Soccer requires a lot of sudden stops, cutting, jumping and landing movements, which have all been shown to increase the risk of lower extremity injuries, especially to the ankle. Ankle sprains account for about 80% of all soccer related injuries, and the average time lost from play is roughly 48 days. Given the high prevalence and long recovery time associated with ankle injuries, implementing prevention strategies is key to keeping athletes healthy on the field.

Mechanism of Injury

50% of soccer related ankle sprains occur during contact with another player. Other common mechanisms include:

• Overuse;
• Tripping on grass;
• Jumping, twisting and landing;
• Tackling;
• Shooting/kicking.

What are the risk factors for an ankle sprain?

• If you have sustained an ankle injury in the past, you are 7 times more likely to injure your ankle again;
• Muscle tightness (specifically in the calves);
• Slower reaction time;
• Poor proprioception;
• Poor balance;
• Playing on artificial turf;
• Poor lower limb power.

While the above risk factors are modifiable and can be changed, it is predicted that 30% of ankle sprains occur due to a chance event that cannot be avoided.

What exercises can you do to prevent an ankle sprain?

1. Proprioceptive exercises are designed to optimize the ability of the dynamic stabilizers to protect the joint. Exercises should work on balance in a static position, progressing to dynamic movements, including equipment such as a bosu or balance board to allow adaptation to unstable surfaces. These exercises will eventually become more sport specific to include balancing tasks, along with kicking or throwing motions. The greatest benefit in injury reduction comes from exercises that are sport specific and include a cognitive task at the same time (i.e., reacting to stimuli or decision making).
   • Examples:
     Easy: Eyes open single leg balance; eyes open single leg balance with leg swings;
     Moderate: As above, but with eyes closed;
     Harder: Standing on a bosu/balance disc/pillow with single leg balance adding leg swings or ball toss.
   • Pick 1-2 balance exercises and repeat on each leg for 30 sec. (2 sets each). Progress the difficulty as you improve.
2. Plyometric and agility exercises are designed to enhance joint stabilization and help prevent impending ankle rollover events. Using an agility ladder is a great way to improve footwork, coordination and your ability to react and change direction quickly.
   • Ladder drills: In/Out moving forward, in and out moving laterally, 2 feet in and pause, etc. Progress these exercises by increasing speed and adding a ball toss, kicking, dribbling, reaction tasks, etc.
3. Reaction time exercises: At SPSC we use Blazepods, a flash reflex training system that uses visual cues (pods that light up), and prompts you to challenge your speed, agility and reaction time. The exercises are fun, challenging and motivational.
   • Plank hold with reaction tap: While holding the plank position, the athlete must tap out the pod that lights up. The goal is to get as many hits as possible while maintaining the plank position for 30 seconds.
   • Single leg balance with reaction tap: While standing on one foot, the athlete must react and tap out the pod that lights up. The goal is to get as many hits as possible while staying balanced.
   • Reaction time, speed and agility. Athlete must run between all 4 pods and tap out the pod that lights up. The goal is to get as many hits as possible in 30 seconds.
4. Strengthening exercises of the trunk, hip and knee help optimize neuromuscular control. The three key exercises shown in a recent study include bird dogs, bridges and monster walks.
   • Bird Dogs: Begin on all fours, placing your hands under your shoulders and knees under your hips. Maintain a flat back and activate your core. Raise your right arm and left leg keeping your back straight. Hold this position for a couple of seconds and return to the start position. Perform 10 times per side for 3 sets.
   • Bridges: Lie face up on the floor, with your knees bent. Tighten your core and squeeze your glutes as you lift your hips off the ground. Hold for a couple of seconds and return to the start position. Repeat 10 times for 3 sets.
   • Monster walks: Start in an athletic stance with both knees slightly bent and feet together. Take a step sideways and then bring your feet together again. Repeat 10 steps in one direction and then ten steps back. Place band around knees to start and progress to ankles and feet. Placing the band around the feet will be the hardest, but it has the greatest activation of the glut med and max muscles.
5. Stretching exercises, specifically of the calves to improve dorsiflexion, allows the joint to function in a better range.
   • Gastrocs: Stand in front of a wall and bring one leg back, ensuring your toes are facing forward. Keep your heel on the ground and lean forward keeping the back leg straight. You should feel a stretch in the back leg. Hold for 30 sec. and repeat twice.
   • Soleus: From the same position as above bring your back foot forward. Make sure both heels stay on the ground and bend through your knees. You should feel a stretch in the back leg. Hold for 30 sec. and repeat twice.

