Unlocking your stability: Your ankle holds the key
Cheers to the New England Patriots for another Superbowl Championship! It’s always an amazing night of athleticism and competition. Looking back over the football season, we’ve seen a lot of players, like the Gronk, out of the game with an ankle injury. Ankle and foot injuries commonly put athletes - and the rest of us - on the reserve list. Poor rehabilitation can add insult to injury and create lasting effects on returning to play.
Grounded… and Not Sidelined
Ankle injuries, in the sporting arena, are the second most common injury. And they aren’t just for athletes. Ankle strains are common in everyday life, caused by running or walking on uneven ground and even poor shoe support.
Whether you are a professional athlete or a professional beach walker, ankle injury risk factors include; sex, height, weight, limb dominance, postural sway and foot anatomy. When it comes to sports this risk is also impacted by things like taping, bracing, shoe type, competition duration and intensity of activity. Many times ankle sprains and strains occur from a quick and forceful stretch to the ligaments and tendons around the ankle bones. In the athletic population, we commonly see the ankle roll out (lateral ankle sprain) occur more than the ankle turning in (medial ankle sprain). Injury can be minor like an over stretch or major like a full tearing of the tendons and/or ligaments (ouch!).
About 20% of acute ankle sprains will develop into chronic ankle instability. With chronic ankle instability, the ligamentous elasticity remains lax and most of the time does not return to its previous state. That means following an acute ankle sprain, deficits in postural control, muscle reaction time, limb strength and proprioception must be addressed to minimize the chronicity of ankle instability.
Unlocking the Player
Our feet and ankles function dynamically to accommodate our body weight, maintain balance, transfer forces from the ground to the body and compensate for malalignment in other parts of our body. Chronic ankle dysfunction can occur when the dynamic lock and unlock function within the midtarsal joint goes awry.
“Your ankle needs to dynamically ‘lock’ and ‘unlock’ to keep you stable and balanced.”
During daily weight bearing activities, the midtarsal joint helps your foot adapt to uneven terrain and efficiently push your body forward. As your heel hits the ground during walking and running, the midtarsal joint “unlocks” and allows for increased foot flexibility to help your body accommodate for changing ground conditions and maintain balance. As your body shifts weight over the supporting limb, the midtarsal joint then “locks” to provide rigidity and assure stability for your leg. If this lock and unlock function of the ankle is challenged by structural abnormalities or ankle dysfunction, your ankle and/or foot would either become unstable or the ability for your foot to accommodate the terrain and your shifting weight would be compromised. Either case, of course, is not ideal and can lead to injury or re-injury.
Understanding that your foot and ankle complex are meant to have a stable, but supple function to accommodate your ever-changing functional movements and gait mechanics is key. But did you know, in terms of movement, your foot is an extension of your pelvis? Your pelvis “communicates” with your brain to control proprioception of the rest of your body. Regardless of the type of ankle dysfunction – sprains, strains or chronic ankle instability - the ankle position and decreased sensorimotor control are what make ankle dysfunction so challenging to treat.
Make Lateral and Forward ‘Passes’
Current literature shows balance training and trunk stability are an important part of recovery for ankle injuries. Balance training, like the Interactive WAV Squat, accounts for postural control, dynamic trunk stability, proprioception and segmental spinal reflexes which are necessary to improve chronic ankle dysfunction.
“Balance training and trunk stability are an important part of recovery for ankle injuries.”
The Interactive WAV Squat takes into consideration the decreased postural control, proprioception and increased instability that occurs with chronic ankle instability. The initial descent of this movement into hip flexion and ankle dorsiflexion accounts for the co-contraction required for both dorsiflexion (foot flexed) and plantar flexion (toes pointed) used to maintain stability and keep you from falling forward or backward while walking and running. Rotation is added through the pelvis to shift your weight from one limb to another which requires the midtarsal joint to lock and unlock when moving side to side, ultimately training the 4 dimensions of ankle stabilization.
The ever-demanding function of your ankle-foot complex is governed by the quality of your motor control and your ability to transfer forces effectively throughout your musculoskeletal system. If you suffer from ankle instability or are being treated for an ankle injury be sure to review this move with your physical therapist before starting. She/he may assess your balance with the Star Excursion Balance Test (SEBT) to predict your capacity for chronic ankle instability issues. If you don’t have ankle dysfunction and want to do preventative training to help keep it that way, the Interactive WAV Squat is the perfect exercise.
Interactive WAV Squat
Stimulate the motor control necessary to create ankle stability and minimize sprains and strains.
Stand with your feet roughly hip width apart.
Hold the WAV with an over hand grip at the outer bands, arms at your side. Allow the weight of the WAV to ground you.
Hinge evenly at the hips, knees and ankles to move into a squat position lowering the WAV towards the ground.
Return to standing.
Lower again to a squat. Rotate your pelvis and pivot on your back toe to spiral side to side within the squat position.
Continue to spiral to the other side.
What am I doing?
The interactive squat demonstrates the relationship of the pelvis to the foot as you shift your body weight from one supporting limb to the other. This interaction of the pelvis and foot stimulates the motor control necessary to create ankle stability and minimize sprains and strains.
What am I mindful of?
Does the arch of your foot slightly lift and dome as you shift your weight away, then slightly flatten and expand into the floor as you shift the weight to the foot?
Can you feel the synergy between your trunk, hips, knees and feet as you maintain dynamic alignment?
Are you moving from your pelvis with your knees and ankles aligned?
Is the WAV flowing and can you feel its interplay with your movement?
References for ankle injury, sports rehabilitation and gait mechanics concepts discussed in this article can be found here:
- Holmes A, Delahunt E. Treatment of common deficits associated with chronic ankle instability. Sports Med 2009;39(3):207-224.
- Physiopedia YouTube. Cailbhe Doherty on the research evidence for the assessment and treatment of ankle sprains. Physiopedia, 2017.
- Munn J, Sullivan SJ, Schneiders AG. Evidence of sensorimotor deficits in functional ankle instability: a systematic review with meta-analysis. J Sci Med Sport 2010 Jan;13(1):2-12.
- Roos KG, Kerr ZY, Mauntel TC, Djoko A, Dompier TP, Wickstrom EA. The epidemiology of lateral ligament complex ankle sprains in National Collegiate Athletic Association sports. American journal of sports medicine. 2016.The American Journal of Sports Medicine Vol 45, Issue 1, pp. 201 - 209
- Soboroff, S. H., Pappius, E. M., & KOMAROFF, A. L. (1984). Benefits, risks, and costs of alternative approaches to the evaluation and treatment of severe ankle sprain. Clinical orthopaedics and related research, 183, 160-168.
- Cote KP, Brunet II ME, Gansneder BM, Shultz SJ. Effects of pronated and supinated foot postures on static and dynamic postural stability. Journal of athletic training. 2005 Jan 1;40(1):41.
- Orthoinfo-Sprained Ankle
Want to know more about using the WAV for injury recovery and prevention? Contact us for more information about our sensory-based training approach.