Functionally Stable Ankles

I have sprained my ankles about 10 times as an adult.  For a while I joked that they were so loose I could not sprain them anymore.  Add several years of an altered stride with my left foot due to a problem with my left big toe, and I have problems.

Medical and fitness experts are finally recognizing that repeated strains/sprains of ankles can impact the neurological and muscular fitness of the joint, affecting movement -especially balance- for the rest of a indivual’s life.  There is even a name for this: Functionally Unstable Ankles.

Can you stand and balance on one foot?  Can you close your eyes and balance?  Many individuals, when they try this, will have a relatively firm stance at the foot.  Their hips, their waist, their shoulders, their head will show some wobble and oscillation as they try to maintain their weight on one leg.  With practice at firming their core and becoming aware of aligning their body correctly, balance improves.

For me, I begin my remaining fairly firm from the waist up.  The core is strong, the shoulders level, the head level.  Look at my ankle, however, and the foot is rolling side-to-side and toe-to-heel like a rowboat in a hurricane.  The knees and hips follow the ankle in this oscillating action.

Does this sound familiar?

What can be done for those of us with FUA?

Jimmy Smith wrote a great article , The Ankle Paradox, at T-Nation.  Smith discusses that one ankle sprain can cause several problems:

The restriction we put on the ankle while it heals can cause weakness in the foot and front of the calf as these areas must take over for the damaged ankle.

Proprioception is damaged.  We have the most mechoreciptors in our feet and ankles.  When the ankle is damaged, these receptors can damaged also leading to a foot aware of its place. This “unawareness” is complicated by our wearing shoes -especially shoes with thick cushioned soles- all the time.

The likelihood of repeated sprains increases.  (a-hem… ):

Continual ankle sprain is the single most overlooked issue I see. For one, it’s viewed as something that came and went like it never happened. I often hear comments like, “I sprained my ankle a few months ago, but it’s fine now.”  Well, if you keep hitting your head into a wall, I bet it’s going to do something to your noggin.

Every time you sprain your ankle, numerous dysfunctional patterns may occur. After a single ankle sprain, 70 to 80% of patients will suffer at least one subsequent sprain.(8) This is termed chronic ankle instability, which is characterized by frequent ankle sprains, and the feeling of “giving way.”  The majority of ankle sprains will present in this way. Contributing to ankle instability will be peroneal weakness, proprioceptive deficits, and anatomical laxity.(9)

Here’s where Smith’s work gets interesting.  He believes that these repeats sprains end up with us damaging the “firing” mechanism for our glutes max.  As the glutes fail to work -or work hard, we end up not only with weak ankles, but weak and painful lower backs.  What starts at the foot, moves all the way up our bodies.

Is there hope for those of us with chronically unstable ankles?  Fortunately, yes there is.  I have been working on a program similar to the one Smith recommends and it seems to help.

My program:

1. I roll the entire bottom of foot every day whenever I remember using a golf ball.  As Smith explains:

Rolling a tennis ball or golf ball along the base of your foot on a daily basis will break up the fascia and enable improved function of everything from the ankle to the low back to the neck. Have a go at this test: Perform an old-school hamstring stretch by bending over and trying to touch your toes. Pay attention to how tight your hamstrings feel. Now, roll a tennis ball under each foot for 60 seconds. Bend over and try to stretch again; you should notice a greater stretch2. This simple test validates the theory of fascial trains.

2. I foam roll the heck out of my back, butt, hips, and legs.  Again, I should do it every day, but I do it when I remember.

3.  Go barefoot whenever I can.  I rarely remember to take my shoes off while doing exercises in the gym -and they frown on barefootedness in the weight area.

4. Do some exercises to work my glutes and the front of calf.  Specifically I do clam-shells, bird dogs, and cobras for the glutes and back.  For the front of the calf, stretchy band exercises (pulling the foot toward the shin, pointing away, rolling foot in and out) help a lot.

5. Force production.  This one might get you looks in the gym, but damn it works.  It’s a perfect exercise to pair with your step ups.  Step up onto a platform or bench.  Then step off, landing on your one foot.  Stick the landing and try to hold it for 3-10 seconds.  Do about 10 reps/foot.  About the 7th time I do this, I feel my foot burning but I also swear I feel the reciptors re-awaking.

6. Walk on sand.  With summer quickly approaching this is great option to resensitive the reciptors in the feet.

7. Vary/wear specific shoes.  I have a pair of MBTs that give me a slightly unstable walking condition.  Wearing these for a full day always has me waking up with pain in my weakest leg.  The muscles up through my lower back complain.  So I limit my time in these to about 4 hours.  The next day I switch to a pair of Nike Frees.  These shoes have a very thin sole that lets me sense the world under my feet.  Combining the two seems to be helping with some restoration of my proprioception.

8. Unilateral workouts.  I make sure to concentrate on unilateral exercises (using one side at a time) at least every 3 months.  This lets me test and work on specific muscle weaknesses that occur.

9. Limited controlled unstability work.  I do not want to “train” myself to wobble and be unbalanced.  So while I’m working on repairing years of damage, I limit my actual ankle balance work to perhaps once a week doing one-legged foot pushes. I still do lunges and step ups twice a week -making sure that all the steps above have been done before.  These keep the hips, obliques, abdominals all still aware of working together for stability and balance.

10. Walk on my toes.

If you have ever had an ankle sprain and current notice a lack of balance, plantar fascaitis, and/or lower back pain try these steps to improve things.  And let me know how it goes.



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