If your child's ankle gives way more and more easily during sports, and, eventually, during everyday activities, and suffers repeated ankle sprains, he has developed chronic ankle instability. Often times, such instability is the result of an ankle sprain that has not been allowed to fully heal.
Repeated ankle sprains cause a loss of proprioception (communication between the central nervous system and the muscles, tendons, and ligaments of the ankle), which, in turn can lead to faulty technique or a sudden loss of control or balance, either of which can, in turn, lead to even more sprains!
If your child has a chronically unstable ankle, sports medicine experts say that a rehabilitation program supervised by a certified athletic trainer (ATC), or physical therapist is absolutely essential.
The program should include:
- Strength exercises for the muscles in the front, outer side of the shin (remember, virtually all ankle sprains are what are called "inversion" sprains, which is a sprain caused by the ankle turning out sharply; so to avoid future sprains, these are the muscles to build up)
- Stretching exercises for the Achilles tendons;
- Physical therapy on a so-called "wobble board" (a four foot disk on a rubber sphere about the size of a tennis ball), which can help restore proprioception. Note, however, that wobble boards are expensive (about $400), so you should ask your child's doctor, ATC or physical therapist if they can access one. As with athletes without chronic ankle instability, those with the problem should wear a brace when returning to sports to minimize the chances of another ankle sprain.
In conjunction with a good physical therapy program, some kids may also benefit from shoe inserts (e.g. orthotics).
In its recent position statement on the prevention and treatment of ankle injuries (1), the National Athletic Trainers' Association says a number of intervention strategies consisting of single-legged-stance activities that demanded balance in challenging environments (unstable surfaces, movement, additional upper extremity tasks) have shown promise for reducing symptoms and risk.
Parents need to understand that getting kids to do the home exercises prescribed by the physical therapist or ATC will be hard, and they will need to be pushed to do them. Also, because this condition is chronic (e.g. it doesn't really ever go away completely), be prepared for flare ups requiring treatment ranging from RICE (rest, ice, compression, and elevation) to more physical therapy.
1. Kaminski TW, Hertel J, Amendola N, Docherty CL, Dolan MG, Hopkins TJ, Nussbaum E, Poppy W, Richie D. National Athletic Trainers' Association Position Statement: Conservative Management and Prevention of Ankle Sprains in Athletes. J Athl Tr 2013;48(4):528-545.
Revised and updated July 1, 2013