The ankle joint can sometimes be neglected as an important joint to rehab properly, particularly in the sense of maintaining full strength and mobility beyond full recovery from injury, which may increase the chances of experiencing chronic ankle instability.
Ankle stability is crucial for injury prevention, injury rehab, daily function, and high level sport performance. This article will describe some safe and effective exercises commonly used for those who are managing chronic ankle instability.
For those looking for additional external support to help aid in their ankle stability while they work on improving strength and proprioception, please refer to our article outlining some of the best ankle braces.
Acute vs. Chronic Ankle Instability
You may see the terms “acute” and “chronic” to differentiate between different types of injuries, conditions, or ankle instability.
Acute ankle instability refers to a sudden loss of ankle stability due to a recent injury. In this case, patients can usually describe when and how the injury occurred, and they typically seek treatment for this. An acute ankle sprain would be the most common example of this.
Chronic ankle instability can refer to a few things:
1) Acute ankle instability that was not properly rehabilitated and has remained an ongoing problem.
2) Episodes of ankle instability that have added up over time from repeated mild ankle injuries, for example, a history of recurrent ankle sprains.
3) Ankle instability that is a result of other conditions that create hyper-mobile joints whereby the supportive ligaments don’t provide the expected baseline level of stability.
Additionally, you may see the term “functional ankle instability”. This is basically the instability most people think of – the ankle isn’t as strong and is more prone to rolling, leading to a high risk of ankle sprains. Functional ankle instability is basically what we are addressing with the exercises described in this article.
Is treatment different for acute vs. chronic ankle instability?
Given ankle instability can occur for a variety of reasons, it’s important to consider the context of the person’s health status and lifestyle to appropriately address the problem.
For example, rehab for ankle instability that has occurred as a result of a recent severe ankle sprain will likely look different in the sense that the ankle needs to be protected at first.
There may be a significant amount of ankle pain with acute ankle instability, and there should be a focus on reducing ankle pain prior to initiating any aggressive exercises. The initial ankle stability exercises will be basic and gentle, and will gradually progress over time, and all other areas of ankle function will be addressed as well (e.g. range of motion).
On the other hand, someone who doesn’t really have much ankle pain, has full range of motion (or excessive range of motion), and has reasonable strength, may be able to jump right into more advanced ankle stability exercises even with a history of recurrent ankle sprains.
Sometimes people refer to chronic ankle instability as chronic ankle sprains. While they aren’t technically the same thing, chronic ankle sprains (or recurrent ankle sprains) will certainly lead to a much higher risk of instability and associated ankle inuries.
When in doubt, we always recommend seeking advice from a physical therapist in person to determine the best course of action for your injured ankle and to avoid any potential safety hazards.
Examples of Chronic Ankle Instability Exercises
The following are examples of common ankle stability exercises that can be used for chronic ankle instability and other ankle injuries.
Chronic Ankle Instability Exercises (Easy)
Resistance Band Exercises: These are basic ankle strengthening exercises that can help provide a stepping stone to more functional ankle stability exercises. For a detailed description of these, please visit our recent article describing 4-way ankle Theraband Exercises.
Tandem Balance: Balance exercises are great for improving ankle stability and are typically part of rehabbing any ankle injury. This exercise is one of the easiest balance exercises, and it bridges the gap between normal standing and single leg balance. It challenges medial and lateral ankle stability by using a narrow base of support, but you still get help from both feet.
The dose will depend on your current condition. 5 reps of 20s holds daily can be a good start.
Single Leg Balance: This is pretty simple. Simply stand on one leg and fight to keep your balance. If you find this too easy, try closing your eyes at the same time, as this will challenge your ankle proprioception (essentially joint position sense) by forcing your brain to focus more on the feedback it’s getting from the ankle joint and muscles, as opposed to visual input.
The dose will depend on your current condition. 5 reps of 20s holds daily can be a good a good start.
Calf Raises: Calf raises are more of a strength exercise, but when performed in a slow and controlled manner with less hand support, they can certainly challenge the stability of your ankle, especially when performed in a single leg fashion.
