Ankle sprain is one of the most common orthopaedic injuries. It accounts for greater than 25% of all sports-related traumas.

Recurrent Ankle Sprains

Most patients have full symptom resolution; however between 10% and 40% continue to show symptoms of chronic instability.  This causes ongoing functional limitations and increases the risk having chronic recurrent ankle sprains (CRS).

What they Say

•  Recurrent rolling of ankles
•  Difficulty with uneven surfaces
•  Sensation of giving way of the ankle
•  “Weak ankles”

What We See

•  Decreased proprioception during single leg stance.
•  Often find ligamentous laxity or poor end feel of the lateral ankle ligaments.
•  Weakness of ipsilateral hip abduction and ankle eversion.
•  Tenderness on palpation of lateral ankle ligaments.

What We Do

  • Biomechanical Evaluation: For most ankle sprains, clinical measures of impairment resolve within 4 to 6 weeks. Underlying biomechanical deficits may persist, however, and these require manual therapy, bracing or training to correct.
  • Unstable Surface Training: Many studies show positive results with 6-12 weeks training on unstable surfaces for postural stability and onset latency.  Program progression is required to positively influence proprioception.  Progressions are made through further destabilization, changing position, distraction and becoming more activity specific.
  • External Perturbation Training (elasticresistance): A recent study looked at the use of band resistance around the opposite ankle to train the injured stance leg. This method imparts external forces via the elastic band on the body forcing the closed chain stance leg to react.  With 4 weeks of balance training every second day, all subjects in the study showed significant changes in balance when measured on a force plate.  Progression was made by stretching the band tighter thus providing a higher level of perturbation.  A benefit of this program over many others is that the band is portable and inexpensive.


Prevention of chronic instability is of utmost importance because of the relationship between instability and long-term sequelae such as post-traumatic Osteoarthritis, increased fall risk and further ankle sprains.  Those with poor balance suffer between six and seven times the number of ankle sprains.  Rehabilitation programs focus on improvement of postural stability, proprioception and improving muscle onset latency. These interventions have shown a decrease in recurrence rates of 50%-70%.

Han, K. Ricard, M. Fellingham, G.  Effects of a 4-week exercise program on balance using elastic tubing as a perturbation force for individuals with a history of ankle sprains.  J Orthop Sports Phys Ther.  2009 Apr; 39(4):246-55
Taghavi, C. SooHoo, N.  Foot and Ankle: Lateral ankle instability.  Curr Othop Pract. 2009; 20(2):117-22

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