Ankle Impingement Exercises

Whether you’re dealing with a posterior or anterior ankle impingement, quickly addressing your ankle injury with proper treatment will result in quicker recovery. Rebuilding ankle function is crucial and a well-rounded treatment plan should include appropriate ankle impingement exercises that focus on both flexibility and strength. Keep reading to learn more about the best ankle impingement exercise recommended by physical therapists.

Range of Motion & Flexibility Exercises

Swelling, pain, and abnormal ankle mechanics from ankle impingement commonly result in limited range of motion and poor flexibility. Gently stretching the ankle joint and lower leg muscles can give pain relief, improve blood flow, allow better joint mechanics, and improve your ability to return to daily activities. Regardless of whether you’re suffering from anterior ankle impingement or posterior ankle impingement work on adding these exercises to your daily routine.

1. Standing Calf Stretch

There are many different ways to stretch the calf muscle; including this staggered lunge. This area is often stiff and sore with any ankle issue.

• Stand with a chair or the wall in front of you for balance
• Step the foot you want to stretch back into a lunge with both feet facing straight forward
• Keep the back knee straight and both feet flat on the floor as you shift your weight into your front foot and bend the front knee
• Continue shifting until you feel a stretch in the back of the calf
• Hold for 30+ seconds for 2-3 sets on each leg

A standing calf stretch can also be done in sitting with a stretch strap or standing on a step.

Additionally, you can try stretching the ankle in the opposite direction; such as a plantarflexion stretch like this one.

2. Seated Ankle Range of Motion

When your ankle is feeling stiff, some simple guided stretches with your hand can feel pretty great. The key is to stay as relaxed as possible and let your hands guide your ankle passively. These stretches will address local ankle muscles, tendons, the joint capsule, and ligaments.

• Sit on the floor, long sitting, or in a chair with the foot you want to stretch resting on your opposite knee (think figure 4). 
• Wrap one hand around around the top of your midfoot and the other around the bottom of your heel
• Guide your toes up toward your shin as far as possible
• Use your hand on your heel to apply overpressure for a deeper stretch
• Hold for 10-20 seconds
• Move in and out of the stretch up to 10 times for 2-3 sets
• Do not force this stretch if there is pain

This explanation is specifically for addressing stiff ankle dorsiflexion, the most common deficit with ankle impingement. You may choose to add other stretching options such as plantarflexion (most sensitive for posterior impingement), inversion and eversion. Simply use your hands to guide your foot into the area of restriction- pointing the toes or shifting the entire food inward or outward.

3. Posterior Ankle Mobility

This mobilization exercise keeps the tibia in an optimal position as you bend the ankle. This helps improve normal joint mechanics, range of motion and flexibility with dorsiflexion. When done correctly, you should notice immediate results with more pain free ankle range of motion.

• Grab a stretch strap or loop band and secure it around a sturdy surface about 1 foot off the ground
• Next, grab a small step, such as a stepping stool, and place it in front of the strap- about 2-3 feet away (depending on the length of your strap or band)
• Put your foot on the step facing away from the band
• Then, place the band around the front of the ankle. It should be placed right where the ankle hinges, as low as possible
• This will hold the talus (top foot/ankle bone) in place while the tibia (lower leg bone) glides more easily with ankle dorsiflexion 
• There should be enough tension in the band or strap to keep the foot in place as you shift your weight forward and bend your knee
• Keep your foot on the ground and shift forward until you feel a stretch in the front of the ankle
• Do not force any pain or pinching- back off the stretch if necessary

Strength Building Ankle Exercises

When dealing with ankle pain and weakness, a simple 4-way ankle strengthening routine can be great for mobility and function. This routine is based off of the four primary movements of the ankle joint: inversion, eversion, plantarflexion, and dorsiflexion. Start with low resistance and build the intensity and number of repetitions with time as your ankle can tolerate it.

4. Ankle Inversion and Eversion

Grab a resistance band and sit on the floor with the legs out straight for this exercise. These moves strengthen and mobilize the medial (inside) and lateral (outside) ankle joint muscles and connective soft tissue.

• For inversion, cross your legs (with the foot you’re working on top) and wrap the middle of the band around the midfoot
• Hold both ends of the band in the same hand as the foot/ankle you’re working, holding it as far away from the body as possible- creating diagonal across the body
• Bring the foot inward (toward the middle of the body) as far as possible and hold for an extra beat before returning to the starting position
• Continue moving the ankle joint slowly and in control for 10 repetitions for 2-3 sets
• For eversion, you will now be strengthening the ankle in the opposite direction
• Uncross the legs and wrap both ends of the band under your opposite foot, securing the ends with your opposite hand
• Now, push the foot away from the body and against the resistance and hold for an extra beat again
• As before, repeat for 10 repetitions for 2-3 sets

5. Ankle Plantarflexion

Grab your resistance band again for this one. This is a gentle way to strengthen the calf muscle and promote better joint mobility without the pain that often occurs with weight bearing exercises.

• Place the band around your midfoot again and secure both ends with your hands
• Hold your leg out in front of you with an appropriate level of resistance to make the exercise challenging without pain
• Gently push the mid-foot down into the band, as if pushing a gas pedal, and point the toes
• Go as far as possible and hold for 1-2 seconds before slowly returning to the starting position
• Repeat for 10-15 repetitions for 2-3 sets on each leg

6. Ankle Dorsiflexion

Weakness with dorsiflexion is common with anterior ankle impingement. To strengthen the shin muscles that dorsiflex the ankle, you will need to create your own pulley system or ask someone for help!