The dose will depend on what you’re trying to achieve, but I personally like 3 sets of 12 reps. From there, you can add reps if you want to emphasize more endurance, or reduce reps and add resistance if you want more strength (e.g. holding a dumbbell).
Chronic Ankle Instability Exercises (Medium)
Single Leg Balance on a Bosu Ball: This exercise will challenge your ankle stability by providing an unstable surface that your ankle has to constantly adjust to in order to maintain balance, especially in the medial and lateral directions, thus challenging your proprioception (Strom et al, 2016).
The dose will depend on your current condition. 5 reps of 20s holds daily can be a good start. The more inflated the bosu ball is, the more challenging this will be. You can use the bosu ball upright, or upside down standing on the flat surface.
Single Leg Balance on a Wobble Board: This is very similar to single leg balance with a bosu ball, but incorporates a slightly different type of challenge. Personally, I find the wobble board to be one of the more challenging balance exercises, especially when using a circular wobble board. In this case, you can usually adjust the piece on the bottom to stick out more (more challenging) or less (easier).
The dose will depend on your current level of recovery. 5 reps of 20s holds daily can be a good start.
Double Leg Squats on a Bosu Ball: For this exercise, you can flip the bosu ball over so the flat part is up. Standing on the flat surface with both your feet, you can perform squats while attempting to keep the surface level, which will require constant correction from your ankles, knees, and hips.
For increased challenge, you can do a single leg squat on either side of the bosu ball. In either case, I like beginning with 3 sets of 12 reps with a slow tempo, but you can adjust this as you see fit by increasing or decreasing reps, or adding load (e.g. holding a dumbbell or kettle bell).
Chronic Ankle Instability Exercises (Hard)
Y Balance Squat: This exercise is basically a single leg squat, but you can use your other leg as a tool to further challenge your ankle stability. This is also a great exercise for various knee or hip injuries, so it’s great for overall lower body strength and stability and is often included with a functional rehabilitation program.
This squat involves reaching in three different directions without touching the floor with that reaching foot: 1) Straight ahead – return to neutral, 2) back and to the side – return to neutral, and 3) back and across – return to neutral.
Try to reach as far as you can by bending at the hip, knee, and ankle. Keep in mind that this should be with good control and balance, meaning you don’t want to let the knee roll or collapse inwards. By avoiding that tendency, you will be optimizing your alignment using numerous different muscles to do so, all the way from your glutes to the small foot intrinsic muscles.
Interestingly, some research has shown that those who are unable to reach as far on the Y balance squat are more prone to ankle sprains (Hartley et al, 2018), which helps put a little more weight behind this ankle instability exercise, and is one of the reasons why this is a common exercise for other ankle injuries as well.
It’s tough to identify a proper dose without assessing an individual’s current capabilities, but I like starting with 5 “rounds”, or 5 reps in each direction sequentially at a slow controlled tempo.
This would account for 15 single leg squats all in, and if you’re going slow, that’s a reasonable amount of time under load. Once that becomes easy, you can progress by adding repetitions, adding a resistance band (see below), or an unstable surface like a stack of towels or bosu ball.
FYI – this exercise is also known as the star excursion balance test, or at least a variation of that.
Single Leg Squat with Medial or Lateral Pull of Resistance Band: This exercise is your basic single leg squat, however, by adding a resistance band, you can challenge specific components of your ankle instability. Functional exercises with components of strength for the entire leg can be an effective way to improve chronic ankle instability (Feger et al, 2014).
For example, if you have a history of lateral ankle sprains, it is likely there is some lateral ankle instability. By looping the band around the inside of your ankle so that it’s pulling towards the outside, this will further challenge the ankle muscles, specifically the peroneal muscles, to maintain strong activation to prevent rolling the ankle.
For those with a history of medial ankle sprains involving the deltoid ligament complex, the band can pull towards the inside which will try and force your ankle into eversion, and you will have to resist the using muscles like tibialis posterior and tibialis anterior.
