Ankle Strengthening for Soccer Injuries

Ankle Strengthening Exercises for Soccer Players

Soccer is undoubtedly one of the most competitive and physically demanding sports. As such, it’s also strongly associated with a high injury rate.

One of the most commonly diagnosed injuries in the game is ankle injuries, specifically the notorious ankle sprain.

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Normally, the consequences are not that severe and if its the first sprain most players can return to soccer practise within a few weeks.

Unfortunately, injuries that damage ankle ligaments tend to reoccur because the ligaments get stretched out. 

While the player may suffer from reduced physical activity and endurance levels and lost game time the biggest risk is chronic ankle instability. An injury that is extremely difficult to recover from. 

In this article, we will review risk factors of ankle injuries and why they affect soccer players, as well as identifying how you can apply ankle strengthening exercises in terms of prevention, pain treatment, and rehabilitation.

What Is An Ankle Sprain?

Most ankle sprains are triggered by the foot accidentally rolling inwards and damaging a ligament known as the anterior talofibular ligament, which you can locate in the middle-right section of picture:

anterior talofibular ligament

Source: https://en.wikipedia.org/wiki/Anterior_talofibular_ligament 

After an ankle sprain, the ligament is normally stretched but rarely completely broken.

What most players do in this case is simply to rest and wait for the swelling to go down, before quickly getting back into action.

As you may suspect or have experienced, this is rarely a sustainable solution and usually results in the same injury returning just a few weeks later.

The ligament is then stretched even further and unless you undergo a proper ankle sprain rehabilitation, it’s likely that the problem will continue.

What causes an ankle sprain?

Ankle injuries among soccer players occur for several reasons.

According to research, some of the most common risk factors include lack of structured warm up, insufficient training, chronic fatigue, previous injury history, and foul play [1].

Another hot topic that you may be familiar with is the potential relation between ankle injuries and soccer games played on artificial turf.

Although some studies suggest that there’s a connection between the two, further research is required before any conclusions can be drawn [2, 3].

How common are ankle sprains in soccer?

Studies show that elite soccer players experience as many as 13 to 35 injuries per 1000 competitive player-hours, of which 74% are caused by direct player contact [4].

Out of these, the lower limb is most commonly affected with the ankle making up to a third of all injuries [5].

If we review the statistics further, soccer had more foot and ankle related injuries than any other team sport during the 2004 Olympics [6].

In the 2010 FIFA World Cup, ankle sprains were one of the most diagnosed injuries and out of these, close to 50% prevented participation in training or competition [7].

More recently, a study of an English Premier League club showed that 20% of the team’s injuries during a four-year period consisted of foot and ankle injuries [8].

The most striking data, however, are that 75-80% of all ankle sprains are relapse injuries [8].

This is obviously bad news since every time you sprain your ankle, the ligaments around your foot are stretched further and further, which can result in permanently reduced ankle function.

Fortunately, there are precautions that can be taken to prevent this.

What to do if you sprain your ankle

When you encounter an acute injury such as an ankle sprain, blood rapidly begins streaming to the damaged area.

As a result, pressure around that area is increased and triggers pain in the ankle joint.

It may also lead to a lack of oxygen in the tissue around the ankle, which could cause further tissue damage.

Basically, the more blood that flows to the damaged area, the more severe your ankle sprain will be.

This is why the immediate thing you should do is to follow a treatment process known as RICE: Rest, Ice, Compression, and Elevation.

In the next sections, we will explain each step in more detail.

1. Rest

Firstly, when you suspect that an injury has occurred; play it safe and end the activity you were performing as soon as possible.

The reason this is so important is due to the fact when a specific muscle group is highly activated, the blood flow to that muscle area will be up to 10 times higher compared to when in resting state.

While this physiological function is beneficial during physical performance, it actually turns into a disadvantage when you encounter a tissue damage.

Thus, the sooner you can reduce the blood flow to the damaged tissue, the better.

The other obvious reason why you want to end the activity as soon as possible is to prevent the injury from turning worse. If you neglect this and continue the activity, what started as a partially torn muscle could easily transition into a complete muscle rupture.

During the rest process, you should also avoid exposing the damaged muscle or joint from any high impact movements within the first 24-48 hours after the injury occurred.

A simple way to do this if you suffer an ankle sprain is to use crutches, which will help to support your foot and ankle.

2.Ice

After you’ve ended the activity, you can beneficially cool down the damaged area by applying an ice bag to your ankle joint.

As a precaution, you may use a thin piece of cloth between the ice bag and your ankle to avoid direct contact.

Although some studies suggest that the ice might slow down the blood flow to the damaged area, the main function with applying ice is to reduce pain.

The recommended time frame for this step is to place the ice bag on your ankle for approximately 20 minutes.

