Weak Ankles?

At MOVE Physical Therapy, we see a variety of orthopedic conditions in which we determine that the ankles and feet are at least partially responsible for. These conditions include knee, hip and even back pain. But what happens when the ankle has been injured, is weak or painful? As often as we see ankles with limited mobility, we also hear patients describe a history of “weak ankles” resulting in or from ankle sprains. Traditional rehabilitation in a typical physical therapy facility may incorporate an elastic exercise band for strengthening of the ankle musculature directly involved with the ankle. Even Consumer Reports published these exercises for preventing or fixing ankle sprains:

10 • OCTOBER 2012 • Consumer Reports on Health

In terms of the big picture, I have a problem with these. These exercises do not resemble movements that we make in real life: walking, running, stair negotiation, or any functional activity that consists of our feet being on the ground. Look again at the pictures above. Do these resemble anything you do in real life? The gas and brake pedal are about the only things I can think of. Exercise band and ankle isolation exercises may be an appropriate start if weight-bearing is not allowed or is too painful. However, there is a lot more likely involved when a person describes his or her ankles as “weak.” The trunk (including the core), pelvis, hips, and the rest of the lower extremities, although far from the ankles, contribute greatly to overall function of the ankle. These regions “act on” the ankle. Greater efficiency above makes for less demand on the foot and ankles. As you’ve probably heard: “It’s all connected.”
Why is this important? It is because too many rehabilitation programs for “weak” or sprained ankles rely primarily on the exercises above. I question whether these types of exercises are doing anything at all. Minimal strengthening of the small muscles around the ankle will likely do very little the next time you run, jump, pivot or negotiate steps.
Do your ankles feel weak, roll or sprain easily? The key dysfunction may be from up above. If true weakness is found in the ankles then functional, foot-on-the-floor activities and exercises that target these muscles may be more appropriate.

Dr. John De Noyelles, PT, OCS, CSCS