Ankle injuries – How to reduce the risk of recurrence

Ankle sprains are the most common injuries in a variety of sports, and chances are it’s an injury you suffered yourself.

Sprained ankles are caused by soft tissue damage to the ligaments around the ankle joint resulting in ankle swelling and pain. Whilst severe sprained ankles, (ones where you can’t put your weight down) should be reviewed by a medical professional, most people self treat following the RICE protocol: rest-ice-compression-elevation. However, after treatment of an ankle sprain, the risk of the injury recurring remains high.

How can you reduce the risk your ankle injury will recur when you return to sport?

Proprioceptive training has been shown to reduce recurrences in ankle sprain by 50%. Proprioceptive exercises teach the body how to control an injured joint and generally involve balance training. Research published in the British Medical Journal this month investigated whether an unsupervised proprioceptive training program is effective in preventing recurrences of ankle sprain.

The researches recruited 522 athletes from both sexes, all ages, all types and levels of sports, and different types of treatment. They were told to treat the sprain as they normally would, ranging from medical intervention to simply rest.



Half the subjects acted as control with the others assigned to an intervention program. The intervention group received a balance board and were prescribed 3 training sessions a week, with maximum durations of 30mins a session. The detailed exercise program and exercises can be found here. The athletes were encouraged to perform the exercises as part of their normal warm up with exercises gradually increased in difficulty and training load during the eight week programme.

During the one year follow-up, 145 (28%) athletes reported a recurrent ankle sprain: 56/256 (22%) in the intervention group and 89/266 (33%) in the control group. The researchers found that the intervention program was associated with 35% reduction in risk of recurrence compared to no program.

There was also in a reduction in the severity of the recurring injury with the intervention program with lost sports time twice as unlikely due to recurrent sprains. Severe ankle sprains that led to costs were also 3.6 times higher in control athletes than in intervention athletes.  The overall incidence of ankle sprain per 1000 hours of sports was 1.86 in the intervention group and 2.90 in the control group.

Whilst there was no significant differences between either groups if they were also under medically supervision, athletes in intervention group not medically treated had significant lower risk of recurrence than controls not medically treated.

Due to the wide range of subjects followed, the results from this study suggest that the entire range of athletes, from young elite to recreational senior athletes, would benefit from using a proprioceptive training programme to prevent recurrences of ankle sprain, especially if you did not have medical treatment for your ankle sprain.

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