Preventing Ankle Injuries With Balance Training
Ankle Injury Impact on Professionals & Sport Players
The second most common type of injury, besides knee injuries, in several sports including rugby, soccer, volleyball, handball, and basketball is ankle injuries. Ankle injuries are also extremely common in several industries including emergency services sector (ESS) and military services during academy and bootcamp training.
Players and professionals are subjected to various types of injuries including sprains, strains, contusions, fractures with a history substantially increasing the risk of osteoarthritis development, joint instability, and reduced physical activity. An individual with a previous ankle injury is 3x more likely to incur a future ankle injury. Additionally, an individual with injury is subjected to time off for recovery, average of 15 days of ankle sprains, and healthcare-related expenses minimizing potential opportunities to successfully complete academy/bootcamp or successfully practice and play in sport competition.
Intrinsic Risk Factors & Effectiveness of Balance Training
Among soccer and basketball players, intrinsic risk factors for non-contact ankle injuries representing 33-64% of all ankle injuries are associated with poor single leg balance, laxity of the ankle joint, neuromuscular control, proprioception, and reduced dorsiflexion range of motion. One effective method for improving ankle stability, proprioception, balance, performance and prevention of lower limb and ankle injuries was related to incorporating balance training. Balance training for an average of 2-3x sessions for 3-12 months (greater effect from 6+ months) improved all aforementioned concerns along with postural sway and dynamic neuromuscular control across various sports and professionals. Overall, injury prevention programs that included neuromuscular training or balance training exercises reduced the risk of ankle injuries by 36% and 41%, respectively, based on total exposure hours.
Balance Training Protocol
An appropriate balance training protocol varied dependent on duration, frequency, and specific exercises implemented. More trials are needed for dose-response relationship and optimal strategy, however current studies state optimal outcome achieved by performing training sessions 2-3x/week for 6-12 months. Achieving a minimal protective effect requires 10 minutes 1x/week for 3-12 months with a higher number of sessions resulting in additional benefit.
Additionally, increased compliance via moderate to excellent compliance at 60-100% achieved program completion was associated with reduced risk of injury. Current literature showcased a higher reduction in injuries in the experimental groups utilizing balance protocols with improved efficacy.
There are various balance training protocols however, I’ll list a generalized program below with various phases for progression:
Warm Up (5-10 Minutes)
Aerobic Exercise:
Running straight ahead, backwards, hip in/out, circling partner
Dynamic Stretching:
Inch Worm, Lunge with Overhead Reach, Standing Hand Kick to Romanian Deadlift
Balance Training (15-20 Minutes)
Balance/Wobble board, Balance pad with double/single limb stance eyes opened and eyes closed, Single leg exercises, Various Jumping techniques
Neuromuscular Training (10-20 Minutes)
Some literature utilized specific strength, agility and plyometrics into balance training, dependent on sport or industry related task
Key Takeaways
Ankle injuries are the 2nd most common injury for various sports players
Ankle injuries can lead to increased ankle instability, reduced activity in the future, osteoarthritis development and recurrent injury
One of the most effective strategies to reduce various ankle injuries is balance training
Balance training can significantly reduce rates of ankle injuries, approximately 41% based on 1000 hours of exposure
An optimal program should be follow 2-3x/week for 6-12 months
Utilize a general or specialized balance training program, tailored to person, sport or profession, to ensure increased compliance and greater reduction in injury prevention.
References
Al Attar WSA, Khaledi EH, Bakhsh JM, Faude O, Ghulam H, Sanders RH. Injury prevention programs that include balance training exercises reduce ankle injury rates among soccer players: a systematic review. J Physiother. 2022;68(3):165-173. doi:10.1016/j.jphys.2022.05.019
