Ankle proprioception is extremely important in day-to-day function, and even more important when it comes to sports. This type of sensation becomes compromised after any ankle injury, especially ankle sprains, and as such, it’s imperative to keep this in mind when rehabbing any ankle injury (Ma et al, 2021).
This article will discuss some of the most common ankle proprioception training exercises that you can build into your rehab program, and some can be maintained when you are back to full-on training or fitness regimes.
What is ankle proprioception?
Ankle proprioception, also known as ankle joint position awareness, is the ability of our body to understand where the ankle is in space and how it is moving.
Specifically, our brain receives feedback from specific types of receptors and their associated nerves located in the joints and muscles of the foot and ankle that tell us where the ankle is and how to adjust or react if needed.
As such, proprioception is high involved in balance, coordination, and reactive control, and is very important to work on after an ankle sprain or other injury.
While we are focusing on ankle proprioception specifically in this article, it is a type of sensation used by the entire body.
Why is ankle proprioception important?
Given your foot and ankle represents the connecting factor between your body and the ground, proprioception plays a huge role in day-to-day function as well as high level sports performance, and this becomes severely compromised after an injury like an ankle sprain.
One analogy to consider is a self-driving car. The car can be super fancy, it can be lightweight with high horsepower, great tires, and a luxurious interior. However, if the car can’t identify when it is in the correct lane, or if it can’t adjust to changes in the surrounding environment, major problems are inevitable.
Therefore, proprioception is highly important throughout the entire rehab process for any ankle injury, especially a sprained ankle, and becomes even more important for prevention of re-injury in general (Kaminski et al, 2019).
When can you start ankle proprioceptive training after an injury?
As long as you have been cleared to move the ankle in any capacity, then you can start ankle proprioception exercises very early in the recovery process. Like range of motion and strength exercises, these will start out as fairly basic light exercises, and will progress to be more advanced as your ankle recovers.
Examples of Ankle Proprioception Exercises
In this section, we will describe some common ankle proprioceptive exercises that are relatively simple to perform.
We will break it down into different phases, keeping in mind these phases aren’t so much dependent on time as they are meeting physical criteria for progression of rehab for ankle sprains, which can be guided by your physical therapist.
Early Ankle Proprioceptive Training
Matching Lower Body Position
This is arguably the most gentle ankle proprioception exercise possible for ankle sprains, and represent a way to get started if your ankle is immobilized and you are non-weight bearing.
For this exercise, lay on your back and close your eyes. Bring your non-injured foot towards your bum to an arbitrary angle of knee flexion (flexion = bend). Then, bring your injured ankle towards your bum and try to match the knee angle, or in other words, try to make your knee angles symmetrical. Open your eyes and check if they are the same or different.
While this is more focused on the knee joints, proprioceptive training of the lower body in general can really help get you started and allow you to regain your lower body proprioception earlier than you would otherwise.
This is one many patients will roll their eyes at, but like the exercise above, it’s a great way to get started with improving ankle mobility and proprioception when protecting the injured ankle is still a high priority.
In this case sit with your ankle out in front of you and trace the letters of the alphabet with your foot and ankle, but avoid rotating your hip and leg when you are doing this. It is important to visualize the letters you are tracing, as this will help restore the connection between your ankle and your brain.
This should be done within a pain-free range of motion, and if the full alphabet is too much to get through, simply stop when you are uncomfortable and try to do a little more each time.
This is a very simple exercise. Sitting in a chair, place your foot flat on the floor. While keeping your foot flat on the floor, slide it forwards and backwards within a pain-free range of motion.
While this is a simple ankle range of motion exercise, it can be targeted more towards proprioception by giving yourself targets on the floor that your toes have to reach. You can close your eyes or look away and see how accurately you can slide your foot towards the target. This is yet another gentle exercise for ankle sprains.
Balance Board Circles
These ones are surprisingly tough for patients rehabbing ankle sprains, especially if the ankle is stiff and sore.
In a seated position, place your foot in the centre of a circular balance board, also known as a wobble board. Without moving your hip or knee, attempt to lightly touch the edge of the balance board to the floor and move it in a circle while keeping the wobble board’s edge lightly in contact with the floor.
This will require constant adjustment of your ankle, which requires your brain to analyze the information being received through proprioception receptors and associated neural pathways.
