Using elastic resistance bands for ankle strength can be a safe and effective way to optimize your ankle rehab and build overall ankle stability, especially after an injury like an ankle sprain, and over time this can also be useful to help prevent and relieve ankle pain.

This article will discuss different ways you can strengthen the ankle using resistance bands, ensuring to touch on all areas of the ankle, allowing you to develop a convenient and effective home exercise program.

A Theraband is simply one type or brand of elastic resistance band. It’s a very common brand in physical therapy settings, and personally, I really like them because they offer a variety of strengths, the resistance is smooth throughout, and you can get different styles.

Therefore, in this article, we may use the term resistance band, resistive band, and Theraband interchangeably.

Ankle Eversion With a Resistance Band

Banded ankle eversion is one of the most common exercises following an ankle sprain, fracture, or other common injuries of the ankle joint.

This is especially important when rehabilitating a lateral ankle sprain, as it can help improve your functional ankle instability (Palmieri-Smith et al, 2009).

While it may be introduced at different time points for different injuries, the common theme is that it will allow for strengthening of some of the primary ankle stabilizers fairly early on in your rehab, particularly if you haven’t been cleared to strengthen these muscles in weight bearing positions yet.

Muscles Worked: Peroneus longus, peroneus brevis, and peroneus tertius. These muscles are sometimes also called fibularis longus, fibularis brevis, and fibularis tertius, as they run along the fibula bone on the outside of the shin.

Avoid/Caution With: Unstable fractures, a healing deltoid ligament sprain, severe peroneal muscle or tendon strains, tibialis posterior and/or tibialis anterior tendon strains, tarsal tunnel syndrome.

Start Position: While keeping your foot and ankle in a neutral position, tie the resistive band around your mid-foot or forefoot so that it’s trying to pull your foot inwards. Then, either 1) loop the band around the opposite foot and hold the end of the band in your other hand, or 2) tie the band off to another object like a table leg.

Technique: With tension on the Theraband to start with, pull outward against the tension of the band into a position of ankle eversion. This movement is like you’re trying to bring the outside of the foot up towards the outside of your shin. You should feel, or even see, the muscles on the outside of your leg contract. Hold for a second, then return to the neutral position and repeat. I personally like to keep y leg straight for this, but technically, this can also be done in a seated position.

Cheating Pattern: The main cheating pattern I see in the clinic is that the whole leg rotates outwards as a unit, which means the motion is now coming from your hip, which defeats the purpose. This is a small motion which can feel a little frustrating at times, so try to avoid the temptation to perform large movements that move the entire leg/hip.

Dose: This can be guided by your physical therapist in person, but I often like starting with 3 sets of 12 repetitions, ensuring that you don’t cause any ankle pain.

Ankle Inversion With a Resistance Band

Banded ankle inversion is also a go-to exercise to help building strength and stability around the ankle, especially on the inside of the ankle.

As such, it’s a common exercise for when rehabbing medial ankle sprains, or if additional support for the medial arch is needed, which is often the case with plantar fasciitis or people with excessive foot pronation (Alam et al, 2019).

This exercise may be delayed when rehabbing a lateral ankle sprain, as you want to ensure proper healing of the lateral ankle ligaments, and this exercise may stretch those ligaments a bit too much if in the acute or sub-acute phase of rehab.

Muscles Worked: Tibialis posterior, tibialis anterior, flexor hallucis longus, and flexor digitorum longus.

Avoid/Caution With: Unstable fractures, healing lateral ankle sprains, severe peroneal muscle or tendon strains, severe tibialis posterior and tibialis anterior muscle or tendon strains.

Start Position: While keeping your foot and ankle in a neutral position, tie the resistive band around your mid-foot or forefoot so that it’s trying to pull your foot outwards. Then either 1) cross your other leg and loop the band around that foot and hold the end of the band in your other hand, or 2) tie the band off to another object like a table leg.

Technique: With tension on the Theraband to start with, bring your foot inwards against the tension of the band into a position of ankle inversion. This movement is like you’re trying to bring the inside of the foot up towards the inside of your shin. You should feel a squeeze on the inside of your foot and ankle, sometimes even the bottom of your foot. Hold for a second, then return to the neutral position and repeat.

Cheating Pattern: The main cheating pattern I see with this one is rotating the whole leg inwards as a unit, which is simply rotation through your hip instead of the ankle. Again, this is another small movement, so try and limit the movement to your foot and ankle to ensure you are targeting the proper muscles.

Dose: This can be guided by your physical therapist in person, but I often like starting with 3 sets of 12 repetitions, ensuring that you don’t cause any ankle pain.

