Should I do proprioceptive retraining on both ankles or just my injured ankle? Well, that is a great question and that is what we’re talking about today on the Doc On The Run Podcast.
I was recently on a follow-up webcam call with a runner who has chronic ankle instability and, in her case, she actually is getting back to running on trails and she is trying to decide when it is safe for her to make the transition from running on a smooth, flat surface like asphalt to actually running on technical trails. And because she is a trail runner, obviously she wants to do that sooner rather than later.
But she has had a long history of ankle sprains that have kept her off of running for a long time and she does not want to get re-injured. So, she asked me a great question on a recent call. She asked me, “Should I be doing this proprioceptive retraining on both ankles or just the injured ankle?”
Well, the first thing is, is that when you get an ankle sprain, the reason you get proprioceptive trouble, which means you cannot tell positioning in space, you cannot tell where your foot is, well, you can retrain your brain to actually tell where your foot is underneath you using some very specific exercises to accomplish that.
The thing is, is I was telling her about all the different research on these studies as I share it with doctors when I do this lecture at medical conferences called Conservative Management of Ankle Sprains in Runners. One of the studies I cited was one that is from the British Medical Journal, or it’s actually BMJ, they changed the name a long time ago, but back in 2009, it was actually called the British Medical Journal. And there was a study in there actually called the effect of unsupervised home-based proprioceptive training on recurrences of ankle sprains, randomized control trial.
In that study, there’s a randomized control trial, so high-level research, they found that unsupervised retraining, proprioceptive retraining at home could actually reduce the risk of an ankle sprain even an initial ankle sprain by 35%. And of course, when I said that, she was like, wow, that sounds awesome, so I should do it on both feet and I said, well, maybe.
She said, what do you mean? I said, well, here’s the thing. We know there’s a 35% reduction in ankle sprains, and there was also a meta-analysis, a big study published in the Journal of Athletic Training in 2017 that also found that it would prevent recurrence of ankle sprains. And so when we’re on that call, and she got all excited about it, she said, I should do both, right? And I said, well, yes and no.
Would it help you to have a 35% reduction in the risk of getting an ankle sprain on your non-injured foot? Yes, that would be helpful. However, as I always say, you’ve got to focus on the goal if you’re a runner and you’re trying to get back to running. In her case, she’s already running. She’s never had an ankle sprain on that other foot. Her injured foot, the one that has had chronic ankle sprains, is way less stable and way worse.
I said, look, here’s the way I think about this. You’re already running on pavement, but your goal is to run on the trails and the Marin Headlands. And so, if you actually start doing the proprioceptive retraining exercises that I gave you, and you start doing them on both feet right now, both feet are going to improve and she said, that is a good thing.
I was like, well, it’s a good thing in terms of risk reduction. It is not a good thing for when you need to make this decision on when it’s safe for you to run on trails. Because in her case, given how she’s progressed, I said, I don’t think you should start retraining your good, uninjured ankle until your bad ankle catches up because I gave her some specific tests to tell when she’s restored her proprioception balance and is safe to actually run on trails. And I said, if you wind up doing both the good foot and the bad foot right now, your good foot is going to improve and your stability is going to improve on that foot. And that is your measure of when you’re good enough.
I said, you’re basically going to be chasing the gains made on the good foot with the training that you’re doing to it and it’s going to take longer for your bad foot to catch up to your good foot. So, what I think you should do is use your good foot as a control. Don’t change anything with your good foot. Let it stay the way that it is ad then do these tests to compare right versus left.
Once your bad foot is as stable as your good foot, then you know it’s safe for you to start running on trails. Then you can start doing the proprioceptive retraining on both. That is the safest way to do it and it’s the best way to get back to running on trails as safely as possible. Because you’ve got to make sure that your injured foot has restored proprioception that is about the same as your other foot. So, that is the way I went about it with her.
If you want to learn more about the strategies I use with athletes like her, who’ve had ankle sprains or trying to get back to running, they’re trying to get past this ankle pain, you can come join me and I go into a deep dive in those specific strategies in the Ankle Pain Masterclass for Runners. You can get it for free at www.docontherun.com/anklepainmasterclass. So, come sign up and I’ll see you in the training.
Reference:
Hupperets MD, Verhagen EA, van Mechelen W. Effect of unsupervised home based proprioceptive training on recurrences of ankle sprain: randomised controlled trial. BMJ. 2009 Jul 9;339:b2684. doi: 10.1136/bmj.b2684. PMID: 19589822; PMCID: PMC2714677.
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