My 15-year old son has been playing competitive basketball since before he could dribble. Since he was old enough to understand why he has taken great care and pride to maintain proper conditioning. I also take pride in his conditioning as it was I who taught him of its importance. Since the eighth grade he has been involved in regular strength and conditioning training. As a result, he has suffered very few athletic-related injuries, especially considering the number of games he has played.

He just recently suffered only his second ankle sprain (the result of landing on a teammates foot) and it kept him out of two games. His first sprain wasn't severe enough to cause him to miss his next game. I don't believe this has been dumb luck. I firmly believe his good fortune was largely the result of the faithful application of proper training techniques.  Don't misunderstand me, even the strongest ankle will turn from time to time but I am convinced many such injuries can be avoided with proper training.

Ankle injuries are among the most common of all sports injuries, especially for basketball players. Research indicates ankle injuries account for up to 15% of all sports injuries or roughly 2 million cases per year. Treatment practices for injured ankles are well publicized. The question here is what can be done to prevent ankle injury in the first place.

Proper strength and flexibility conditioning are key parts of a plan to avoid ankle injuries. Weak or inflexible ankles are more prone to injury than properly conditioned ankles. Whether or not to wear an ankle brace or tape the ankle has been an ongoing debate among coaches, players and trainers for many years.

Before I address the issue of prevention it is a good idea to understand exactly what a sprain is and to be able to identify the most common symptoms of a sprain.

What is a Sprain?

A sprain is simply a stretched or torn ligament. Ligaments connect bones together at a joint and help to keep the bones from moving out of their proper place. Ankle sprains are the most common of joint sprains. They may occur when you fall, twist your ankle too far or too suddenly, or when the joint is forced out of out of its normal position. This latter occurs often when landing after leaping, especially if landing on an uneven surface (or someone’s foot) or when the landing foot is not in the proper position.

The most common signs of an ankle sprain include:

• pain or tenderness
• bruising
• swelling
• stiffness
• inability to walk or bear weight on the joint

How badly the ankle is sprained depends on how badly the ligaments are stretched or torn. If the sprain in mild, there may not be much pain or swelling, and the ligaments may only be stretched. If a severe sprain, one of more ligaments may be torn and the joint may be severely swollen. Severe sprains are usually accompanied by severe pain.

On a cautionary note, you should have any joint sprain examined by a physician. What seems like a simple sprain to you could be something much worse and delaying proper treatment could have serious consequences. Let a doctor make the determination whether it is a sprain or something else. Better to be safe than sorry!

Strength and Flexibility Conditioning

Proper strengthening of the ankles is an important part of reducing the incidence of ankle injury. However, ankle injury can still happen even in a strong ankle. What follows is a number of exercises that help strengthen and stretch the muscles, ligaments and tendons around the ankle. These exercises should be done 3 times per week and should take around 20 minutes to complete. All these exercises should be done pain-free. See your coach, trainer or physician should you experience pain while doing these exercises.

Gastrocnemius Stretch

Lean against a wall with right foot behind you. Keep right knee locked and your heel on the ground. Lean forward until you feel a stretch along your calf. You may have to move the foot closer to the wall or further back in order to feel the stretch properly. Stretching should not be painful! Once you get a good, pain-free stretch and hold it for 15 seconds then work the left leg. Repeat with each leg 4 times.

Soleus Stretch

This exercise stretches the soleus or the ‘deeper’ calf muscle. Lean against a wall with your right foot behind you. Bend your right knee and keep the heel in contact with the ground. Lean forward until you feel a stretch along your calf. Remember, a stretch should never hurt. Once you get a good, pain free stretch and hold for 15 seconds then switch and stretch the other leg. Repeat with each leg 4 times.

Anterior Tibialis Stretch

Sit in a chair and cross your right leg over your left thigh. Your malleolus or ankle bone should be about 2 inches off your thigh. With your left hand, grasp the top of your foot andpull your foot towards your left side, making sure movement occurs at the ankle joint. Get agood, pain free stretch and hold for 15 seconds then switch and stretch left leg. Repeat with each leg 4 times.

Range of Motion

Sit on a table, bed, or couch and rest your right leg so that your foot hangs 2 inches off the edge. Use your toes as a pointer and draw small circles in the air. First circle clockwise and then counterclockwise for 15 seconds in each direction. Repeat again in each direction. Now draw large circles in a similar fashion, clockwise first and then counterclockwise for 15 seconds in each direction and repeat. All movement should be occurring at the ankle joint. Repeat the exercises with the left foot.