Ankle Plantarflexion With a Resistance Band

Banded ankle plantarflexion is a great way to bridge the gap between plantarflexion range of motion and the more strenuous calf raises in weight bearing. This can help strengthen the calf muscles, load the Achilles tendon, and improve plantarflexion range of motion.

Muscles Worked: Gastrocnemius (if the knee is straight), soleus, plantaris, tibialis posterior, flexor digitorum longus, flexor hallucis longus.

Avoid/Caution With: Unstable fracture, very early phase of Achilles tendon tear rehab, anterior talofibular ligament (ATFL) sprains, severe deltoid ligament sprains, severe extensor digitorum strains.

Start Position: While keeping your foot and ankle in a neutral position, loop the Theraband around the bottom of your mid-foot or forefoot so that it’s trying to pull your foot up towards you. Hold one end of the band in each hand with some stretch already place on the band.

Note: For less tension, tie the band around your foot and hold the other end in your hand, so that you now have a single strand as opposed to a double strand.

Technique: Press your foot down against the resistance of the Theraband moving your ankle into a plantarflexed position. This motion is similar to pressing the gas pedal. Pause for a moment, then bring your foot back up with control, and repeat. You should feel the calf muscles on the back of your leg contract when you do this exercise.

*** To strengthen all calf muscles, keep the leg straight. If you want to target the soleus muscle more, or avoid strengthening the gastrocnemius muscle, simply keep the knee in a bent position while you perform the same exercise.

Cheating Pattern: I find this exercise is quite simple and constrained to the proper movement. That said, do try to make sure that your ankle joint is moving, not just the toes. Additionally, doing this with a straight knee will ensure you get all calf muscles involved, so if you find you’re bending your knee with this exercise, you may not be getting as much gastrocnemius strengthening as desired.

Dose: This can be guided by your physical therapist in person, but I often like starting with 3 sets of 12 repetitions, ensuring that you don’t cause any ankle pain.

Ankle Dorsiflexion With a Resistance Band

Banded ankle dorsiflexion is another really important exercise for building ankle stability, but for whatever reason, it’s often overlooked. This will help strengthen muscles that can otherwise be a little challenging to target, and will go a long way in rehabbing any ankle injury.

Muscles Worked: Tibialis anterior, extensor digitorum longus, extensor hallucis longus.

Avoid/Caution With: Unstable fracture, Achilles tendon strains or ruptures, moderate to severe high ankle sprains, calf muscle strains, severe tibialis anterior strains.

Start Position: While keeping your foot and ankle in a neutral position, loop the Theraband around the top of your mid-foot or forefoot so that it’s trying to pull your foot down towards the floor. The other band will likely have to be lopped around, or tied off, to something like a table leg.

Technique: Pull your foot up towards you like you are bringing your toes towards your nose against the resistance of the band. Pause for a moment, then lower your foot back down with control. You should feel the tibialis anterior muscle on the front of your shin contract while you do this.

Cheating Pattern: The main cheating patterns I see with this one are only extending the toes and not using the ankle joint itself. Additionally, sometimes I see people lift their heel off the ground if they’re doing this in a seated position, which suggests they are either extending the knee or flexing the hip, which defeats the purpose of isolating the ankle dorsiflexors.

Dose: This can be guided by your physical therapist in person, but I often like starting with 3 sets of 12 repetitions, ensuring that you don’t cause any ankle pain.

Summary

These 4 way ankle Theraband exercises represent a great way to target ankle strength and stability, especially in the subacute phases of an ankle injury, including ankle sprains and strains, ankle fractures (once stable), and can also be used for more long term conditions like chronic ankle instability and ankle osteoarthritis.

Like anything other aspect of rehab, there are times when you may want to avoid certain exercises, especially if you are in the acute stages of rehabbing an ankle injury.

Therefore, we always highly recommend checking in with a physical therapist in person to ensure you’re on the right track and to allow for the development of a safe and effective rehab program.

References

Alam, F., Raza, S., Moiz, J. A., Bhati, P., Anwer, S., & Alghadir, A. (2019). Effects of selective strengthening of tibialis posterior and stretching of iliopsoas on navicular drop, dynamic balance, and lower limb muscle activity in pronated feet: A randomized clinical trial. The Physician and Sports Medicine, 47(3), 301-311.

Palmieri-Smith, R. M., Ty Hopkins, J., & Brown, T. N. (2009). Peroneal activation deficits in persons with functional ankle instability. The American journal of sports medicine, 37(5), 982-988.

Disclaimer:

The content here is designed for information & education purposes only and is not intended for medical advice.