Optimizing Ankle Instability Rehab

Hi guys, I’m Mai-Linh Dovan, Certified Athletic Therapist and Founder of Rehab-U Movement and Performance Therapy. 

Welcome to our YouTube channel!  This week, we’re going to talk about using wedges to optimize your ankle rehab. 

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Now, we know ankle sprains are a common injury, lateral ankle sprains are a common injury in sports.  We have Virginie here who’s actually had  several ankle sprains. 

Normally with ankle sprain rehab, especially initially in your earlier rehab process, you’d be concerned with restoring mobility, particularly restoring end ranges of motion.  For example, end range dorsiflexion and end range plantar flexion, which are of particular importance.

With someone who has had several ankle sprains, like Virginie,  you will often find a lot of laxity, so we can observe that she doesn’t have a range of motion problem. This means, we don’t need to work on end range plantar flexion or inversion range of motion with her.   She’s got plenty of room there. In fact, with Virginie, I can almost create a fulcrum with that lateral malleolus and just bring that foot plantar aspect of the foot all the way inside. 

So, there is no need for range of motion work here. However, what she does need in her mobilization sequence is for us to work on proprioception.

When someone has a lot of range, or laxity, what I like to do is bring them into a vulnerable position, so bring Virginie into her end ranges and do proprioception work from there. I’m trying to populate those specific ranges of motion. 

This is where our wedges come into play. 

So, what we’re going to do first for Virginie in the mobilization sequence is we’re going to get her in a little bit of an inversion position. Note that we don’t want to get her too much in inversion. We don’t want to put her in a dangerous position but we’re using the wedge to get her into a little bit of inversion. 

From this position, we’re going to do an object tracking exercise where we’re stimulating the visual and vestibular system. She’s crossing the ball overhead, following it with her eyes as well as with her head. And you can see how that challenges her stability, and we’ve put her in that vulnerable position, just enough inversion that she’s not going to roll over on that ankle. So that’s an example of something that we would do for her in the Mobilization sequence. 

In the Activation sequence, we  want to continue to work on end ranges of motion. Something that’s often lacking with many people who have had several ankle sprains and have chronic ankle instability, is end range plantar flexion strength. 

So what we can do is use the wedge and get her into a plantar flexed position, and from there she will perform a calf raise using repeated isometric holds.  She’s going to hold the top position for 10 seconds (or until she gets a calf cramp, which often does happen).  Then, she can take a break from there for five to ten seconds and she’ll do repeated isometric holds for five times ten seconds. 

The angle of the wedge can also be progressed to increase the plantar flexion range of motion from which she starts.

And then, because Virginie has a lot of inversion range of motion, we want to strengthen that lateral aspect of the ankle. We can use the wedge to get her into an inverted position and have her do an eversion raise, where she’s starting from inversion and working up and into eversion.  Remember, plantar flexion and eversion are ranges that we often forget to work.  Typically, we have done calf raises and we have done plantar flexion, but we haven’t really integrated those end ranges of motion. And with Virginie, we need to be very concerned with that because she’s got so much of that range of motion. 

So those are things we would be doing in the activation sequence using repeated isometric holds (5 times 10 seconds).

Next, in the Integration sequence, we’re also going to use the wedge to load her in a vulnerable position. In this instance, we’re going to get her once again into an inverted position and we’re going to have her do a functional reach: she’s reaching over the foot and back up. A functional reach is essentially a lunge variation, but the reaching aspect creates rotation of the torso over the lower extremity.

We can have Virginie reach even further over the front foot,  so she’s getting into that inversion position, loading that inverted position.   This is an example of a loaded integration exercise using the wedge to load specific, vulnerable positions.

Then, of course we want to work on something dynamic where her center of gravity is rapidly displaced laterally, forcing her into that inversion position and requiring her to control that and get out of the position. 

Banded lateral jumps are a great exercise for this.   The bad resistance is pulling her laterally in the direction that we want and she’s going to land and jump.  So we use extra resistance to pull her further into the affected plane, or in that vulnerable direction, and we have her push rapidly out of the position. 

So, this is an example of a progression that allows you to see what we would do in the Mobilization sequence, the Activation sequence, and the Integration sequence. In Virginie’s cas, we do not need range of motion, but motor control, and proprioception. 

Then we want to strengthen those end ranges or activate muscles in those end ranges,  and finally put her under load in those vulnerable positions with loaded and dynamic integration exercises. 

Hopefully, this gives you some ideas on how to use wedges to optimize your ankle rehab. Often times, we need to get athletes in those vulnerable ranges, we need to get them beyond the ranges that they’re used to working in and have that inclination using the wedge to get them there. Using wedges is super, super helpful to get into those little areas that we are typically not getting into. 

So, if you are working with athletes who have had chronic ankle sprains and you found this video helpful, please do let me know in the comments and we’ll see you in our next video.

Mai-Linh Dovan M.SC., CAT(C)
Certified Athletic Therapist
Founder of Rehab-U