Ankle sprains are the most common lower extremity injury in athletic populations, representing up to 30% of all sports-related injuries. These injuries can result in long term disability, high economic costs due to persistent symptoms and repeated ankle sprains; and can potentially lead to knee, hip and back pain if left unresolved.
Rehabilitation typically includes proprioceptive training of the foot and ankle with "proprioception" being defined as a complex neuromuscular process concerned with internal kinesthetic awareness of body position and movement, or, as I prefer to explain it: " proprioception is the Brain's ability to know where your ankle is in space with your eyes closed".
Proprioceptive training involves exercises that challenge the capacity of the nervous system to detect shifts in centre of pressure and joint position. Some of the most common proprioceptive training modalities include wobble boards, air cushions, trampolines, bosu, etc ; all of which are forms of instability training. The problem is, a recent meta-analysis examined the effects of unstable surface training on proprioception and balance in active adults with chronic ankle instability and demonstrated great inconsistency in results. Due to this inconsistency, it was questioned if the integration of mechanoceptive stimulation ( 3 options below) would actually enhance the efficacy of traditional instability training? A fair question indeed.
Mechanoception is a type of receptor that is found on the sole of the foot and palm of the hand. These nerves respond to mechanical deformation, which when stimulated, communicate with the somatosensory cortex to build foot and body awareness.
1. Tactile stimulation such as skin stretch was first introduced into the athletic industry in the form of athletic taping. It is proposed that ankle taping, such as that with RockTape, increases the input of skin mechanoceptors, stimulated by the traction of the tape on the skin.
When combining athletic tape with instability training it was found that there was a significant acceleration in rehabilitation in subjects with chronic ankle instability.
2. Vibration is another form of mechanoceptive stimulation that can potentially have a powerful impact on ankle perception and stability. Vibration, such as that created by the PowerPlate, translates to dynamic movement and the perception of ground reaction forces when our feet strike the ground. Like skin stretch, combining vibration to traditional proprioceptive training resulted in faster recovery and return to sport for athletes.
3. Texture is the third and final mechanoceptive stimuli from our feet which can be integrated into ankle rehab. The detection of texture or two-point discrimination, such as that created by Naboso Insoles, has been shown to play an integral role in quiet stance and the control of medial lateral sway.
So What does all this mean for your Wobbly Ankle ?
Let me spell it out.
If you are using a wobble board alone, you are missing opportunity.
Combine your wobble board with Rock Tape, add some vibration, and some Nabosa Insoles and you will get your strength and stability results FASTER.
This concept of 'neural stacking" is powerful and one I use repeatedly with clients. I 100% believe in the power of sensory stimulation for the optimization of movement and that the sensory stimulation should be multi-dimensional : meaning texture, vibration, skin stretch, proprioceptive, visual and auditory.
When we fully GET that our Brain is the key to our rehab, not our muscles, then rehabilitation programs look very different to what you may be used to. No exercise sheets, no recipe prescriptions. Suggested exercise protocols are just that - Suggestions. They are not customised for your body and it's unique "quirks". Follow a recipe and you might get there in 6 months. Follow a customised prescription of graded sensory inputs and you will get your outcomes FASTER and with Superior Quality.
For a customised rehabilitation program for your wobbly ankles -
Or - to rehab your feet from home, check out Marion's online Free your Feet Course