Trail runners, basketball players and high-heel aficionados have something in common: increased risk for ankle sprains and related injuries. That’s because uneven surfaces (characteristic of trail running and high heels) and lateral movement (basketball) are common ankle-injury culprits.
But they’re not the only ones, says Lee Firestone, a marathoner, District-based podiatrist and sports-medicine specialist at Foot and Ankle Specialists of the Mid-Atlantic. Foot type, inadequate shoes, excessive range of motion, obesity and lack of core strength also contribute to problematic ankles.
When our core muscles are weak — particularly the gluteal muscles — we internally rotate legs and feet, or pronate, Firestone says. This is even more likely for people with weak or low arches. Pronation puts us at risk for posterior tibial tendon dysfunction – the tearing or partial tearing of the tendon on the inside of the ankle. It’s not technically a sprain, but that’s what many laymen call it.
The true ankle sprain — which more typically correlates with a high-arched foot — is a little different: a tear or partial tear of the ligament on the outside of the ankle.
Both injuries can be extremely painful, and Firestone cautions against masking the pain with pain medication as that can slow the healing and allow you to do risky things because you aren’t tuned in to the body’s signals.
Furthermore, in both injuries, “you’re looking at six weeks of rehab – at least,” Firestone says.
Six weeks may be optimistic. The recovery time for tendon and ligament tears and inflammation is very hard to estimate. Just ask Steph Curry, the point guard and shooter extraordinaire for the NBA’s Golden State Warriors. Curry has been said to have the “best worst ankles in sports,” because of his amazing play despite many sprains – one of which sidelined him after Game 1 of the 2016 playoff series.
“Fractures are actually much more predictable,” Firestone says. “In fact, sometimes torn ligaments don’t heal.”
At that point interventions such as surgery or regenerative therapy can be necessary.
Ouch. How do we not have that happen?
“We need to work on strengthening our core – our gluteus,” Firestone says.
Unfortunately, modern life – as in sitting at a desk – actively weakens the gluteal muscles, he says. That’s why the “weekend warrior” – the person who has a sedentary job during the week and then goes out and plays hard on the weekends – often is at risk for ankle and other injuries.
But there are things you can do to better get your body in order for trailrunning, pick-up basketball or high heels. And you might not even have to put on workout clothes.
“People have such busy schedules so I like to suggest exercises they can do anywhere,” says Rachel Miller, a physical therapist and co-owner of ProAction Physical Therapy in Rockville.
Like standing on one leg – which helps improve balance and strengthen the gluteus and other leg muscles. Start by holding 30 seconds at a time. Repeat five times and then change legs.
Progress the exercise by adding a mini squat. Once that is mastered, do the same exercise with the eyes closed. Once that is easy, maybe add an unstable surface to the one-legged stand drill.
“I am a big believer in building hip and core strength when it comes to creating ankle stability,” Miller says. “If you don’t have core strength, the posterior tibialis has to work that much harder.”
And though we all appreciate the power of the posterior tibialis (a key stabilizing muscle of the lower leg) it’s nowhere near as important as the powerful gluteus – the big kahuna of human muscle groups. Miller, who is also a certified running coach, says gluteus and hamstring activation is key for proper running form.
“Oftentimes the calves are overworking and in those cases I tell runners to kick their heels up more to activate the gluteus and hamstrings,” she says.
She and Firestone both recommend a lot of core exercises that seem to have nothing to do with ankle health — but they really, really do. These include one-legged bridges, squats, single-leg exercises, clam shells and bird dogs.
Unfortunately, most people don’t find exercising their core to be much fun.
“I find it tedious and boring which makes it really challenging to do mobility and corrective exercises,” says Ben Wiedemer, director of personal training at D.C.-based Balance Gym.
“When I work out I want to lift heavy weights and run hard,” Wiedemer says.
His solution for a while was to hire a trainer — though he is one himself — to make sure he got to these important but “tedious” exercises on a regular basis.
“My recommendation is to try to incorporate it into your regular routine – the single leg stuff,” he says.
“Single-leg stuff” including single leg squats, single-leg deadlifts, single-leg reverse lunges. Like Miller, Wiedemer recommends progressing the exercises over time, in his case by adding a coordination drill (like throwing and catching a ball while in a lunge), an unstable surface or an external load.
“You’re working on certain movements in a controlled environment,” he says, “so that the body can make the necessary adjustments subconsciously, whether it’s on a trail run or a basketball court.”
Or on the dance floor in five-inch heels.