common cause of this condition. The most common exercises I prescribe for people with ankle instability are ankle-strengthening exercises that focus on both the concentric (shortening) contraction of the muscles and eccentric (lengthening) control of the muscle. We start in an unloaded position, and as the person shows they can control the range of motion of their ankle, we progress to the loaded or standing position. It is important to strengthen the ankle muscles through the full range of motion to prevent future ankle sprains and exacerbation of ankle laxity.
EXERCISE #1 - Ankle Dorsiflexion with Resistance
- Setup: Begin sitting tall on the ground with one knee bent and the other leg straight, with a band looped around the top of your foot. The band should be anchored near the floor in front of you.
- Movement: Bend your foot up against the band, raising your toes towards the ceiling.
- Tip: Make sure to only move at your ankle and try to keep your knee still.
EXERCISE #2 - Single Leg Balance in March Position:
- Setup: Begin in a standing upright position, holding onto a chair for support.
- Movement: Lift one leg off the ground and hold it at a 90-degree angle in front of your body, keeping your standing leg knee unlocked and lifting the arch of your standing leg foot. Squeeze your butt muscles together as if you have a $100 bill between your cheeks and you don't want someone to pull it out. Maintain your balance in this position for 1 minute.
- Tip: You can try to balance without leaning on the chair for help, but this exercise is more for muscle activation versus improving balance.
EXERCISE #3 - Forward T Hinge (advanced rehab)
- Setup: Begin in a standing upright position with your hands resting at your waist.
- Movement: Balancing on one leg, bend at your hips and slowly tilt your body forward while extending the other leg backward, then return to the starting position and repeat.
- Tip: Make sure to keep your back straight, and don't let your knee collapse inward during the exercise.
Incorporate Multi-Directional Slider Lunges
Some of my go-to exercises for ankle instability include: performing a slider lunge forward, backward, laterally, and diagonally to start loading the involved foot in different directions. I also like to work on agility using two or more cones and having patients do a lateral shuffle with cone tap or suicides. Lastly, I like to introduce exercises in single-leg stance (SLS) on the involved leg with ball toss and catch against the wall or on a rebounder with a weighted ball. To progress this, I have patients perform SLS on the involved side while I introduce an external perturbation by tapping them on their body in different directions with a physioball.
The real world is unpredictable, so it is important to introduce exercises on various surfaces with eyes open and eyes closed. I also prefer for these exercises, with the exception of the lateral shuffle, to be performed barefoot to work on proprioception, which tells you where your foot is located in space.
Introduce Single-Leg Standing Variations
As a physical rehabilitation specialist, I often prescribe the single-leg standing exercise to aid patients with ankle instability. This exercise targets balance, proprioception, and ankle stability. Initially, I recommend holding the position for 30 seconds to 1 minute, gradually increasing the duration as balance improves. Core engagement is crucial for stability.
I introduce variations to intensify the exercise. Closing one's eyes removes visual cues, enhancing reliance on proprioception. Standing on unstable surfaces, like a Bosu ball or foam pad, challenges stabilizing muscles further. Dynamic movements, such as reaching in different directions to mimic the star excursion balance exercise, improve effectiveness. Additionally, incorporating throwing and catching a ball while standing on one leg adds a dynamic element, requiring coordination and stability.
Regular practice strengthens ankle muscles, enhances proprioception, and improves overall stability. It's essential to begin with an appropriate difficulty level and progress gradually to avoid injury.
Utilize Balance Board for Proprioception
Integrating balance boards into a rehabilitation program can significantly aid in improving proprioception, which is a sense of joint position that is crucial for ankle stability. The patient stands on a board that wobbles unpredictably, forcing the ankle muscles to engage to maintain balance. Over time, this can enhance the neuromuscular control around the ankle joint, reducing the chances of re-injury.
Frequent sessions on a balance board can lead to better coordination and agility. Start incorporating balance board exercises into your regime to support your recovery journey.
Implement Resisted Dorsiflexion with Therabands
Resisted dorsiflexion exercises with therabands provide a targeted approach to strengthen the muscles around the ankle. This exercise involves pushing the foot upward against the resistance of an elastic band, working the muscles that stabilize the ankle during walking and running. By progressively increasing resistance, patients can build muscular strength in a controlled manner.
Such strengthening is especially beneficial for those recovering from ankle sprains or strains. Remember to include resisted dorsiflexion in your daily exercise routine to steadily enhance ankle stability.
Add Controlled Toe Raises to Routine
Controlled toe raises are an effective exercise to build muscular fortitude in the calves and improve ankle stability. By slowly raising onto the tips of the toes and lowering back down, these raises encourage the muscles to contract in a controlled fashion, aiding in strengthening not just the muscles but also the surrounding tendons.
This exercise can be performed with or without weights, according to one's rehabilitation stage, and is simple to execute from nearly anywhere. Be sure to add toe raises to your daily exercise practice to see a noticeable improvement in stability.
Engage in Dynamic Calf Stretches
Performing dynamic calf stretches can contribute greatly to ankle flexibility, which is an important aspect of maintaining joint health. These stretches involve moving the ankle through its full range of motion, thus reducing stiffness and increasing circulation to the area. Improved flexibility can lead to better performance in daily and athletic activities, as well as a decreased risk of ankle injuries.
Such stretches can be easily implemented into any warm-up or cool-down routine. Make sure to engage in dynamic calf stretching exercises to keep your ankles limber and strong.
Strengthen with Non-Weight-Bearing Swimming
Swimming is a recommended therapeutic exercise for those dealing with ankle instability because it provides an opportunity to strengthen the muscles without placing weight on the joint. The resistance of water offers a gentle yet effective muscle workout, and the buoyancy decreases the risk of further strain or injury.
Additionally, the diverse range of motions used while swimming helps to enhance overall joint mobility and health. Dive into regular swimming sessions to help fortify your ankles while giving them a break from the stresses of weight-bearing activities.