Why Your Ankle Exercise Rehab Program is Not Helping Your Clients

Ankle Sprain
Ankle Sprain

Before I get to this great paper.

Just a reminder that the Exercise Rehabilitation of the Lower Body Courses are this weekend:

Saturday, May 30, 2009 – 8:45 am to 1:00 pm – Register Now
Exercise Rehabilitation of the Knee
Douglas College (Royal Ave & 8th St ) – New Westminster, BC

Saturday, May 30, 2009 – 1:15 pm to 5:30 pm – Register Now
Exercise Rehabilitation of the Hip
Douglas College (Royal Ave & 8th St ) – New Westminster, BC

Sunday, May 31, 2009 – 8:45 am to 1:00 pm – Register Now
Exercise Rehabilitation of the Ankle
Douglas College (Royal Ave & 8th St ) – New Westminster, BC

Sunday, May 31, 2009 – 1:15 pm to 5:30 pm – Register Now
Balance Training for the Rehab Client

Douglas College (Royal Ave & 8th St ) – New Westminster, BC

Early registration ends today! (Tuesday, May 26, 2009)

I was reading an article from the American Journal of Sports Medicine, called Peroneal Activation Deficits in Persons with Functional Ankle Instability.

The article reported that 40% of FAI (Functional ankle instability) occur after an initial ankle sprain. FAI is a fancy wording for frequent ankle sprains. The recurrence rate (likely hood of another ankle sprain after the first) is as high as 80%.

The authors commented that the reasons for constant ankle sprains have been thought to be:

1) proprioceptive deficits
2) residual joint laxity
3) impaired balance
4) muscular insufficiency

The authors in this paper focused their research on muscular insufficiency.

The muscle they focused on was the peroneal muscle which plays a key role in rearfoot supination or protects the ankle from sudden inversion. Damaged mechanoreceptors after ankle sprain may lead to reflex inhibition of the peroneal muscles. The authors feel traditional ankle sprain rehabilitation exercises are not helping address the inhibition of the peroneal muscles.

Take home message:

1) 40% of ankle sprains lead to frequent future ankle sprains
2) People with frequent ankle sprains have an inhibited (10% decrease) peroneal muscle which decrease the stability of the ankle
3) Traditional range of motion and strengthening exercise do not address peroneal inhibition
4) Exercise principles of cardiovascular, strengthening and stretching won’t help a sloppy ankle

I know you are thinking, what do I do about it?

What exercises do I give?

I am just finishing of another article that goes through a great ankle exercise program that address the above problem. I will be going through it with the registrants at this weekend Exercise Rehabilitation of the Ankle & Foot course.  See you there!

– Rick Kaselj

For more details:  Palmieri-Smith, R., Hopkins, J., & Brown, T. (2009). Peroneal activation deficits in persons with functional ankle instability. Am J Sports Med May 2009 vol. 37 no. 5 982-988.