Author: Dr. Leor Giladi, CSCS, CF-L2
I used to train in martial arts pretty extensively, I even competed for both glory and tiny trophies. I studied a lot of different styles but I went the furthest in Judo. There’s something deeply satisfying about getting into your opponent’s head, navigating every move and counter move. It was like chess, but with actual fighting and no getting punched in the face. This article isn’t about my love for throwing people though, it’s about how I used to sprain my ankle every few months. One wrong step, one moment of lost focus and I was off of the mat and out of the gym for 2-4 weeks. This obnoxious cycle kept me from getting as strong and as skilled as I wanted. It left me feeling fragile. What was the point of training so hard, of honing my body, if I could be taken out so easily, and so often, by the simplest thing. I no longer have these issues, but if this sounds anything like you I’d keep reading.
There are many kinds of ankle sprains, but we’re going to focus primarily on inversion sprains as they’re more common. An inversion sprain is where your heel rolls inward and the outside of your foot falls into the ground. This happens for a whole slew of different reasons, but the two most common are when your center of mass (COM) shifts outside of your base of support (BOS) or when the peroneal muscles, the muscles on the outside edge of your lower leg, don’t turn on quickly enough as the ankle rolls. Your peroneal muscles primarily evert the foot and ankle complex, essentially opposing the mechanism of an inversion sprain. You want them on your team. For the sake of this article we’re going to focus primarily on the latter cause.
The term “sprain” means you’ve caused damage to a ligament, one of the connective tissue structures that connect one bone to another bone. You have hundreds of ligaments in your body, but when it comes to an inversion ankle sprain the most likely to be injured are the anterior talofibular ligament (ATFL) and calcaneofibular ligament (CFL). Ligaments, unlike muscles, are non-contractile and don’t have their own blood flow. This means they both heal slower and can’t change their length once healed.
Fun fact: the number one predictor of a future ankle sprain is a previous ankle sprain
That’s an interesting statistic, don’t you think? Let’s investigate why. People are taught that our ligaments hold our bodies together. This is not completely true. Ligaments are not that strong, only muscles have the power to truly hold us together and move us through the world. Your ligaments are full of mechanoreceptors, little organs that help you to sense where your body is in space. As you move your bones shift and tug on your ligaments, sending hundreds of signals into the brain which, once interpreted, let you know where every bone is in relation to each other. This phenomenon is called proprioception and without it you’d basically walk around like you were drunk all of the time.
When you sprain a ligament you legitimately cause damage to it in the form of forced stretching and partial tearing. As the ligament heals, it does so at this new length. If you remember from about 12 seconds ago, ligaments can’t change their length, so your ligaments post-sprain are a bit longer than they were before. If ligaments are how your brain knows the position of all of your bones, and your ankle ligaments are now longer, this means that the signals they send to your brain will be a bit delayed compared to before your injury. It might only be microseconds, but with high intensity activity microseconds matter.
Wanna know something cool? Your muscles have mechanoreceptors too. Retraining the muscles of your lower leg and foot to pick up this slack (see what I did there?) is a critical part of rehab and returning to sport following an ankle sprain. It can’t ONLY be strength. Now you know why you keep spraining your ankle, but what should you do about it? Stay tuned to catch my next article where I’ll go over a few starter exercises that we believe are mandatory as part of any complete ankle rehab program.