This week's Gympa exercises are designed to strengthen and stretch the ankles. They are useful to prevent sprained ankles. They might not be the best exercises to recover from injuries, but as long as they don't produce pain, you'll probably be all right. Of course, the ankle is a joint supported by leg muscles. To strengthen the ankle, you strengthen these muscles, whether they are actually in your ankle or not.

First, I will assume that you don't have a Hoover ball. There are a lot of ankle exercises that don't require the use of a Hoover ball...

1. Get a small towel and put it on the floor. Bunch it together and pick it up using your toes. Work on pulling your toes downwards towards the bottom of your foot rather than manipulating the towel between your toes. This should manipulate those small muscles that control your feet.
2. Without the use of equipment like a Hoover ball, it is difficult to strengthen some muscles, but you can do so by pushing against an immovable object. To strengthen the muscles that turn your foot inwards and outwards (while keeping the bottom of your feet pointed away from your head), stand in a doorframe. Put one foot ahead of you so that the side of the big toe or small toe is against the doorframe, and push against the wall (push against anything really, the doorframe is just a convenient bit of equipment). Hey, this is Gympa you can even do at your desk! Work your foot in both directions.
3. Many twisted ankles involve tears to the ligaments along the outside of your ankle. In other words, the bottom of one foot gets turned inwards towards the other foot. To strengthen the muscles that counteract this, sit on a cushion or bed, or even a carpeted floor with one knee, the side of that leg, and the outside of the associated ankle against the cushion. Turn your ankle outwards, lifting up your leg or pushing into the cushion with the outside edge of your foot.
4. There has been great deal of debate in OK circles over how important it is to have a flexible ankle. Some people like Mook swear that having flexible ankles prevents turned ankles (it is difficult to stretch a flexible tendon too far), while others like Spike prefer to have very tight ankles and count on avoiding turning the ankle in the first place (probably by a lot of rough surface running practice). If you do decide to work on ankle flexibility, stretch the outside of your ankles by standing in shoes. Simply tip one foot on its edge and lower the outside of your ankle towards the floor stretching the foot in essence as you would if you were spraining it this way. Don't expect a lot of progress in a few days, but as with any tendons, you can get more flexibility in time.
5. You can prevent some ankle sprains by gaining a better sense of where your ankle is in space. In other words, coordination. One simple way to do this is to run over rough ground. This carries some risk of exactly the injury you are trying to prevent, however, so may not be the way to recover from an existing sprain. If you already have sore or tight tendons from a sprain, try something else... An indoor way to gain ankle coordination is to balance by standing on a board that is on top of a smoothly rolling object like a ball or rolling pin. Learn how to adjust your feet to compensate for imbalances. When you're good, you should be able to roll back and forth like a circus clown impressing your friends!

If these exercises seem to be inadequate, it is probably because you don't have a Hoover ball. Anyone who is serious about strengthening ankles, or Gympa in general, ought to go get a Hoover ball!

-- Dr. Mook (everett@psi.edu), December 19, 2000

Answers

For ankle exercises, I utilized a book I found in the KU science library. After processing the information, I devised a number of exercised to build ankle strength. They all involved using Thera-bands, which I'd tied into a loop.

I would do exercises to strengthen the sides of the ankles by wrapping the loop around both feet and lifing the outside edges of both feet. (This can also be done with each foot, one at a time.) Then, I would cross my legs, loop the band around my feet and lift the inside of each foot against the resistance. To strengthen the front of the ankle, I'd wrap the band around some object and over the top of my foot near the toes. Then I'd raise my toes towards my shin. Before I found the bands, I remember doing these exercises with each foot and a weight on a loop of webbing. Inversion, Eversion, and Flexion. Extension is taken care of with the easily done exercise of toe raises (stand on tip toe, add weight if desired and do on the edge of a step to get greater range of motion).

For balance, a trainer at APOC in 1980 recommended a set of exercises of simply remaining stationary on one foot. However, to make if more challenging, the upper body is held in three different positions -- horizontal to the ground with the stomach down and the other leg to the rear, horizontal to the ground with the back down and the other leg to the front and horizontal with the same side to the ground and the other leg out to the other side. To further increase the challenge, try these with your eyes closed (really get a sense of what's going on proprioceptively!). The thinking is that not only do the ligaments get torn, but the nerves that relay the information about the position of the bones, muscles, etc are damaged. These 'exercises' supposedly help renew the neural damage.

Oh, and medicine balls can be purchased at local sporting goods stores, but Flaghouse (1.800.793.7900) has many supplies, including colored medicine balls in size ranges from 4-5# (red) $14.95, 6-7# (yellow) $16.95, 9-10# (blue) $18.95 and 11-12# (orange) $21.95. One could also use the medicine balls in ab work, holding one between the knees and raising the legs upwards. (Late holiday present anyone?)

