Houston Methodist. Leading Medicine

Ankle FAQ

Question:

I've always had weak ankles right from the start. After spraining them both (again), I went to see an athletic trainer to get some exercises. But even after six weeks of doing them everyday, last Saturday, I sprained my left ankle again. What am I doing wrong?

Answer:

Once you've sprained an ankle, there's a good chance you'll sprain it again. And each time the ankle is injured, the more likely it is that you'll develop chronic ankle sprains. The orthopedic term for this condition is functional ankle instability (FAI). People with FAI report episodes where the foot and ankle just collapse, give way, or roll under them. Lateral ankle sprains are the most common. Lateral refers to the outside ankle or the side away from the other leg. Physical therapists and athletic trainers help patients regain normal muscle activation and joint proprioceptionperoneal muscles. The peroneal muscles evert the foot and ankle. Evert means to move it away from the other foot. The idea was to check for a deficit of muscle activation called arthrogenic muscle inhibition (AMI). AMI refers to the fact that the peroneal muscles are not being activated with sufficient force for a strong muscle contraction. Without this dynamic activation, the ankle is more likely to be unstable, giving way without warning. If the muscle isn't getting the nerve messages needed to contract, why not? Is there a problem with local control of the nerve to muscle communication pathway? Or is the breakdown occurring more centrally in the spinal cord of the nervous system? After conducting the experiment, it became clear that the problem was still in the peroneal muscles. It wasn't a matter of neuromuscular inhibition or processing at the central nervous system interfering with ankle stability. That means we are back to the drawing board reviewing rehab protocols. Obviously current approaches are not restoring peroneal muscle function as needed to prevent reinjury. If you are following what your trainer gave you, then you probably haven't been doing anything wrong. And most likely, he or she gave you the most up-to-date program. This study helps point out the need to identify specific exercises, activities, or interventions that target and return peroneal muscle activation to normal. What's being done traditionally may not be enough or just right for some patients like yourself. Riann M. Palmieri-Smith, PhD, ATC, et al. Peroneal Activation Deficits in Persons with Functional Ankle Instability. In The American Journal of Sports Medicine. May 2009. Vol. 37. No. 5. Pp. 982-988.

*Disclaimer:* The information contained herein is compiled from a variety of sources. It may not be complete or timely. It does not cover all diseases, physical conditions, ailments or treatments. The information should NOT be used in place of visit with your healthcare provider, nor should you disregard the advice of your health care provider because of any information you read in this topic.
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