Start with light resistance on the band, as a little bit goes a long way. Over time, you can increase the tension on the band for further challenge. This is one you would want to avoid if the ligaments, muscles, or tendons around the ankle are still healing, so it’s better reserved to late stage rehab or chronic ankle instability.
For a dose, I like to start with 2-3 sets of 5. Limiting your sets to 5 reps is a good way to maintain focus and slow tempo. From there, you can increase reps, resistance, or alter the surface you are standing on accordingly.
Chronic Ankle Instability Exercises (Advanced)
Single Leg Lateral Hop and Holds: This dynamic balance exercise challenges the lateral stability, and some extent, the medial stability, of your ankle, and is usually reserved for more advanced phases of rehab for an injured ankle, especially if it’s an acute ankle sprain.
The advanced factor in this case is the increased rate of loading provided by the dynamic nature of this balance exercise, meaning your ankle has to withstand large forces and be able to stabilize itself in a very short period of time, which is why we usually avoid something like this in the initial stages of an ankle injury rehab program.
Jump to the side from one leg, landing on the other, and hold the landing before jumping back. You can start with small jumps to get the feel, then progress to increasing the height and/or distance of your jump to further challenge the landing.
The “hold” part for this exercise is extra important, as a cheating pattern can be to “escape” the hold by jumping back to the other side before you have your balance. I big portion of this exercise is trying to fight for your balance after landing.
Additionally, you want to try and make it a soft landing by absorbing the impact via triple flexion, meaning bending at the hips, knees, and ankles.
I like to start 3 sets of 5 reps to each side, and while the dose is very manageable, it does require that you have already built up prerequisite strength and endurance. It is typically not recommended to start with jumping exercises if you have severe ankle instability, and instead, build up over time.
Ladder Hopping and Quick Feet: Ladder drills are also great for dynamic balance and involve controlling single leg impact and quickly transitioning to generating force. For these drills, there are a wide variety of patterns you can try out, so the example in the pictures below is just an example.
You can start out by hopping and holding the landing before jumping again, but eventually, you want to be able to perform this in rapid fashion, which will challenge your ankle to respond to a variety of high force inputs for a prolonged duration of time. It should be fairly fatiguing on the ankle.
Quick feet is a little different in that you aren’t just hopping on one foot, but instead, rapidly stepping into and out of the boxes in specific patterns. While this exercise may not challenge your dynamic balance as much as the ones listed above, it’s a good selection for when you’re getting closer to return to sport, as it will work on your speed and agility.
The dose will depend on your conditioning, ankle strength and endurance, and what setup you have available to you. I usually like doing one round of hopping or quick feet to 80% fatigue, and repeat that 5 times.
Summary
Ankle stability is crucial for daily function and sport performance, and as such, ankle instability can really be a detriment to one’s quality of life.
Additionally, you can think about the ankle as the foundation for standing. If you are strong and stable at the ankle, it simply makes movement so much easier in any setting.
The above exercises represent a small fraction of the exercises available to improve your ankle instability, but we hope they provide you with an idea of the general concept and different levels of progression.
When in doubt, it’s best to consult with a physical therapist in person to ensure the most safe and effective program for you particular ankle instability, injury, or condition.
References
Hartley, E. M., Hoch, M. C., & Boling, M. C. (2018). Y-balance test performance and BMI are associated with ankle sprain injury in collegiate male athletes. Journal of science and medicine in sport, 21(7), 676-680.
Feger, M. A., Donovan, L., Hart, J. M., & Hertel, J. (2014). Lower extremity muscle activation during functional exercises in patients with and without chronic ankle instability. PM&R, 6(7), 602-611.
Strøm, M., Thorborg, K., Bandholm, T., Tang, L., Zebis, M., Nielsen, K., & Bencke, J. (2016). Ankle joint control during single-legged balance using common balance training devices–implications for rehabilitation strategies. International journal of sports physical therapy, 11(3), 388.
Disclaimer:
The content here is designed for information & education purposes only and is not intended for medical advice.
