**5.4 Improve proprioception and balance**

Once the athlete achieves full weight-bearing without pain, proprioceptive training is started for the recovery of balance and postural control. Various devices have been designed for this phase of rehabilitation. Their use in performance with a series of progressive drills has effectively returned athletes to a high functional level. As somatosensory and visual feedback is altered, the athlete must develop consistent motor patterns even with inconsistent feedback. Furthermore, the athlete can be tested under various visual and support conditions. The simplest device for proprioceptive training is the wobble board. The athlete is instructed to stand on the wobble board on one foot and shift his or her weight, causing the disc's edge to scribe a continuous circular path. These exercises can be progressed by having the athlete use different-sized hemispheres and by varying visual input. A common progression when performing balance exercise is to move from a position of nonweight-bearing to weight-bearing, bilateral stance to unilateral stance, eyes open to eyes closed, firm surface to soft surface, uneven or moving surface. Another variant is when the therapist manually moves the ankle and foot through various positions and then asks the athlete to actively and passively replicate the joint angles. This helps improving joint position sense. As the body is trained to sense directions from perturbation, sensory input is received from all parts of the body and sent to the central nervous system via afferent pathways. Therefore, conscious and unconscious appreciation is important to protect functional joint stability. Proprioception


#### **Table 2.**

*Structured strength training progression.*

is useful for preventing injury in slow, moderately quick, or even quick tasks; however, it may not be adequate for forces that challenge the neuromuscular system at the highest levels. The therapist should also focus on variability of speed and intensity while training proprioception and balance (**Table 3**).

#### **5.5 Sports-specific training**

Once the distance walked by the athlete is no longer limited by pain, he/she can be put on sports-specific training or advanced training. The use of sports-specific means of training, parallel to general conditioning training, leads to considerable improvement of performance among athletes. The sports-specific training includes intricate activities like jogging which eventually progresses to running, backward running, and pattern running. Circles and figure of 8 are commonly employed patterns. These activities can also be done using ankle weight to increase the difficulty level. Star excursion balance training can also be used in which the athlete stands on the sprained ankle while using another foot to reach as far as possible in eight directions as outlined in the Star Excursion Balance Test. The exercise can consist of 8–10 rounds clockwise and counterclockwise foot reach with 3 s rest between each direction. The difficulty level can be increased by adding variations to the exercise such as with the sprained ankle (affected leg's knee) flexed, eyes opened, followed by eyes closed. At higher speed, i.e., at an angular velocity of 120°/s, the eversion to inversion ratio is >1.0, adding to the risk of injuries [19]. Hence, resistance bands can be used to strengthen the ankle musculature, i.e., training an athlete on an isokinetic machine while tying the band on the affected ankle and with the therapist holding the other end and maintaining the resistance through the movement.

**107**

*\**

**Table 3.**

*Rehabilitation of Lateral Ankle Sprains in Sports DOI: http://dx.doi.org/10.5772/intechopen.89505*

**Exercise 3**

legs **Variations** 1 2

**Exercise 4**

or catch a ball

both legs **Variations** 1 2

**Variations on basic exercises:** 1.The standing leg is stretched 2.The standing leg is flexed

followed by eyes closed

hand below the waist)

*A Prospective Controlled Trial [18].*

head)

technique

technique

of 5 m

3.The standing is stretched and first eyes are opened, followed by eyes closed

4.The standing leg is flexed and first eyes are open

5.The standing leg is stretched and upper hand technique (throwing the ball from above the

6.The standing leg is flexed and upper hand

8.The standing leg is flexed and lower hand

\*This can be done by the therapist, and the athlete or the athlete can stand opposite to the wall at a distance

7. The standing leg is stretched and lower hand technique (throwing the ball while keeping the

\*Make pairs. Both stand in one-legged stance with the knee flexed. Keep a distance of 5 m. Throw and/or catch a ball 5 times while maintaining balance. Repeat 10 times for both

\*Make pairs. Stand both in one-legged stance with the hip and knee flexed. Keep a distance of 5 m. Throw and/

5 times while maintaining balance. Repeat 10 times for

**Exercise 1** One-legged stance with the knee flexed. Step out on the other leg with the knee flexed, and keep balance for 5 s. Repeat 10 times for both legs **Variations** 1 2 3 4

**Exercise 2** One-legged stance with the hip and the knee flexed. Step out on the other leg with the hip and knee flexed, and keep balance for 5 s. Repeat 10 times for both legs **Variations** 1 2 3 4

**No material Ball Balance board Ball + balance board**

**Exercise 5** One legged stance on the balance board with the knee flexed. Maintain balance for 30 s and change stance leg. Repeat twice for both legs **Variations** 1 2 3 4

**Exercise 6** One-legged stance on the balance board with the hip and knee flexed. Maintain balance for 30 s and change stance leg. Repeat twice for both legs **Variations** 1 2 3 4

**Exercise 7** Step slowly over the balance board with one foot on the balance board. Maintain the balance board in a horizontal position while stepping over. Repeat 10 times for both legs

**Exercise 8** Stand with both feet on the balance board. Make 10 knee flexions while maintaining

balance

**Exercise 9** One-legged stance on the balance board with the knee flexed. Make 10 knee flexions while maintaining balance. Repeat twice for both legs

*Adapted from: The Effect of a Proprioceptive Balance Board Training Program for the Prevention of Ankle Sprains:* 

*All the exercises done by the Athlete, can be done in pairs or the athlete can stand opposite to a wall at distance of 5 m*

