Ankle Instability: The Weak Link in Your Fitness Chain

HOW BORING!!!! Ankle instability, that sounds like the most LAME fitness post right? What if I told you that chronic ankle instability results in altered movement patterns in activities like walking, jogging, and turning, a higher risk of falls due to impaired postural control. Research explains these issues as well as states, ” individuals with chronic ankle instability (CAI) often experience functional limitations affecting daily activities, leading to poor quality of life, so CAI is a major public health issue.” (PMID: 39425153)

Chronic ankle instability also is a main issue in causing knee issues, “the principal findings in these studies were that CAI subjects had decreased knee flexion compared to the control group…Decreased knee flexion has shown to be a key risk factor in non-contact knee injuries. In the future, more research needs to be done comparing chronic ankle instability to non-contact knee injury rates.” (PMID: 30761190)

We even see chronic ankle instability leads to issues in the hip and low back, “Chronic ankle instability (CAI) results in hip neuromuscular impairments that can perpetuate dysfunction through reduced lumbopelvic stability and subsequent malpositioning of the lower body during functional movement. Lumbopelvic stability might be further impaired through changes in trunk muscular contractility. However, lumbopelvic stability and trunk muscle morphology have not been compared between individuals with and without CAI.” (PMID: 34123527)

So, what is the most common cause of this chronic ankle instability in the first place? Ankle sprains are the most common cause of chronic ankle instability and ankle sprains are one of the most common injuries in our society. Often we write them off as just a temporary injury that gets better with a bit of time and taking some pressure off. That is true, the pain can go away with smart management, but what most people don’t realize is that the instability can persist.

There are estimates that 40% of ankle sprains go on to lead into more chronic issues (Mugno AT, Constant D. Recurrent Ankle Sprain). Considering that it is such a common issue, it makes sense that we do become more thoughtful about addressing something that may not be causing us pain in the ankle, but issues in the rest of the body. You don’t have to experienced an ankle sprain either to have chronic ankle instability. Other issues such as lack of physical activity, poor shoe wear over a lot of use, and other factors can contribute to lack of ankle stability.

The solution? As orthopedist, Dr. Johnathan Kaplan explains, ” In truth, improvement of ankle stability is not only dependent on overall ligament and muscle/tendon function, but also our brain function. There is a term called proprioception, which is our mind’s awareness of the body’s given location in space at any particular time. These training regimens work both on the physical function of our ankles but also the mental component as well.”

Just working your ankle therefore in isolation isn’t ideal when we are looking to build that stability which will benefit us in numerous ways. What should we do?

Neuromuscular Control & Reactive Stability

 

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How do you build stability that translates to better movement, strength, and resilience? You have to teach the WHOLE chain to work together. That includes the foot, lower leg, hips, and core. Yes, research has shown not only are the areas close to the ankle important in helping provide stability to the ankle, but those further away too. An 8 week study found core stability training helped chronic ankle instability (PMID: 37301558). That is why exercises like physical therapist, Jessica Bento shows are better than just trying to isolate areas of the body.

Better Instability Training

While there is some evidence that unstable surface tools can help ankle instability, the issue still arises it is difficult to have appropriate progression for those that have stability issues. That is why when it comes to building instability using strategies such as load and body position are our preferred methods. As you can see in the post below, Jessica uses an inline press that is very effective way to work on foot and ankle stability, single leg stance where she is using a band to provide feedback on the foot to create the foundational stability, as well as various states to challenge how the ankle creates stability especially in an unstable stance like a split stance with a moving Ultimate Sandbag.

 

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Bring More Demands To Movement

People love to do exercises like carries, but in such exercises it is easy to hide many issues including ankle instability. Using the carries like Jessica shows below (you could use a tape line in the ground, but some type of small balance beam works better) really forces the stability of the ankle, but also works on the feet, hips, core, and lower leg all at the same time. Especially with frontal plane stability which is where most lack ankle instability.

Hopefully you found another possible answer to why your feet, knees, even low back, and hips keep being issues for you. If we work on ankle stability we can see improvements that go throughout the body. It doesn’t have to be isolated, nor should it be, to JUST the ankle. These are powerful exercises that give a host of benefits INCLUDING ankle stability.

If you want to find out more, check out physical therapist, Jessica Bento’s upcoming 2-week online course on knee pain. You can save 20% on the course right now with code “coach20” HERE

 

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