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Why you may sprain same ankle repeatedly

What’s worse, once you’ve had one, you are inclined to sprain the same ankle repeatedly unless you do exercises to strengthen it. The biggest risk of suffering an ankle sprain is having had one in that ankle already.

The reason for this is the weakening of what’s known as proprioception. It’s a phenomenon that affects all of our joints, directing the body’s intuitive ability to know where it is in time and space — such as being able to touch your finger to your nose with your eyes closed, or walk in a straight line without looking down.

Proprioceptors are sensory neurons found in muscles, tendons and joints that instantly shift the body in an unconscious, instant course correction that keeps it centered. It develops over time, which is why toddlers learning to walk still often look at their feet, and ebbs as you age, one reason the elderly are susceptible to falls.

“It’s your body’s internal GPS system,” says Nicholas DiNubile, a Havertown, Pa., orthopedic surgeon and doctor for the Pennsylvania Ballet. “Every joint has proprioceptors, which are networks of neurons. These are position sensors. If you start to tilt, they help you self-correct when you veer off.”

Proprioception has an especially important role in weight-bearing joints, such as the ankle. When you sprain an ankle, proprioceptors become damaged. This impairs the body’s ability to right itself, and makes it more likely you will sprain that same ankle again. What physicians often call a “floppy” or loose ankle — which results from the initial sprain — actually is a slowdown in the feedback loop between the nerves and the brain. The brain cannot react quickly enough to keep that ankle from turning again.

If it’s a moderate or severe sprain, “the ligament is loose for life,” unless you do exercises to retrain these key nerves, DiNubile says.

Before you start doing them, however, you need to first treat the sprain. “I have always believed that ankle sprains are the most undertreated injury seen in the emergency room,” says Sheldon Laps, a D.C. podiatrist. “X-rays are usually taken, and if they are negative, patients are usually sent home with crutches and advised to ice the area and stay off it until they are able to walk on the foot.”

He and other experts still recommend the old sports acronym RICE: rest, ice, compression and elevation. They advise that you put ice on it — the sooner the better — to reduce swelling (I once sprained an ankle while out running during the winter, and stuck my foot in a nearby snow bank for a few minutes before hobbling home. I’m convinced it shortened my recovery time.) Ice it for 15 to 30 minutes, then take a 15 to 30 minute break, and ice it again. Do this as often as you can the first day. Don’t use heat, which worsens the swelling.

Some experts in recent years have disparaged the RICE formula, ice in particular, saying research suggests it delays healing and may make things worse. But many still believe it can be a big help immediately after an injury occurs.

“Swelling after acute injury, such as an ankle sprain, is the body’s response to protect the injured area and limit more damage by preventing movement or motion,” Laps says. “Ice causes vasoconstriction, which narrows the blood vessels and reduces further swelling. I recommend ice for acute injuries [and] for swelling with chronic injuries. I don’t believe that ice hampers or reduces the inflammatory process or delays healing when used immediately post injury. My feeling is based on treating athletes for over 35 years.”

DiNubile agrees that ice is valuable in the hours immediately following an injury to reduce swelling and pain. But he suggests skipping ice after several days in favor of the remainder of the formula — elevation, compression, rest and/or gentle movement.

“We don’t necessarily believe anymore that extended use of ice is necessary, except after the initial injury, and could be counterproductive,” he says.

Wrap your foot with an elastic bandage and elevate it — keep it higher than your head, if possible, but definitely above your heart. This keeps blood from pooling in the ankle, which also will increase swelling. (If it is still swollen and painful after a couple of days, consider having an X-ray to rule out a fracture.)

Laps tells his patients to avoid exercise until they can walk briskly and pain-free on the ankle. He also suggests wrapping the ankle before exercising, and stretching before and after. After exercise, ice the ankle for five minutes if it still tends to swell after a workout. Runners especially should keep their mileage and intensity low when they start back, and run alternate days on a flat surface, such as an outdoor track, before resuming hard training or serious competition, he says.

“I see quite a few injuries in runners from repetitive stress of running or working out every day,” Laps says.

Once healed, it’s time to work on that proprioception. Some of the most effective exercises include sitting with your legs crossed with a resistance band around the injured foot. Bend your foot up and outward, that is, in the direction away from the big toe. Do three sets of 15 repetitions — as it gets easier, increase the strength or the band and the number of repetitions.

Also, try balancing on the leg with the injured ankle. Stand on the bad leg only, and try to balance on it for a minute. If that’s easy, do it with your eyes closed. If that’s also easy, stand on a pillow, which is a mushier surface that makes it more challenging. If that’s easy, too, try it with your eyes closed.

DiNubile also recommends the yoga “tree” pose. “With your eyes closed, stand up with your arms straight out to the side and put the heel of one foot to the inner side of the knee so it looks like a letter P,” he explains. “On the good leg, they might be able to do it, hold it and have no problem. On the bad side, they’ll be wobbling all over the place, ready to go over. If they can’t do it with their eyes open, I have them look in a mirror. Then, I have them do it without a mirror, then with their eyes closed.”

Finally, experts suggest performing agility drills. These involve such maneuvers as side-to-side shuffling, backward walking or running, figure-eight running, and cone drills that involve running in a “box” shape or around cones. Start with wide loops and progress to tighter loops as the ankle gets stronger.

If you are diligent about strengthening that ankle after the first sprain, you reduce your chances of having another, DiNubile says.

“An injury like an ankle sprain can really compromise your proprioception,” DiNubile says. “But the good thing is that it can come back.”

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