Q and A (Ankle Mobility and an Ouchie)
Q: Hello Mr. Gentilcore,
I am a college basketball player and I suffered an ankle sprain this past December and after going to physical therapy I still have a pinching tightness in the anterior part of my ankle that comes whenever I try to stretch my achilles. I have been unable to regain mobility in that ankle because any time I try to do mobility work the anterior part of the ankle becomes so painful I can barely bend at the knee. My one-legged jump on that foot has drastically decreased (and I feel pain upon landing) which has me a bit worried for next season. I thought it was scar tissue in that area but the PT was not convinced. Any ideas as to what the issue imay be would be greatly appreciated.
A: First off, no need to call me Mr. Gentilcore. It sounds way too serious and “proper” for my liking. Mr. Bad Ass Mofo sounds a lot better. Kidding of course. Seriously though, Mr. Captain Awesome will work too.
Here are some quick bullet point thoughts on your situation:
1. First and foremost, you may just need to find a new PT. At Cressey Performance, we have yet to meet one basketball player who doesn’t have a ton of scar tissue in their ankles. The fact that your current PT is “unconvinced” doesn’t make sense to me. To be honest, he probably doesn’t know how to perform really good soft tissue work anyways. Time to kick him to the curb. No really, kick him. Hard.
2. Do you walk around barefoot at all? Many of our athletes train barefoot and we always tell them to get out of their shoes as often as possible. Doing so may help regain some of that “lost” mobility and help you re-learn how to use all those small, intrinsic muscles at the bottom of your feet.
3. Are you doing any soft tissue work in your calves? Below is a great video from Bill Hartman, a superb PT in the Indianapolis area and co-creator of the Inside Out dvd. I’m willing to bet if you do a little extra work on your calves, the ankle may start feeling better.
4. You need to regain some proprioceptive feedback in that ankle.
According to Eric Cressey, unstable surface training doesn’t have a lot of merit in HEALTHY individuals, but does have quite a bit of use with someone in your situation. Essentially, following an acute lateral (inversion) ankle sprain, chronic lateral instability develops in 20-30% of patients. This chronic instability (also known as Functional Ankle Instability) is predominately related to residual pain and an increased risk of sprain recurrences due to delayed proprioceptive response.
Individuals with FAI, require significantly longer to stabilize in both anterior/posterior and medial/lateral directions after a single leg jump landings. Furthermore, activation patterns are altered prior to landing as well, so it is apparent that there are feed-forward mechanisms at work. Long story short, it probably wouldn’t be a bad idea to include “some” unstable surface training into your programming such as slide board reverse lunges and/or wobble board exercises to help improve any proprioceptive deficits that may be lingering.
PS: get a new PT