Prevent Ankle Sprains With Balance and Proprioception Exercises

Photo of a woman performing yoga balance exercises.
Balance and proprioception exercises may help prevent ankle sprains. Dave and Les Jacobs/ Getty Images

Research suggests that performing proprioception and balance training can possibly prevent ankle sprains. Your physical therapist is one of the best resources available to help you with proprioception training in hopes of preventing ankle sprains and injuries.

An ankle sprain can be a painful injury, and it is one of the most common orthopedic causes of an emergency room visit. Ankle sprains occur when your ankle rolls over abnormally when running, jumping, and landing from a jump.

As your ankle rolls over, the ligaments—those cartilaginous structures that attach one bone to another—that support your ankle are stressed, and possibly overstressed. Too much stress to those ankle ligaments, and they may stretch and tear, leading to an ankle sprain.

Although an ankle sprain is considered a minor injury, if you feel you have sprained your ankle, you should visit your doctor to get it checked out. Your doctor may perform an x-ray to rule out a serious ankle fracture, and he or she may refer you to a PT for treatment for your ankle sprain.

If you have sprained your ankle, you may benefit from working with a physical therapist to help you regain normal functional mobility. The goals of therapy may include:

  • Restore normal ankle range of motion (ROM)
  • Improve muscular strength and stability around your ankle
  • Decrease ankle pain
  • Decrease swelling around you ankle joint
  • Restore normal balance and proprioception to your entire lower extremity

    Your PT should provide you with a strategy to prevent future ankle sprains. One component of your ankle sprain prevention program should be working on balance and proprioception.

    What Is Proprioception Training?

    Proprioception is your body's ability to realize where it is in space. Example time: look straight ahead and hold your arm out to the side, parallel to the ground.

    Then bend your elbow 90 degrees and take a look at the position of your arm. It is likely pretty much out to the side and bent at a right angle. But how did your brain know where and how to position your arm without looking at it? That's proprioception.

    There are specialized of nerve endings—millions of them—all over your body communicating with your brain about where your body is and how it is moving and changing. When you are walking, these nerves in your feet, ankles, and legs give your brain information about what type of surface you are walking upon, if the surface is level, and how much stress and strain is on the various muscles that are moving your legs. Proprioception is an important component to human movement, as it helps us to move fluidly and easily without have to consciously think about the forces (like gravity) that are acting upon your body.

    Sometimes after an injury, your proprioception system stops working properly, and you may need to do some specific PT balance and proprioception exercises to re-teach your body what it needs to do. And guess what? Research shows that working on proprioception training can help prevent ankle sprains and other lower extremity injuries.

    What Does the Research Show?

    A recent meta-analysis (a study that examines the results of many different studies) in the Journal of Science in Medicine and Sport looked at the effectiveness of proprioception training in people who have suffered an ankle sprain. In all, 7 studies that include over 3000 participants found statistically significant results favoring the use of proprioception training to prevent future ankle sprains.

    This particular study also examined the effectiveness of proprioception training in preventing ankle sprains in general, before an injury occurs. The researchers found that in 2 studies, the results favored adding proprioception training to your exercise routine to prevent primary ankle sprains.

    Another study of 34 athletes with chronic ankle instability examined the effect of balance and proprioception training on overall ankle function. One caveat to this study: the participants performed balance and proprioception training with their non-injured ankle whenever possible. The results indicate that performing balance and proprioception training on one leg (the "good" one) yielded positive results for the injured or sprained ankle.

    What does this mean for you? Even if you have a sprained and unstable ankle, you can still utilize proprioception training to improve overall balance and, hopefully, decrease your risk of future injuries.

    Bottom line: the evidence points to performing balance and proprioception training as a way to rehab and prevent primary ankle sprains. Unfortunately many gym and fitness programs tend to ignore the balance training component. Many times your fitness program will center around aerobic and cardiovascular conditioning, strength training, and flexibility. Proprioception is often ignored. But there are easy ways to incorporate balance and proprioception training into your fitness routine to minimize risk of ankle sprains and injuries.

    Starting a Balance and Proprioception Training Program

    Certainly if you have a sprained ankle, visit your doctor and check in with your physical therapist to get the best treatment and care for your injury. If you have never sprained your ankle, it may still be a good idea to visit your local PT to learn specific ankle balance and proprioception exercises. These exercises may include:

    • Single leg standing with your eyes open and closed
    • Single leg standing with upper extremity motions
    • Single leg standing on various unsteady surfaces
    • Using a BAPS board
    • The T-Stance exercise
    • Tandem walking

    Your physical therapist can tailor the right ankle proprioception exercises to your specific needs. Your ankle exercise program may also include other components like ankle stretches or strengthening exercises for the muscles around you ankle and lower leg.

    An ankle injury can be painful, and it may limit your ability to enjoy your normal recreational and work activities. There is some evidence that proprioception exercises may help decrease your likelihood of sustaining an ankle injury, and they can help you fully recover if you have sprained your ankle. Check in with you physical therapist to learn which exercises are best for you to minimize your risk of an ankle sprain or injury.

    Sources: Hale, DS, etal. Bilateral improvements in lower extremity function after unilateral balance training in individuals with chronic ankle instability. Journal of Athletic Training. 49(2): 2014; 181-191.

    Schiftan, GS, etal. The effectiveness of proprioceptive training in preventing ankle sprains in sporting populations: A systematic review and meta-analysis. Journal of Science in Medicine and Sport. 18(3):  May, 2015.

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