Ankles and Athletes: Why so many injuries?

preventing ankle sprains

If you’re not on the court, you’re not helping your team. It’s that simple. Yao Ming, Greg Oden, Vince Carter, Grant Hill, and hundreds of others have fallen short of their true potential because of recurring injuries. That’s why NBA strength and conditioning coaches spend an inordinate amount of time, around 80%, working on injury prevention, corrective exercises, and movement training strategies, as opposed to strength/power training. Big biceps, a high vertical jump, and sprinter-like speed mean nothing if the player can’t play.

Gray Cook, world renowned physical therapist and strength coach, creator of the Functional Movement Screen, and consultant to collegiate and professional teams across the country, is famous for saying “never add strength onto dysfunction.” Unfortunately, that’s what is happening in high schools across the country. Coaches are pushing athletes to “add more weight” while never even giving mobility, stability, or movement patterns a second glance.

That current mantra is never more evident than in the increased incidence of ankle sprains in basketball players, particularly high ankle sprains which are much worse from a rehab perspective. Not only during games, but now even in training kids are wearing heavy, high-top shoes and ankle braces completely restricting mobility in the ankle. They’ve completely blocked the vast amounts of sensory and proprioceptive information their feet and ankles relay to their central nervous system. If you’re not aware of your feet, you are much more likely to injure them.

Strength coach Mike Boyle, owner of the #1 rated athletic performance center in the US, and Gray Cook 5 or so years ago started looking at training athletes from a different perspective. Instead of just focusing on movement patterns in their training, they also started to look at the human body as a stack of joints. Some joints required mobility, while others required stability. An efficient athlete would have the necessary mobility and stability in their respective joints. They classified the ankle as a joint that needed mobility, while the knee was a joint that needed stability.

 

If for instance the athlete’s ankle didn’t have mobility (ankle braces, high-top shoes, lack of rehab after an ankle sprain, etc), the body would find that mobility from another joint during motion. More than likely, that joint would be the knee, which should be more stable than mobile. Now not only do we have an immobile ankle, but also a mobile knee. That opens the door for an entire new set of injuries (chronic knee pain, the dreaded ACL tear, etc). It just doesn’t stop at the knee. Clinical studies have also shown pain in the lumbar spine (lower back) and neck have even been caused by poor ankle mobility. Essentially, the dysfunction goes right up the chain, from the feet to the head.

How do we fix it? It’s actually pretty easy. 2 drills. 2 minutes each. We do them in our dynamic warmup.

1) Wall Ankle MOBs – sagittal plane mobility

Have an athlete face a wall. Extend both arms shoulder height, hands pressing against the wall. Bend the knee of one leg while extending the other leg. The bent knee that’s closest to the wall is the working ankle. Trying pushing that knee directly over the toes, as far as you can go without lifting the heel off the ground. Do one, hold for 1-2 seconds, and repeat. Tell the athlete to really focus on pushing through the ankle. It’s imperative that the heel of the working leg doesn’t come off the ground. Perform 10 directly over the foot, 10 towards the big toe, and ten towards the small toe. If the athlete is used to static stretching, they will not “feel” this as much as a stretch. We’re working on mobility, not flexibility. Make sure that both legs have the same range of motion. Asymmetries are one of the leading causes of injuries. You can tell this from measuring the distance from the wall to the foot. If the knee touches the wall from 5″ away on both legs, symmetry is perfect. If not, do an extra set on the leg that lacks the mobility.

2) Wall lateral leg swings – Frontal plane mobility

Most people use this drill as adductor/abductor mobility drill. Although it’s a good drill for those muscles, it’s a much better drill for frontal plane ankle mobility. Set up exactly as you did in the above ankle mobility drill. Now flex the hip and knee to 90. The foot of the non-working leg should be off the ground, around knee height. Now swing the the leg that’s in the air back and forth, from right to left. Once again, really focus on driving the movement through the ankle that is on the floor. We’re working on ankle mobility, not hip mobility. Perform 10 reps on each side.

That’s it. All it takes is a few minutes before training sessions, practices, and games. Make sure to keep track of how far your foot is away from the wall when your knee touches the wall. The goal is to continually add more mobility so your foot should gradually move farther and farther from the wall.

4th Quarter Insider Training Tip:

In addition to these two drills, we also try to regain the sensory and proprioceptive ability of the foot that has been lost by the modern shoe. We try to do as much of our warm-up and strength training barefoot. If you haven’t read Born to Run, you should.

More ankle mobility resources:

1) Baltimore-area strength coach Nick Tumminello shows an ankle mobility drills he incorporates into his yoga-plex. Awesome exercise to wake up with every morning. Check it out here

2) Performance specialist Carson Boddiker gives an overview of ankle biomechanics and anatomy as well as a few drills. This is a paid-member site. Check it out here.

3) Strength coach Jim, Diesel, Smith gives us a few more mobility exercises to try for the ankle. At one time we were alternating these exercises with the ones above, but because of time constraints, we’ve had to just focus on the ones we described above. If we had an athlete that had extremely poor ankle health, we’d add a little more ankle-specific drills like these. Check it out here.

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