Video Transcript: Chronic Ankle Sprains

Hi, everyone! Dr. Orit Hickman here from Pain Science Physical Therapy.

Today, I’d like to talk to you about chronic ankle sprains. So, you or someone you know might be experiencing this: You’re walking along. You’re feeling fine. And then, all of a sudden, your ankle gives way. 

I have treated many different patients who come in with this diagnosis. The most common, believe it or not, are typically young patients who are highly active who sprain their ankle once on the field while they’re playing a sport. And then, they continue to have these persistent ankle sprains that sort of dog them. They just keep bothering them over and over and over again. And then, I’m treating them as an adult, and they’re telling me, “Oh ya. I’ve had ankle sprains since I was a little kid.” So, I want to talk a little bit about what it is that’s actually happening when this is occurring and how you can treat this. 

Sometimes, this is happening because you’ve actually damaged the ligaments so significantly that they’re no longer holding the bones together. It’s really important to know that that’s not as common as the other thing that we’re going to talk about. Ok? So, yes. Patients will actually injure their ligaments so severely that they lose the connective tissue [and the] integrity of the ankle joint. And, some will need surgery as a result of it. But, most of the time, if you’ve been through physical therapy for an ankle sprain, you go through the process of strengthening all [of] the muscles around the ankle joint, and then your ankle feels a lot more solid than it did before you sprained the ankle and injured the ligaments. So, that’s one scenario. 

But, it’s actually not as common as this next scenario, which is that when you go to sprain the ankle, there’s something that happens. As soon as you have this huge inflammatory response around the ankle, your brain gets disconnected from the ankle. It’s almost like the brain kind of gets foggy about where the ankle is in space. 

So, the reason why this is a problem is that every time you go [to] take a step, your brain is really tuned into the sensory information in your lower body so that it knows where you are in space. But, if you sprain the ankle and now your brain is kind of foggy about where that ankle is, then when you go to step, your brain might forget to control the ankle, and the ankle might twist. 

So, this is a super common thing. Patients will often say that they really were doing nothing when the ankle gave out on them and it does it all the time. It’s very common for patients to experience this on both feet, so bilaterally.

And so, I want to talk about a really simple thing that you can do. You’ve probably seen some of my videos that talk about how to strengthen your feet. Those videos are also great for strengthening your ankle. Any of my balance videos [are] also great for that. 

But, if the reason that the underlying reason that the brain--the ankle is starting to sprain is because your brain is foggy about where the ankle is in space, then a really simple activity is every step that you take, I want you to think about the ankle. So, if it’s the right ankle, then every step that I take, when my right foot hits the ground, I’m going to go, “Right. Right. Right. Right. Right.” 

And then, the other thing that I’m going to do is I’m going to look at people’s right feet. So, let’s say I’m sitting around and there are people walking past me. I’m going to be looking for people’s right feet. I’m going to be like, “There’s a right foot. There’s a right foot. There’s a right foot.” 

The more often that you do this, what it does is it helps your brain find your right foot because here’s the thing that’s important to note: You actually have images of your body parts on your brain. You’re born with this. So, your brain has a picture of a right ankle, and it has a picture of a left ankle. And, it needs to have those images be very, very crisp and clear and in focus. Now, remember when you’ve sprained your ankle, that image gets kind of fuzzy or blurry. So, doing things to help your brain be connected to the ankle and foot will help that image become crisp and clear. [The] easiest way to do that [is to] look at lots of feet. 

So, when you’re going around and you’re walking through--let’s say you’re walking on a surface that you feel a little unstable. Focus in on that ankle that feels unstable. Really think about it with every step. And then, when you get the opportunity, look at other people’s feet. These are simple activities to do. They help to clarify that image of our body part in your brain. And then, you want to follow it up with exercises. You want to do balance exercises. You want to do different things to help your brain be very, very connected in with that body part.

I hope this helps. This is just one simple suggestion for helping to clear up having persistent ankle sprains. If you thought this video was helpful, I would love a thumbs-up. If you have any questions or comments, please leave those below. And then, if you’d like to have more videos on persistent pain, then please subscribe to my youtube channel. Thanks!