Does your ankle need unstable surfaces for stability training?

Ankle sprains are among the most common musculoskeletal injuries, resulting in a loss of stability at the ankle joint. Subsequently, there is no shortage of approaches for treating them and restoring that stability. In the age of technology and the Internet, the surplus of information is overwhelming, so let’s unpack ankle training a bit and demystify the concept of “stability training.”

BOSU balls, foam pads, trampolines, lions, tigers, and bears…oh my. Step foot into any gym or physical therapy clinic and you’ll see many soft, squishy, and incredibly challenging things you can stand on; there are plenty of unstable surfaces to choose from. Now the traditional thought process has been that soft surfaces are harder to balance and therefore we’ve created a correlation between successful balancing on difficult surfaces and better balance overall. Unfortunately, there is a line connecting the dots that shouldn’t be drawn. More complicated, more difficult, or more modern (technology) doesn’t always equate to more return on investment. Simply because the task is more complicated doesn’t mean your success at that task will result in better outcomes or performance, especially when it comes to sports. Far more often it is better to keep it simple. For all of its intricacies, the body is surprisingly straightforward when it comes to rehab or exercise. And when it comes to ankle stability, less is more. 

To understand this we need to talk about two things:

• Proprioception

• Specificity of training

Simply put proprioception is your body’s awareness in space. You have sensory receptors (proprioceptors) all over your body and they sense what position you are in at all times. These receptors send that information up to your brain so you can make appropriate responses to changes in position and they should be finely tuned, otherwise risk of injury goes up. Imagine if your thermostat wasn’t calibrated correctly. Your furnace wouldn’t know when to kick on and for how long. Your body benefits from efficient sensory receptors and your foot/ankle is no exception to this as it is your interface with the world. Not only does it require fine-tuning of these receptors in that area but injuries and swelling will compromise them more. Therefore for you to effectively rehab or train your ankle then you must have an appropriate plan of action. If your thermostat is broken then you need to fix that so the furnace can function as expected to meet the temperature demands.. If your ankle stability is compromised then you need to fine-tune it so that your brain can learn how and when to fire specific muscles to meet the physical demands.  

Specificity of training is the concept that to improve at a task you must practice or mimic that task in your training. This means all of the skills, all of the movements, and all of the actions that you will have to use, execute, and handle should be the main focus of your training. This is especially true when rehabbing an injury to return to activity or sport. For instance, if your goal is to get back to running, jumping, and changing direction on a soccer field, or basketball court then you need to be practicing those movements on the same surface and with the same equipment as the task. If you’re a gymnast and you must get better at barefoot cartwheels on a beam, jumping on a springboard, or landing on a mat, then you must also prioritize those demands in your ankle rehab or ankle training. 

There are no substitutions. I realize the caveat here is gymnastics or any sport that requires landing on a soft surface, but the vast majority of activities whether it be sports, going up or down stairs, or stepping off a curb aren’t replicated with blow up domes or intricate setups at the gym. They will not yield the same results as if the setup mimicked the intended activity. 

I don’t mean to speak down about certain types of equipment. I’m simply attempting to distinguish between when they are applicable and when they are unnecessary. The research is also tipping the scales in favor of specific training approaches. Current research has concluded that unstable surface training bypasses those peripheral proprioceptors in the foot/ankle. The BOSU, foam, disc, trampolines, etc training has been shown to, instead, challenge the part of the central nervous system more responsible for interpreting the proprioceptive input rather than finely tuning their input. So again that’s more like going right to the furnace and making it respond faster to the incorrect temperature readings when the real benefit comes from fixing the thermostat first. 

Is that worth the effort? Is there a good return on investment with this type of training? The proprioception, specificity of training, and research show us that it’s probably not. Personally I don’t see the risk worth the reward. If your goal is to run, jump, and change direction, on a flat-level surface then your ankle NEEDS you to challenge it progressively and frequently on flat-level surfaces.  

We’ve been at this a long time and our job is to get you back fast and safe. We don’t want you to miss the mark. We want you to practice heavy strength movements like squats, deadlifts, and step-ups to mimic the heavy forces your ankle will experience with more intense movements. We want you to practice agility drills and change of direction on your playing surface. We want you to do repetitive jumping and landing to mimic a fatigued state on your playing surface. We want you to replicate all of the demands you will expect to face whether you’re trying to get back on your team’s roster or making sure you can go up or down stairs or walk long distances in the city. 

The ankle is a unique animal but it can be quite straightforward if you have the discipline to keep it simple. I’m not saying to ditch the fun stuff completely; instead, make sure you can check off all of the other boxes first before you go all American Gladiator on the different obstacles you might find piled next to the weights. 

Happy Training!