-- Fritz (fpmenninger@hotmail.com), December 20, 2000.

A quick review of sites (ala google) with suggestions on how to recover from ankle sprains:

http://www.stoneclinic.com/anklesprainstg2.htm

stretches, resistance exercises, and balance exercises

http://www.painreliever.com/therabandsystem.html

therabands for sale

http://www.orthoassociates.com/Ankle_rehab.htm

nice page including pictures with stretches, resistance exercises and balance exercises

am reminded of the difference between lifting the edge of the foot (inversion/eversion: rotating the foot along an axis from heel to toes) versus 'rotating' the foot (abduction/adduction: rotating the foot about the pivot point of the heel, along the axis from the hip to the heel)

http://www.orthohealth.com/askthedoc/anklesprains.cfm

another page with pictures, similar information to orthoassociates

http://www.physsportsmed.com/issues/1997/03mar/garrick.htm

lengthy treatise by one who deals with ankle sprains frequently. Cool picture of a properly 'compressed' sprain.

a couple of quick quotes

How soon can the patient expect to return to his or her full activity level?

This, of course, depends on the severity of the injury and appropriate early management. It can take anywhere from 3 days to 6 weeks, depending on how comfortable the patient feels with the movement and how quickly he or she regains muscular strength. If you were to wait for a ligament to heal completely and regain substantial tensile strength, then no one would be back to sports in less than 6 months. The point is that the majority of patients are back to full activity long before the ligament heals. If you are strong and have good muscles that are working properly, you can compensate for almost any degree of ankle instability.

The earlier you mobilize, the less strength you lose and the quicker you regain motion. And the quicker you regain normal motion and strength, the less likely it is that you will get a recurrent injury.

http://www.athleticadvisor.com/Injuries/LE/ankle_exer.htm

Good page showing theraband exercises

http://www.runnersweb.com/running/deb_may2000.html

balance, stretching and resistance. color pictures, one of the balance exercise I spoke of, calling it the '747'

http://www.jointhealing.com/pages/foot/acute_ankle_sprain_tx.html

Finally. A page that mentions meds for pain along with RICE... along with LOTS of plugs for their products.

Also has a link to a 'motivational' page... which recommends tai chi!

http://www.totalcoaching.com/athtrain/anklerehab.html

reinforces the idea to gradually progress and suggests which exercises belong where in the process.

http://www.usa-gymnastics.org/publications/technique/2000/5/flexibilit y.html

interesting article addressing strength v flexibility in gymnasts

http://www.ahp.hhsweb.com/pt/..%5Colson/Sub/unit03a.htm

a page for physical therapists, decribing the different motions and how to evaluate an ankle

http://www.som.tulane.edu/departments/orthopaedics/sportsmed/page15.ht ml

with links to progressive running and plyometrics programs

-- Fritz (fpmenninger@hotmail.com), December 20, 2000.

Having nice flexible ankles is great, but I suspect that the level of flexibility required in order to go for the "rubber ankle" approach is way, way beyond what you can develop through any kind of exercises or stretching. I'm blessed with such ankles (due to the fact that I seem to have Ehlers-Danlos syndrome (type III)), but I can't imagine anyone developing this degree of flexibility. (And I do nothing whatsoever to cultivate this, by the way.) If you can't stand upright on the edges of your feet, with the soles in full contact with each other (and your knees straight), I'd suggest you go for strengthening.

-- J-J (jjcote@juno.com), December 20, 2000.

I think the best training to strengthen the ankles is easy running or jogging in the woods. I would think that other excercises (like balancing on one foot) are good things to do. But, they can't replace running on rough terrain.

Running style can also increase or decrease you ankle problems. If you run with an up-right form (standing tall with your hips very straight), I think you're more likely to turn an ankle. If you run with a bit of flex in your hips (almost like you are beginning to sit down), you don't put as much stress on your ankles each time you put your foot down. I've noticed that if I'm doing a lot of off road training my running form changes -- I run with more bend in my hips. This is a good way to run in rough terrain. But, it is slow when you get on a road.

Everyone who orienteers is going to sprain an ankle now and then. So, you should probably figure out how to recover. It is quite easy to start running too soon. Then it is easy to sprain the same ankle again. When I've turned an akle, I treat is as soon as possible (R.I.C.E. or I.C.E.-T.). I take a bit of time away from running in rough terrain. I'll also do some easy strength excercises (like balancing on one foot). I've also had good experiences with using an ankle support when I begin to run in rough terrain. I think Fritz and Dan are fans of air casts. I like the "active ankle."

-- Spike (mike_eglinski@kcmo.org), December 20, 2000.