Ankle Instability

Ankle Instability? Try the dot drill!

Written by Stacy Ciarleglio, a licensed athletic trainer and ultra runner. 

 Many of us have sprained our ankles at some point in our lives. A lot of people don’t think ankle sprains are a big deal. They are one of the most common athletic injuries, and, if given enough time, the swelling eventually goes down and you can resume activity. That’s where a lot of problems begin. For runners, particularly those who enjoy running on trails, those ankle sprains of the past could come back to haunt you.

Running on uneven surfaces like a trail (or an uneven sidewalk) requires ankle strength, balance, and proprioception. The ankle is a very mobile joint. Its large range of motion allows us to perform a variety of movements including running, jumping, and cutting. The same mobility that makes it possible to perform those activities also contributes to its vulnerability.

There are three major ligaments on the lateral aspect (outside) of the ankle that contribute to the stability of the joint. The muscles around the joint, most notably, the peroneals, provide added stability. The most common sprain is a lateral ankle sprain which is caused by ankle inversion, or a “rolling in” of the foot and ankle. When this type of sprain occurs, the ligaments are overstretched, and often, there is an onset of swelling, pain, and loss of motion. The swelling inhibits normal function of the muscles and reduces proprioceptive feedback from the ankle to the brain, resulting in a dysfunctional ankle. 

The biggest problem after a sprain is the resulting instability of the ankle. The ankle relies heavily upon proprioceptive feedback. Proprioception is the body’s awareness of itself in space. When the receptors in the ankle sense that it is in a vulnerable position, it sends this message to the brain. The brain then responds with a message to the muscles of the lower leg (peroneals), to contract to protect the ankle. After an ankle sprain, proprioceptive awareness is decreased. As a result, the body cannot react to help stabilize the ankle. Often, there will be recurring, nagging, sprains of the ankle. Sometimes they are major, involving swelling and the inability to continue activity. Most commonly, the sprains are minor and don’t cause much swelling if any at all. Since there is no injury to really “see,” people don’t think much of it. These recurrent ankle sprains can be very annoying and potentially harmful to the long term health of the ankle joint. 

To prevent or rehabilitate an ankle sprain, the focus must be on increasing ankle strength, balance, and proprioception. One of my favorite exercises is called the dot drill. This drill incorporates a change of direction in many different planes of motion, making it very functional for athletic activity. Some gyms have dots already painted on the ground. If not, you can make dots on the floor with athletic tape, or, imagine the dots are there (that’s usually what I do)! There should be five dots; four corners with one dot in the middle. Start at a corner and on a single leg, hop to the side to the get to the other corner. From there, hop to the center dot, then to the two opposite corners. Then hop back to the starting dot and repeat three times. When you are done, switch directions and repeat three times the opposite way. It should be done slow enough that you are working on balance on each dot, but not so slow as to allow your ankle to rest at each dot.

This drill helps your body to react quickly to stabilize the ankle, while getting ready to move in another direction. This can come in very handy while running on a rugged trail (or making a cut in basketball or another ball sport). I rely on this exercise so much for my own ankle stability, that I will actually yell out “dot drill” to my running partner after the many near ankle sprains I’ve experienced while running trails.

Many runners will ask me if there is some sort of brace that they can wear while they are running. This is a tough question since most people don’t like to run with a lot of bulk on their ankle, but they are still looking for support. I have found the CEP RxOrtho Ankle Support to be the perfect combination of being low profile enough to run with, while providing enough proprioceptive feedback that it helps to stabilize the ankle. The graduated compressive qualities of the CEP ankle support make it helpful in reducing any swelling that may be present in the joint. I am not quick to recommend braces for activity as I prefer strengthening the body to protect itself. If proper rehabilitation exercises are being performed and the runner is just looking for something to provide added support, I have no problem recommending this brace.  

Whether you are looking to return to running after an ankle sprain, prevent one from occurring, or are just trying to improve your agility, the dot drill is a great exercise to add to your pre or post run routine. You’ll appreciate the increased ankle strength, balance, and proprioception so much that you might find yourself calling out “dot drill” next time you feel your body prevent an ankle sprain!