How to fix bad ankles (article in the NYT)

http://well.blogs.nytimes.com/2009/0...bad-ankles/?em

copied from article:
Why should balance training prevent ankle sprains? The reasons are both obvious and quite subtle. Until recently, clinicians thought that ankle sprains were primarily a matter of overstretched, traumatized ligaments. Tape or brace the joint, relieve pressure on the sore tissue, and a person should heal fully, they thought. But that approach ignored the role of the central nervous system, which is intimately tied in to every joint. “There are neural receptors in ligaments,” says Jay Hertel, an associate professor of kinesiology at the University of Virginia and an expert on the ankle. When you damage the ligament, “you damage the neuro-receptors as well. Your brain no longer receives reliable signals” from the ankle about how your ankle and foot are positioned in relation to the ground. Your proprioception — your sense of your body’s position in space — is impaired. You’re less stable and more prone to falling over and re-injuring yourself.

For some people, that wobbliness, virtually inevitable for at least a month after an initial ankle sprain, eventually dissipates; for others it’s abiding, perhaps even permanent. Researchers don’t yet know why some people don’t recover. But they do believe that balance training can return the joint and its neuro-receptor function almost to normal.

Interesting... I know that a large portion of the PT I did for both of my knees (different injuries) focused on balance training.. I always assumed it was to strengthen supporting muscles so you weren't as prone to re-injuring the joint.

My right knee has never been 100% since I messed it up (tore my ACL, MCL, did a TON of cartilage and other soft tissue damage). I also can't feel most of the area around it because of the surgery... now I wonder if that is why I just don't feel like I can "trust" it, even though it's been 13 years since it was injured/rebuilt, and I've had reassurance from both my ortho and several different PT's and 9 months in recovery that it's as good as it was before... but my brain still tells me it isn't.

ankle/balance exercises really work. Twice in the last year I tripped and amazed myself on my automatic instant recovery... with my other foot.

Whenever I am in a line, or waiting, I am on one foot or the other. At work at my sit stand desk i can stand here like a crane, with one foot up and the other down. the more of this I've done, the better my balance has become. the stakes for women are very high. Something like 90% of us are going to get Osteoporosis in our lives. And if we can keep our sense of balance, we're just not going to fall as often!

And when you're constantly fighting post-head injury dizziness on a daily basis it's really important!

Way back after my concussion, and my Doc referred to me as one of his "dizzy blond patients" - I was signed up for a jazz dance class. I had a real hard time doing stuff, like pirouetts and even floor exercises that I used to be able to do pre-injury. After talking to my doctor, my dance instructor, and the head of the dance department, the compromise was that I would audit the class. That way my instructor was not pressured into trying to grade me, and I wasn't working for a grade, it was PT. As it turned out my dance instructor was interested in teaching "community" dance classes anyway, so having a "handicapped" student in his class, and working through the balance issues was a personal challenge for him.

But on a bad day when I'm tired, my balance is more likely to be off, and after 25 years, I can still feel where I got hit in the head. But I think I'd be worse if it wasn't for the dance classes.

I almost always include some balance work in the strength segment of my aerobics classes. I try to combine standing on one leg with some one-handed strength moves to create instability, because if I do balance alone the students will get bored because it doesn't "hurt." :rolleyes: Hopefully some of them will have read this... maybe I should print it out.

I still wrap my bad ankle when I'm doing a lot of lateral movement, like aerobics, or when I know I'm going to be walking on unstable surfaces, but I haven't sprained it in, oh, at least five years (touch wood).

I used to sprain my left ankle in gymanstics a lot when I was young - my left calf is still a cm or two smaller than my right - because I just utterly don't trust that ankle, and I still sprain it at the drop of a hat or a hole in the ground. Maybe I'll get a balance board and work at it a bit and see if I improve things.

Back when I used to injure my ankles more, besides balance training, a doctor that I worked out with in karate recommended the following exercise:

Spell out the alphabet with your toes in the air. Do this a few times throughout the day. You can do this while you are sitting at a desk.