3. Compression

Compression is the most effective step in the RICE treatment when it comes to decreasing blood flow to the damaged area, and thus, lowering the swelling.

By wrapping your ankle with an elastic bandage, you may decrease the blood flow by as much as 95%.

For maximal effect, you should wrap your ankle as tightly as possible, especially right after the injury has occurred since that’s when the blood flow is at its peak.

If you experience the pressure from the elastic bandage as somewhat painful, that’s completely normal. What you may do then is simply to ease up the wrap a bit. However, try to keep it as tight as possible for at least the first 10-15 minutes.

In total, the elastic bandage should stay applied for approximately the next 24-48 hours after the injury.

A common question is whether it’s safe or not to keep your ankle wrapped overnight. As there is little research regarding this concern, your best option is to consult with a physiotherapist.

If you are still unsure, simply take off the elastic bandage while you sleep and wrap it on again the next day.

4. Elevation

The purpose of the elevation step is once again to reduce the blood flow to the damaged area and should primarily be applied during the first day after the injury.

In order for this step to aid in minimizing the swelling of an ankle sprain, make sure to place your foot above the level of your heart.

This can be achieved by using a pillow to support your foot into a higher position, any time you sit or lie down.

Elevation may also be a good alternative to compression during the night if you decide to not sleep with an elastic bandage.

Does RICE really work?

There have been many discussions regarding the effectiveness RICE [9, 10].

According to some critics, this treatment is outdated and perhaps not as efficient as first perceived.

However, while the evidence for RICE is limited, there is research that suggests it could have a positive impact on the rehabilitation process of ankle sprains – especially among athletes [10].

With that said, RICE alone should not be considered a cure for ankle sprains.

Instead, it should be view as a complementary treatment during the first 24-48 hours after the injury has occurred, with the main purpose being to minimize swelling and pain reduction.

After this critical stage has passed and you have completed all of the steps in RICE (Rest, Ice, Compression, and Elevation), it’s extremely important that you begin to mobilize and activate the damaged area to accelerate the healing process.

Should you tape your ankle?

The average rehabilitation-time to allow ankle injuries to fully heal is 12 weeks. Of course this is an extreme simplification as each case is going to be unique. In pro sports it happens regularly, guys will be given a 12 week recovery and by week 9 they're back. Of course the opposite tends to occur as well - players aren't able to return as quickly as they'd hope. 

One way to provide support to the ankle, after an injury is by taping (kinesiology) it. Another option is to find an ankle brace that works with your cleats, and shin pads, which is easier said than done. Personally, I had to modify my shin guards and wear a larger sock to slide a minimal ankle brace underneath.

By supporting your ankle through taping, you are likely to be able to resume soccer practise within 2-4 weeks and can then simply continue your rehabilitation program separately. Again, this is going to vary from athlete to athlete and following the treatment plan given by your physiotherapist is the best course of action

As a general guideline, it is not a bad idea to continue to tape your ankle well after your injury.

Which ankle strengthening exercises should you do?

Regarding the topic of what is the most optimal way to treat an ankle sprain, there is still a lack of research and evidence-based literature available.

Many investigations point to strength- and balance- training as most effective.

The main goal for recovering from an ankle sprain is to attempt to rebuild the same full function of the ankle that existed prior to the injury, this strengthening your ankle and working on improving your range of motion. 

In this section, we will present a general training program aimed at helping you to achieve that goal. 

Before beginning this training program, you should keep in mind that it is not optimized to suit all ankle injured soccer players out there. if you're planning on returning to action visit a Physiotherapist who can assess the injury and provide a specific action plan. 

Lastly, the timetable for this training program is VERY approximate.

First-stage mobilization (day 2–12)

After the acute phase of your ankle sprain has passed, the first 24-48 hours, it’s time to progressively start using your ankle again.

Since the swelling in your ankle joint will affect its range of motion negatively, once swelling has gone down you can begin to work on recovering range of motion. Remember to listen to your body.

Keep in mind that during the most severe ankle sprains, the swelling may last for up to 10 days and as result, you might need to prolong the first-stage mobilization phase until the acute pain has decreased.

Below, you’ll find two different ankle strengthening exercises you can follow.

1. Active dorsal and plantar flexion:

Simply take turn between extending and bending your injured foot as far as you can, without any aiding equipment.

Aim for 20 repetitions for a total of three sets.

2. Stretching the calves:

Stretch your calf muscle (gastrocnemius and soleus) by using both an extended and a bent knee.

Aim to stretch 30 seconds for a total of three sets.

Additional to performing these two exercises, you can maintain your condition levels and stimulate your foot and ankle joint by biking.