The benefit of these exercises, extend beyond prevention of ankle injuries. They can also reduce other lower extremity injures and improve athletic performance. In order for an exercise program to be effective, coaches and trainers need to put emphasis and time into doing these exercises regularly and properly. Incorporating them into the regular dynamic warm up is the easiest way to ensure they get done on a regular basis.

If you’re looking for a sports medicine clinic in the Oakville and Mississauga area to treat your current injuries or help put together a program to prevent future injuries, contact Sheddon Physiotherapy and Sports Clinic at 905-849-4576.

Kaminski et al., (2019). Prevention of Lateral Ankle Sprains. Journal of Athletic Training. 54,6, 650-661.

Sheddon Physiotherapy and Sports Clinic (SPSC) has been a member of the Oakville community for over 10 years and strongly believes in being involved within the Oakville community and giving back to those who have supported us throughout the years, as well as helping those who are less fortunate. Over the next few weeks, Sheddon Physiotherapy and Sports Medicine will be collecting donations for its Christmas Food and Toy Drive.

Food donations are in support of the Kerr Street Mission and will be collected until the new year.

• Items needed: instant coffee, peanut butter, cookies + crackers, diapers, breakfast cereals, canned fruit, soups, powder laundry soap, side dishes (grains), etc.

Toys will be collected until December 20th, 2019 in Support of the Oakville FireFighters Toy Drive

• The mission of the Oakville Firefighters Toy Drive is to ensure every local child has an opportunity to unwrap a gift of their own over the holidays. All donations are distributed directly to local families, institutions and community agencies supporting children and youth in Oakville and Halton Region.
• All donations are greatly appreciated, however the area of greatest need are gifts for boys and girls ages 11-15 (ie., gift cards, backpacks, clothing (winter hats and gloves), hair accessories, cosmetics and  movie passes).

We have been blessed to have been strong supporters of both agencies and hope once again we can be generous and help out. We have boxes in the waiting room to hold any donations of new unwrapped toys or non-perishable food. Please consider joining us to make Christmas a little brighter for our local families.

Make this Holiday Season Special for others.

Foam rollers, “The Stick,” lacrosse balls, and tennis balls are all common tools used for self-myofascial release (a.k.a., giving yourself a massage). Anyone who has ever used any of the above tools for self-myofascial release has a love-hate relationship with it. Even though it hurts so badly while you’re doing it, it feels so good afterwards. The most common of the above tools is the foam roller; you see them lying around most fitness gyms, physiotherapy clinics and sports team locker rooms. For years clinicians and trainers have been using self-myofascial release with their clients, but only recently has research started to look at what  it actually does.

Cheatham et al., (2015)  and Wiewelhove et al., (2019) published a systematic review and meta analysis on the effects of self-myofascial release using a foam roller to help support its use in clinical practice. Their findings are outlined below:

1. Range of Motion

All examined studies demonstrated that foam rolling improved one’s range of motion, with increased benefits if it was followed by a static stretch of the same muscle group.

Most studies had parameters of 30 seconds of rolling for 3 sets, followed by a 30-second stretch for 3 sets/muscle group.

2. Post-Exercise Muscle Recovery and Reduction of Delayed Onset of Muscle Soreness (DOMS)

Subjects used the foam roller as a cool down method for two 60-second sets following a strength training workout in order to reduce DOMS. Their results showed that foam rolling had the following benefits vs. no foam rolling:

• decreased subjective pain levels;
• improved vertical jump height;
• improved muscle activation;
• improved joint ROM;
• Improved sprint speeds

3. Muscle Performance

Subjects used the foam roller as part of a warm-up session for 30 seconds on each major muscle group before completing testing in isometric strength, vertical jump height, vertical jump for power and shuttle runs. Unfortunately, there was no significant difference for any of the testing parameters, except in sprint performance.

Take home message:

• Foam rolling can increase flexibility and range of motion, if combined with a stretching program;
• Foam rolling after high-intensity exercise can help diminish DOMS and pain levels;
• Foam rolling does not alter muscle performance when used as part of a warm-up session, except for sprint performance.

Sheddon is currently having a sale on foam rollers for 20$. Get yours while they last. If you want to know more about foam rolling or self-myofascial release, please ask one of the Sheddon Therapists. You can contact us at (905) 849-4576.