Towel Scrunches

Sit in a chair and stretch out a towel on the floor in front of you. Begin with the right foot and keep your heel on the ground and off the towel. Now, using your toes scrunch the towel towards you. Scrunch the towel as far as possible and then straighten it. Repeat a total of 3 times. Switch to your left foot and repeat. When the exercise becomes too easy, place a book on the far end of the towel and then do the scrunches.

Towel Scoop

Sit in a chair and stretch a towel out to your right side. Keep your heel off the towel and on ground. Now using your right foot, scoop the towel towards you moving foot towards the middle of your body. Straighten and repeat for a total of 3 repetitions. Switch to your left foot and do likewise. When the exercise becomes too easy, place a book on the far end of the towel and then do the scoops.

Leg Swings

Stand with your feet a little closer than shoulder-width apart. Balance on your left foot. Swing your right leg forward then back until it passes behind your left foot. Your foot should be no more than a foot and a half off ground. Continue swinging your leg for 15 seconds. Switch to your left foot and repeat. Do this 4 times for each leg. Movement should be from the hip with your knee locked, or slightly bent.

In the same way, swing your leg away at an angle from body. Do this with both legs for 15 seconds, 4 times each. Repeat the motion across your body 4 times for 15 seconds each. When the exercise becomes too easy try doing it with your eyes closed. Later, try the leg swings while trying to catch a ball.

Toe Raises

Stand in front of a chair and place your hands on the back of the chair. Rise up on your toes and hold it there for two seconds. Taking about 2 seconds, lower your heels until they touch the ground. Do 2 sets of 10 repetitions. When exercise becomes too easy, perform the exercise on one foot at a time.

Toe Taps

Sit down in a chair. Beginning with your right foot and keeping your heel on the ground, raise your toes up towards your body and then lower them so that they touch ground. Perform 2 sets of 10 repetitions for each foot.

Jumps

Make a cross on the ground using two strips of tape. Label the quadrants 1-4. Place both your feet in quadrant 1 and jump into quadrant 2. Then go from 2 to 3, then 3 to 4 and finally back to quadrant 1. Remain facing forward the entire time. Make sure you leave off the balls of your feet and land on the balls of your feet. Repeat the exercise but jump from 1 to 4, 4 to 3, 3 to 2 and finally, 2 to 1. Do 10 jumps total, 5 in each direction. Begin slowly and gradually increase your jumping speed. When exercise becomes too easy perform jumps on one foot at a time.

Ankle Braces and Supports

Ankle braces come in 2 basic types. The first type is non-rigid and may look like a thick canvas or nylon lace-up sock. Some non-rigid braces are made of neoprene, the same material used in wet suits. The non-rigid style provides some compression to the ankle and may help in injury prevention but provides little additional stability to the ankle. Their usefulness in preventing ankle injury is questionable.

The other type of ankle brace is the semi-rigid brace. They may be made of similar materials as non-rigid braces but have added features such as molded plastic struts or air cushions. These are built into the medial and lateral sides of the brace. These braces provide more stability and are often are chosen during rehab and upon returning to play.

Most non-rigid and semi-rigid braces also use fabric straps to simulate heel locks. These are usually on the outside of the brace and fastened with Velcro. Many athletes do not feel as comfortable or as stable wearing braces relative to taping, which can be a disadvantage to treatment.

Ankle Taping

The practice of ankle taping and wrapping for the prevention of ankle injuries has been around for over 60 years. It is as much an art as a science. There are various schools of thought when it comes to how and when to tape an ankle.

Proper skin preparation from washing and drying, shaving of taped areas and application of pre-wrap are considerations. How to tape an ankle depends upon the health of the ankle and any preexisting conditions and is beyond the scope of this article. Suffice it to say that the ankle needs to be taped properly to realize any benefit.

The question of the benefits of ankle taping are debatable. All the research on the subject is not in agreement. There is substantial research to support that proper taping does have some benefit in preventing initial ankle injury and preventing the recurrence of ankle injury. Other studies have shown little or no benefit to ankle taping. There is even research that suggests the benefits of taping may be as much psychological as physiological.

Regardless, it is clear that ankle taping and bracing will continue to be a fixture in sports training and medicine. However, proper strength and flexibility conditioning of the ankle is likely more important for the prevention of ankle injuries and to encourage the quick recovery from the same.