*Proprioceptive exercises (the variation and changes should be according to the athlete's requirements).*

**Exercise 10**

Repeat twice

**Exercise 11** Athlete stands in onelegged stance with the knee flexed on the balance board. Throw and/or catch a ball 10 times with one hand while maintaining balance. Repeat twice for both legs

**Variations** 1 2

**Exercise 12** Athlete stands in onelegged stance with the hip and knee flexed on the balance board; the other has the same position on the floor. Throw and/or catch a ball 10 times with one hand while maintaining balance. Repeat twice for both legs

**Variations** 1 2

Athlete stands with both feet on the balance board. Throw the ball with an upper hand technique 10 times while maintaining balance. Repeat twice for

**Exercise 13**

both legs **Variations** 5 6 7 8

**Exercise 14** Athlete stands in onelegged stance with the knee flexed on the balance board. Throw the ball with an upper hand technique 10 times while maintaining balance. Repeat twice for

both legs **Variations** 5 6 7 8

Athlete stands with both feet on the balance board. Throw and/or catch a ball 10 times with one hand while maintaining balance. *Rehabilitation of Lateral Ankle Sprains in Sports DOI: http://dx.doi.org/10.5772/intechopen.89505*

*Essentials in Hip and Ankle*

is useful for preventing injury in slow, moderately quick, or even quick tasks; however, it may not be adequate for forces that challenge the neuromuscular system at the highest levels. The therapist should also focus on variability of speed and

*The athlete should proceed to the next line when he/she can lock out (complete with correct form) the 4th set 10 times.*

Once the distance walked by the athlete is no longer limited by pain, he/she can be put on sports-specific training or advanced training. The use of sports-specific means of training, parallel to general conditioning training, leads to considerable improvement of performance among athletes. The sports-specific training includes intricate activities like jogging which eventually progresses to running, backward running, and pattern running. Circles and figure of 8 are commonly employed patterns. These activities can also be done using ankle weight to increase the difficulty level. Star excursion balance training can also be used in which the athlete stands on the sprained ankle while using another foot to reach as far as possible in eight directions as outlined in the Star Excursion Balance Test. The exercise can consist of 8–10 rounds clockwise and counterclockwise foot reach with 3 s rest between each direction. The difficulty level can be increased by adding variations to the exercise such as with the sprained ankle (affected leg's knee) flexed, eyes opened, followed by eyes closed. At higher speed, i.e., at an angular velocity of 120°/s, the eversion to inversion ratio is >1.0, adding to the risk of injuries [19]. Hence, resistance bands can be used to strengthen the ankle musculature, i.e., training an athlete on an isokinetic machine while tying the band on the affected ankle and with the therapist holding the other end and maintaining the resistance through the movement.

**1st set: 10 repetitions 2nd set: 10 repetitions 3rd set: 10 repetitions 4th set: 10 repetitions\*** 0 lbs (0 kg) 5 lbs (0.23 kg) 1 lbs (0.45 kg) 1.5 lbs (0.68 kg) 1(0.45) 1.5 (0.68) 2 (0.91) 3 (1.36) 2 (0.91) 3 (1.36) 4 (1.81) 5 (2.27) 3 (1.36) 4.5 (2.04) 6 (2.72) 8 (3.63) 4 (1.81) 6 (2.72) 8 (3.63) 10 (4.54) 5 (2.27) 7.5 (3.40) 10 (4.54) 15 (6.80) 7.5 (3.40) 11.25 (5.10) 15 (6.80) 20 (9.07) 10 (4.54) 15 (6.80) 20 (9.07) 25 (11.34) 12.5 (5.67) 18.75 (8.51) 25 (11.34) 30 (13.61) 15 (6.80) 22.5 (10.21) 30 (13.61) 35 (15.88) 17.5 (7.94) 26.25 (11.91) 35 (15.88) 40 (18.14) 20 (9.07) 30 (13.61) 40 (18.14) 45 (20.41) 22.5 (10.21) 33.75 (15.31) 45 (20.41) 50 (22.68) 25 (11.34) 37.5 (17.01) 50 (22.68) 55 (24.95) 27.5 (12.47) 41.25 (18.71) 55 (24.95) 60 (27.22) 30 (13.61) 45 (20.41) 60 (27.22) 65 (29.48) 32.5 (14.74) 48.75 (22.11) 65 (29.48) 70 (31.75)

intensity while training proprioception and balance (**Table 3**).

**5.5 Sports-specific training**

*Structured strength training progression.*

**106**

*\**

**Table 2.**


*Adapted from: The Effect of a Proprioceptive Balance Board Training Program for the Prevention of Ankle Sprains: A Prospective Controlled Trial [18].*

*\* All the exercises done by the Athlete, can be done in pairs or the athlete can stand opposite to a wall at distance of 5 m*

#### **Table 3.**

*Proprioceptive exercises (the variation and changes should be according to the athlete's requirements).*

#### **Figure 1.**

*Star excursion balance test [20]. Note: Star Excursion Balance Test for left-leg dominant participants (Posterior direction is behind athlete's right leg). Abbreviations: A, anterior; AM, anterior-medial; M, medial; PM, posterior-medial; P, posterior; PL, posterior-lateral; L, lateral; AL, anterior-lateral.*

This should be done for 15–20 repetitions 1–2 times/day and with increasing progression. Specific training can include functional activities on various surfaces, e.g., trampoline and foam, and in water with weights. Repetitions should be 5–20, 1–2 times/day (**Figure 1**).
