Athletic Development for Injured Athletes: Part 2 – Ankle Surgery


In this series on returning injured athletes to sport readiness I want to look at 3 case scenarios.

The first is a professional soccer player who is returning from a broken fibula that required the insertion of hardware to stabilize the bone. The surgery went ok but the athlete lost about 50% mobility in the ankle, especially in dorsiflexion. This prevents him from even walking without a limp. This player is one of the best and most athletic soccer players on the professional soccer team I train. Because the team comes in as a group that may have as many as 24 on any given day it can be difficult to provide personal training training. So what I’ve done is individualize the things that the rest of the team is doing and either scale it down or modify it so that he can handle it. The first priorities were getting his mobility back and re-educating the proprioceptors in the ankle joint to function normally. For mobility, I’ve shown him a couple stretches to help increase dorsiflexion range of motion. Without normal range of motion the athlete can’t squat to any depth without extreme compensation, can’t run normally, and likely exposes the knee and hip to an increased likelihood of injury as previous studies have shown that when you reduce the impact loading capacity of one joint that the forces are absorbed further up the chain or on the contralateral side. The most useful of these stretches are ones I learned from Harvey Newton, the head coach of the 1984 U.S. Olympic Weightlifting team. Harvey uses the stretches to increase range of motion in the ankle joint for athletes who have difficulty hitting the low positions necessary to receive the bar following the pull in the snatch or clean. In the first stretch, you place your foot up on a bench or box and lean forward with your body weight to give a deeper Achilles stretch than might otherwise be achieved if loaded with less force. Another variation of this has the athlete sitting with their back against a wall in a deep squat position. This position presumably puts the athlete in to a position that would otherwise test the limitations of their dorsiflexion and the heels would be off the ground. From this position, an external load (like a weight plate or another person) is placed on the knees to force the person in to dorsiflexion. In addition to these stretches, we’re doing quite a bit of single and double support squatting as I’ve found that it’s one of the easiest ways to increase ankle (and hip) mobility when performed with a high-bar through a complete range of motion. He started off only being able to go to about a 1/4 squat before his injured leg heel would lift off the ground and his hips would shift to the opposite side. I had him only go as deep as he could while maintaining equal weight distribution, heels on the ground, and no lateral hip shifting on descent. Because we couldn’t load the squat very much due to both the leg weakness from the surgery and the mobility issues I used the deadlift to build lower body strength since it requires far less ankle mobility. Single leg box squats were also used because the box provided a means of tracking depth progression and providing a ‘safety’ if balance was lost in the low position while in single support. They also ensured that the injured leg could be brought up to speed since we only used loads and rep schemes that would challenge the weaker leg. For proprioceptive re-education we started with locomotive activities in single support like various forms of walks over hurdles and picked that up to include similar activities with increasing speed, incorporating both periods of flight, and sudden stops. Finally, we used the AFX ankle and foot exerciser to both stretch the ankle joint through controlled ranges of motion and also strengthen the ankle joint in ways that would normally be reserved for exercises done with a therapist. I was given the AFX to product test a while back and I’ve found it’s very useful for these types of situations because it makes it easy to control for various degrees of freedom and provides a means of progressively overloading the joint that is often difficult to do with any accuracy using manual resistance. It also puts control of the exercise in the hands of the athlete rather than a trainer which can be useful when dealing with an injured area where pain, discomfort, or over-stretching may be the best guides for execution. The player then moved from forward, backward and lateral movements in a slow and controlled environment on a soft surface to forward, backward and lateral movements in an unpredictable environment over a variety of surfaces. He still has a small limp but it’s beginning to go away and he’s seen action in each of the first two games of the year.

Here’s a video of the AFX in action