As a therapist, I have heard this complaint numerous times, “my ankles are weak.” Ankle sprains are one of the most common athletic injuries, accounting for 22% of all sports injuries.1 Outside of sports, ankle sprains are treated with limited time and resources but have the highest recurrent rate of any other musculoskeletal injury.2 Up to 70% of patients sustaining a single sprain report residual symptoms, including recurrent instability, additional ankle sprains, and reduced capacity for activities of daily living.3 These negative experiences form the principal characteristics of chronic ankle instability or weak ankles.1 Chronic ankle instability can be linked to several mechanical and functional limitations. They include:1
· Decreased ankle dorsiflexion (think holding the door for someone with your foot, toes up)
· Reduced back glide of the talus (a bone below shin or tibia)
· Increased damage to ligamentous tissue on the outside of the ankle
· Residual swelling from a previous ankle sprain
· Poor proprioceptive control (weak gluteus medius (see Figure 1)4, gluteus maximus, tibialis anterior)5
Proprioceptive control or stabilization strength at the hip is vital for maintaining control at the ankle during movement.6,7,8 DeJong et al. found that subjects with chronic ankle instability had as much as 40% less activation of the gluteus medius compared to healthy subjects walking on a treadmill.9 Friel et al. reported that subjects with chronic ankle instability have significantly less gluteus medius strength on the affected side than the non-affected side.10 Based on the information provided above, consider looking at weakness in the posterior hip muscles and strengthening this area.
What exactly is the gluteus medius?
The muscle has both anterior (front) and posterior (back) fibers that work together to isometrically stabilize the foot, ankle, knee, hip, and low back! It is also part of the lateral anatomical sling which includes the tensor fascia latae, iliotibial band (ITB), and peroneals below the knee. The sling is responsible for frontal plane stability when you walk or run. In simpler terms, it keeps your hips from swishing side to side when you move.
How do I strengthen the gluteus medius?
There are a variety of exercises that can be performed to strengthen this muscle. Below is a small sample of exercises you can do to strengthen this area.
Exercise Description
Wall Slides
Lateral tube walks
Cable hip extension
One of the simplest ways to start strengthening the gluteus medius is to balance on one foot for time (15, 30, 60 seconds). Once you can stabilize the entire body without losing your balance or swaying, you can start to reach out in different directions with your other foot, or simply turn your head right and left. It sounds simple but once you start moving your eyes around, balance becomes more challenging.
If you believe that you have weak ankles, try the exercises above for a few weeks, several days per week. You may start to notice improvements in stability at the foot and ankle. If there are any other issues above the ankle, those may improve as well.
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At Sports Academy, we understand the impact that shoulder pain can have on your daily life. Our expert team is here to help you improve your mobility, strengthen your posture, and get you back to living pain-free. Whether you’re dealing with chronic discomfort or want to prevent future issues, our personalized training programs and manual therapy services are designed to meet your needs. 1 Holland CJ, Hughes JD, De Ste Croix MBA. Acute Effects of Increased Joint Mobilization Treatment Duration on Ankle Function and Dynamic Postural Control in Female Athletes With Chronic Ankle Instability. Orthop J Sports Med. 2020;8(6) 2 Anandacoomarasamy A. Long term outcomes of inversion ankle injuries: commentary. Br J Sports Med. 2005;39(3):e14. 3 Wikstrom EA, Tillman MD, Chmielewski TL, Cauraugh JH, Borsa PA. Dynamic postural stability deficits in subjects with self-reported ankle instability. Med Sci Sports Exerc. 2007;39(3):397–402. 4 Gowda AL, Mease SJ, Donatelli R, Zelicof S. Gluteus medius strengthening and the use of the Donatelli Drop Leg Test in the athlete. Phys Ther Sport. 2014;15(1):15-19. 5 Webster KA, Pietrosimone BG, Gribble PA. Muscle Activation During Landing Before and After Fatigue in Individuals with or Without Chronic Ankle Instability. J Athl Train. 2016;51(8):629-636. 6 MacKinnon CD, Winter DA. Control of whole body balance in the frontal plane during human walking. J Biomech. 1993;26:633–644. 7 Beckman SM, Buchanan TS. Ankle inversion injury and hypermobility: effect on hip and ankle muscle electromyography onset latency. Arch Phys Med Rehabil. 1995;76:1138–1140. 8 Sadeghi H, Sadeghi S, Prince F, Allard P, Labelle H, Vaughan C. Functional roles of ankle and hip sagittal muscle moments in able-bodied gait. Clin Biomech (Bristol, Avon) 2001;16:688–695. 9 DeJong AF, Mangum LC, Hertel J. Gluteus medius activity during gait is altered in individuals with chronic ankle instability: An ultrasound imaging study. Gait Posture. 2019;71:7-13. 10 Friel K, McLean N, Myers C, Caceres M. Ipsilateral hip abductor weakness after inversion ankle sprain. J Athl Train. 2006;41(1):74-78.