Q: I recently turned my ankle and suffered a pulled ligament as a result. After 10 days in a cast and a week in an ankle support, Im now able to run again. But Im concerned about long-term weakness. Is there anything I can do to strengthen the ankle, and should I run in a support?
A: Once you have been in plaster, your calf muscles and leg muscles generally will waste. If specific work is not performed to rectify this, there is a chance that, sooner or later, further injury will occur. So you are absolutely right: you do need to strengthen and re-educate the ankle.
Get hold of a latex rubber strip usually called a cliniband or dynaband which you can use to strengthen the calf. Try sitting on the floor with your leg straight and hooking the band around the forefoot. Attach the other end to a table leg (or something immobile at the height of your foot) so that you can use the band as a resistance to strengthen your ankle. Position yourself so that the band resists both the flexion and rotation of your foot. Do three sets of 1215 repetitions of each every day.
In addition, you lose proprioception in a joint that has been injured and immobilised. This means the cells in the ankle that would normally tell your brain where the joint is in space (without you having to look), are temporarily switched off. You need to stimulate them into action by performing balancing exercises. Try standing on one leg with your eyes closed for two minutes. Make sure that youre near something you can hold on to in case your balance isnt as good as you thought.
As for an ankle support, one may be helpful if the ligament is stretched to such an extent that it cant function properly. Ligaments act as strain gauges, and normally give information to your brain to tell the muscles to contract to protect the joint. If the ligaments are loose, the joint can be damaged before the ligaments recognise that its being put under pressure. In this case, a support can be helpful to physically limit the movement in a joint.
Martin Haines, chartered physiotherapist and sports injury specialist