With ankle sprains, it’s possible to be too stiff or painful to keep the edge of the wobble board on the floor for a full circle. In that case, keep your movement within a pain-free range of motion, and for the stiff portions of the circle, simply try to maintain smooth control and movement of the wobble board.
Early Static Balance and Prioprioception
Once you are cleared for full weight bearing, there are many different ways to incorporate proprioceptive training into your rehab. The following are relatively simple and common examples of balance exercises for ankle sprains, but are certainly not the only ones you can do.
When first getting back on to your feet, you may notice that single leg balance is highly affected, and it may be difficult to work on if you are sore or your balance is simply too compromised at that point.
To bridge the gap, tandem stance allows you to work on balance and proprioception in a very narrow base of support, but with a little help from the other leg. Place one foot directly in front of the other and keep your balance. This will be more challenging when the injured ankle is the back ankle.
There is no set dose that you need to follow, but I typically recommend 5 repetitions of 20 second holds for this, and that can be split up throughout the day if needed.
Single Leg Balance Progressions
One leg balance is one of the most popular proprioceptive and balance exercises, as it demands your brain to retrieve relevant information from your ankle to make constant rapid adjustments to maintain balance.
Your brain can perceive pressure from the floor, how hard the muscles are working, and if there are any subtle movements within the foot and ankle joints.
The most basic form is balancing with your eyes open, as your vision will help aid your balance and proprioception. Assuming you are cleared for full weight bearing, this usually represents a safe way to work on balance training after an ankle sprain.
To further challenge your balance and proprioception, try closing your eyes. This will remove the visual input that your brain receives, forcing it to rely more on the information being provided by your foot and ankle, thus training ankle proprioception. Many of my patients are quite surprised at how much more difficult this is compared to keeping the eyes open.
Similarly, if you are uncomfortable with closing your eyes and your ankle has recovered enough to work on an unstable surface, then balancing on an unstable surface like a bosu ball, wobble board, foam pad, or even a stack of towels, can further your proprioception training, and will be very challenging for an unstable ankle.
Again, there is no set dose for this, but 5 repetitions with 20 second holds is usually a good starting point.
Advanced Static Balance and Proprioception
To gradually progress the balance exercises above, you can start to move your body over top of your ankle joint, which will now create a multi-joint pattern with your ankle being the foundation for this.
*** While this could technically be considered dynamic, we are referring primarily to the injured ankle, which is staying in the same spot on the floor for the duration of this exercise.
Single Leg Squat
Stand on the injured ankle and perform a squat trying to keep the pressure from the floor in the middle of your foot. To do this, you may have to stick your hips back like a partial pistol squat, or like you’re sitting back into a chair in a controlled manner.
Go slow with the squat motion, as this will provide you the chance to correct any episodes of instability. Additionally, to protect the knee, try to keep your knee in line with the middle of the foot, as opposes to letting it roll or collapse inwards.
This exercises will challenge your ankle to provide the necessary base of support for this functional movement pattern, and given it’s moving into ankle dorsiflexion as you lower, and into relative ankle plantar flexion as you lift back up, you are also working through your ankle range of motion.
In the early stages, I personally prefer 3 sets of 5 repetitions, as this will force you to take a break between sets and re-focus, as well as ensure you don’t over-do it first time around. From there, you can gradually progress the number of repetitions.
Discontinue if painful or advised by your physical therapist to avoid this movement pattern for a given time.
This is one of the most popular body weight strengthening exercises after an ankle or knee injury, but can also be included in your proprioception training program.
For this exercise, you are thinking of standing on an upside-down letter ‘Y’. Your first movement is a normal squat where you reach your opposite leg straight ahead. Come back up to a neutral position, then reach back and out bending the hip, knee, and ankle to reach as far as you can with good control. Come back up to neutral again, then reach back and across, similar to a curtsy squat.
By reaching your unaffected leg in multiple different directions, you are displacing your centre of mass accordingly and you have to try and maintain your balance.
While doing this, try your best to keep your hips facing straight ahead and prevent your knee from rolling or collapsing inwards. Only reach as far as you can with good control and comfort. In other words, don’t push through bad form or pain.
Given that one round of this requires three squats, I like sets of 5 rounds to begin with (so 15 squats total). From there, you can add sets or rounds as desired.
