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Weak Ankles and Chronic Ankle Instability

Supervised Physical Therapy Essential


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. (CAI)

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.

Long-term effects of chronic ankle instability 

Studies show that up to 70% of those who suffer ankle sprains will suffer from repetitive sprains, and go on to CAI) (up to 74%, according to one study[2]).

Research also shows that long-term patients who develop CAI often going on to develop post-traumatic ankle osteoarthritis,[3] which a 2015 study[4] by researchers at the University of North Carolina - Charlotte suggests may be a direct consequence of the approximately 50% of patients who suffer an ankle sprain but do not seek any medical treatment or evaulation. 

That study, which found a single severe ankle sprain significantly decreased physical activity levels across the lifespan in mice, and which followed closely on the heels of a study by the same researchers[5] finding that college students with CAI took on average more than 2,000 fewer steps per day than healthy controls. led the authors to warn that, "[a]though [an] initial ankle sprain may be thought of as a relatively minor or insignificant injury, if not treated appropriately, or with lack of guidance with rehabilitation and exercise prescription, physical activity levels across a lifespan may decrease," which is a "significant public health concern given the cost associated with treating chronic disease development as well as the further loss of function the patient may experience."  

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.

2. McKay GD. Ankle injuries in basketball: injury rate and risk factors. Br. J. Sports Med. 2001;35:103-108.

3. Hinterman B, Boss A, Schafer D. Arthroscopic findings in patients with chronic ankle instability.  Am J Sports Med 2002;30(3):402-409. 

4. Hubbard-Turner T, Wikstrom EA, Gudarian S, Turner MJ. An Acute Lateral Ankle Sprain Significantly Decreases Physical Activity across the Lifespan.  J Sports Sci Med. 2015;14:556-561 (published online ahead of print August 11, 2015) 

5. Hubbard-Turner T, Turner MJ. Physical Activity Levels in College Students With Chronic Ankle Instability. J Athl Tr. 2015;50(7):742-747.   

Revised and updated September 17, 2015