Late-stage mobilization (day 12–42)

By this stage, the majority of the swelling around your ankle joint should hopefully be gone and this means that you can start to use the injured foot for walking again.

It’s also time to start rebuilding and improving the strength and balance in your foot joint, to the same level as prior to the injury.

During ankle sprains, both the postural muscles and the peroneus muscles are affected negatively, particularly when it comes to balance, reactivity and strength [11].

Thus, you need to dedicate time to reactivating these muscles through various exercises such as the following examples.

1. Calf raises:

In order to achieve a full range of motion, begin with placing your feet on a block stop or a calf block. If you don’t have the proper training equipment, you can use a stair step.

Now, position your feet on the edge of the block or the step.

Make sure that your toes point forward, your back is straight, and your abdominals are pulled in.

Next, raise your heels a few inches above the edge, so that you’re standing on your toes. Hold that position 2-3 seconds, before slowly lowering your heels back to the starting point.

Repeat 20 repetitions for a total of 3 sets.

2. Activating the peroneus muscles with a therapy band

There are countless of exercises that you can do to train your peroneus muscles.

This is a very simple example that you can do at home as all you need is a therapy band, a chair and a table.

First, sit on the chair and position yourself next to the table. Make sure that the furniture does not move.

Put one end of the therapy band around a table leg, and the other on the outside of your foot.

Now, your foot should be turned slightly inwards and from this position, slowly turn your foot outwards (only your foot, not the entire leg) so that you can feel it stretch.

Repeat 20 repetitions for a total of 3 sets.

Remember to keep your knee stationary throughout the entire exercise.

3. Balance board or Bosu ball

Take turns between balancing on both feet or only the injured foot on a balance board.

This exercise can progressively be made more difficult by bouncing a ball against a wall, at the same time as you try to maintain your balance.

Perform the exercise on a daily basis for at least 10 minutes per day.

Coordination and reaction-stage mobilization (day 43–90)

When you have reached this stage, your balance and strength should be close to pre-injury levels. 

The only two components you might be missing now is your coordination and reaction abilities.

These can typically be improved through variations of jumping exercises or basic strength exercises.

Eventually, you can also start to re-introduce smaller exercises that are more soccer-specific.

2. Jumps

As mentioned above, there’s a ton of different jumping exercises that you can apply to rehabilitate your ankle.

One of the most basic ones is to have a starting point from which you begin a cycle of jumping one step forward, one step backward, one step right, and then one step left.

To add a bit more excitement to this exercise, put your timer on 1 minute and try to perform as many rounds as possible.

Furthermore, you can do zig-zag jumps between cones, or start with short-distance jumps that you successively increase to long-distance jumps.

Aim for 2-3 variations of jumps and perform each exercise for approximately 60 seconds.

2. Strength exercises

Performing strength exercises are not only a good way for you to increase your strength levels and prevent future injuries, they can also be used to improve your coordination and stability.

A great example is the military or shoulder-press where you simply finish the movement by standing on your toes.

Obviously, this exercise should be performed carefully and with the purpose of stretching and balancing your ankle, rather than lifting heavy loads.

As for re-introducing soccer-specific exercises, a good start would be to begin with low-intensity movements that don’t put too much pressure on your foot, such as dribbling the ball between cones.

What about ankle sprain relapses?

As we have discussed and previously mentioned, 75-80% of all ankle sprains are relapse injuries [8].

It is also relatively common that players who previously suffered a major ankle injury will encounter a similar or less serious relapse-injury.

This could be a sign of that your foot and ankle joint are still not fully recovered and that you need to continue or start over with parts of your rehabilitation process.

Conclusion

Ankle injuries and relapse of ankle sprains are extremely common among soccer players.

Although there is still a high need for further research on how to best treat and rehabilitate ankle injuries, following the RICE treatment and undergoing a proper training program is a first step to prevent relapse.

Even if performing ankle strengthening and rehabilitation exercises might not be the most motivating way to spend your time, keep in mind that it could improve your chances to return- and remain- on the soccer field with your teammates.

References

[1] https://www.sciencedirect.com/science/article/pii/S0949328X1400060X         

[2] https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2577464/

[3] https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2465249/            

[4] https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4716575/

[5] https://www.ncbi.nlm.nih.gov/pubmed/12860543  

[6] https://www.ncbi.nlm.nih.gov/pubmed/19361341  

[7] https://www.ncbi.nlm.nih.gov/pubmed/21257668  

[8] https://www.ncbi.nlm.nih.gov/pubmed/25457658  

[9] https://www.ncbi.nlm.nih.gov/pubmed/21903616  

[10] https://www.sciencedirect.com/science/article/pii/S0735675714004276  

[11] https://www.ncbi.nlm.nih.gov/pubmed/23899892