Dynamic Balance and Proprioception Exercises
*** We will consider anything where the body is moving through space and your foot is leaving and then contacting the ground to be a dynamic proprioception exercise.
In this case, more basic dynamic ankle balance exercises for ankle sprains will involve a relatively lower rate of loading, such as side steps with a resistance band, walking, lunges, toe or heel walking, etc.
All of these are great ways to continue pushing ankle proprioception while including multi-joint movements and global strengthening, but we will highlight one of our favorites here.
Side Stepping with a Resistance Band
This is one of the most popular strengthening exercises for the gluteus medius muscle, but can also be included in proprioception training for an ankle sprain.
Using a mini-loop band, or tying a standard resistance band around just above your knees, adopt a partial squat position, or more simply put, an “athletic stance”.
Starting with your feet hip-width apart, step out to the side against the resistance of the band while keeping your feet pointing straight ahead. Then bring the other foot back, also keeping that one pointing straight ahead, bringing it back in to a hip-width apart position again.
While performing this exercise, ensure that you are always pushing out against the band with each leg, even though you are only moving one direction. Stay low, keep the feet pointing straight ahead, and don’t let your knees collapse inwards. You can further challenge your lateral ankle stability and proprioception by bringing the trailing leg back in slower.
I typically recommend 3 sets of 8 steps in each direction as a good starting point, but this can be adjusted based on your tolerance and experience with this type of exercise.
As a side note, this is commonly used to strengthening the gluteus medius muscle and to work on knee control as well, so you may see this exercise pop up for many different types of injuries.
Ladder Agility and Jumping Drills
This phase of rehab will combine strength, plyometrics, a higher rate of loading throughout the ankle joint, and joint stability training, all of which are necessary to optimize proprioceptive training and prevent ankle sprains.
Ladder drills are extremely common in sports settings, but they can hep with rehab for the general population as well, especially those involved in high intensity exercise programs.
There are a variety of ways you can mix in ladder drills. First, it can be helpful to get started with quick feet drills, whereby you are stepping into and out of the boxes as quickly as you can with a specific pattern in mind.
The pattern will vary depending on what you are trying to achieve, and whether or not this has a focus for return to sport or simply getting back into recreational leisure activities. Rapid movements that require coordination and proper ankle placement will really help challenge ankle proprioception.
To work on ladder drills for ankle rehab while also incorporating single leg stability, this can now turn into single leg hopping drills, whereby you again identify a specific pattern to follow and hop in and out of the boxes following that pattern. You will require substantial ankle strength for these drills.
Assigning a specific amount of sets and reps is almost impossible without first assessing the individual’s current capabilities.
Generally speaking, I like to limit these drills to 80% fatigue in rehab settings, just to ensure the ankle can hold up well throughout, and then gradually progress intensity and duration towards the patient’s return to sport goals.
Incorporating any other jumping activity will inherently demand an appropriate amount of proprioception from the ankle, knee, and hip, and as such, can be a good way to work on overall lower body proprioception.
Examples can included box jumps, lateral hop and holds, reactive jumping, or a combination of these. Side to side single leg hop and holds are a good starting point, as this will challenge lateral ankle stability while still offering a reasonable amount of control and flexibility with how much you can play around with this exercise.
Box jumps, especially jumping from box to floor, are a little more advanced, as the rate of loading through the ankle joint will be much higher, so these are typically reserved to the most advanced phases of ankle rehab.
Ankle balance and proprioception exercises are crucial for proper rehab from any ankle injury, and can be applicable for both the general population and elite athletes, especially when it comes to preventing ankle sprains.
There is a huge variety of ways you can challenge ankle proprioception, so the examples listed above simply represent more common exercises and provide a sense of how you may progress these exercises with an ankle sprain.
If you are looking for more specific information or treatment plan as it relates to your injury, we highly recommend seeking a physical therapy consult in-person to ensure a safe and optimal program is designed and you know what you need to work on and avoid at certain times of your recovery.
Kaminski, T. W., Needle, A. R., & Delahunt, E. (2019). Prevention of lateral ankle sprains. Journal of Athletic Training, 54(6), 650-661.
Ma, T., Li, Q., Song, Y., & Hua, Y. (2021). Chronic ankle instability is associated with proprioception deficits: a systematic review and meta-analysis. Journal of sport and health science, 10(2), 182-191.
The content here is designed for information & education purposes only and is not intended for medical advice.