• Sit on the floor near a sturdy surface that you can wrap your band around (or have someone hold the band below your foot)
• Place a towel roll under your calf so that your foot can move freely
• Tie a loop in one end of your band and put it around your foot, holding the opposite end with your hand securely (with the band wrapped around the sturdy table leg or doorway)
• Make sure there is enough tension in the band 
• Lift your toes up toward your shin and hold for 1-2 seconds
• Return your foot to the starting position and repeat
• Complete 10-15 repetitions for 2-3 sets on each leg

Balance Exercises

Proprioception, or the ability to sense where our joints are space, is crucial for good balance and safety with daily activities. When the ankle joint is injured, this messes with this delicate sensory system. Additionally, it can lead to weakness or poor coordination with the intrinsic muscles of the food and ankle. Balance exercises are always a great way to restore your confidence in your feet and ankles.

Learn More About Balance Trainers

7. Single Leg Balance

Standing on one leg is one of the easiest ways to challenge your balance. Depending on your current level of fitness and comfort, you can stand on the floor or a softer more challenging surface like a foam pad or balance disc.

• Choose a surface that is challenging but safe to get started (step onto the center of it)
• Stand near a wall or chair for safety and balance
• Shift your weight into the leg you will be standing on
• Lift the opposite leg off the ground
• Focus on a focal point to help maintain your balance, using your hands for assistance as needed to avoid falling
• Hold for 30-60 seconds for 2-3 sets on each leg

To progress, add dynamic moves while standing on one leg. These might include head turns, closing the eyes, arm movements, or movement of the opposite leg.

8. Balance Pad Step Ups

Completing step ups on a foam balance pad adds an extra dimension of balance. You should feel muscles working and coordinating all the way from your core to your toes. You can simply place the foam pad on the floor or on top of a step to add a height challenge as well. To prevent slipping, ensure that the pad is placed in a non-skid area.

• Stand in front of your step or pad
• Place the right foot on top of the step
• Use your strength and momentum to bring the left foot up as well
• Hold for a moment and step back down with your left foot, and then right
• Repeat the sequence, this time leading with your left foot
• Continue alternating until you have done 10 on each side
• Repeat for 2-3 sets total

To progress, you can add further height or try a side step as well.

9. Foam Pad Toe Raises

This balance exercise has so many great benefits for ankle impingement, particularly ballet dancers. You are strengthening intrinsic foot muscles while addressing balance and building tolerance for plantarflexion (pointing the toes). Always make sure that you can properly do a toe raise on a sturdy surface first before progressing to a foam pad. There should be minimal shaking or ankle instability and no pain when completing this exercise.

• Step onto the balance pad with both feet
• Use a chair of wall for balance as needed
• Shift your weight into your midfoot and toes as you slowly lift both the heels off the ground
• Lift as high as you can with full body control- no bending at the hips or leaning forward
• Return slowly to the starting position and repeat
• Continue for 10-15 repetitions for 2-3 sets

To progress, try returning on only one leg at a time (alternating) or doing a full single leg toe raise.

Functional Training Exercises

If you want to take your exercises to the next level to build your strength for daily activities and sport- then the following exercises are a great option for you. These are advanced exercises that are meant to be used in the last stage of the recovery process when you are ready to return to your sport or other activities.

Once again, a great tool for challenging your ankle is a balance foam pad or balance disc to address crucial stabilizing muscles that you need for everyday movement.

10. Single Leg DeadLift

This is a great functional exercise since it promotes optimal balance and muscle control in the leg while standing on one leg. Since we stand on one leg each time we take a step to walk or run, having this control will improve your quality of life.

• Choose a surface that you can complete safely while still making it a challenge
• Stand near a chair or wall for balance as needed
• Place one foot in the center of your balance device and balance on it
• Keeping the abs tight and back straight, then hinge forward at the hips as you bring your chest toward the ground and free leg up toward the ceiling while keeping it straight
• Go as far as you can with good form and without losing balance
• Return to the starting position and repeat
• Continue for 10-15 repetitions for 2-3 sets on each leg

To progress, try holding weights in your hand. Start with 3-5 pounds and build up to 10+ from there.

11. One-Sided Lunge

A lunge is a great functional exercise for coordination, full body movement, strength, and range of motion (particularly ankle dorsiflexion). Lunging is a common daily move that we use to pick small items up off the floor or during sport activities.

• Once again, choose a surface that you are comfortable with challenging yourself on
• Stand near a wall, chair or counter for balance and safety if needed
• Get into a lunge position, with the front foot in the center of your balance device
• Make sure you have good balance and form- with minimal wobbling and the front knee directly over the toes (not in front)
• When you’re ready, bring your entire body closer to the floor as you bend the knees, how deep you go will depend on your form, balance, and strength
• Keep the abs tight and spine upright throughout
• Repeat 10 times on one leg and then switch
• Continue for 2-3 sets on each leg

12. Sumo Squat

A squat is another very functional move that we do every single day. Whether it’s getting up from a chair or a dance move, being able to comfortably squat with good form is essential. It can be particularly difficult with ankle impingement since it requires pain free dorsiflexion.

• Assume a wide squat position with the toes pointed outward and knees over the toes
• Place your balance device under one foot, with the foot directly in the center
• Once you feel balanced, go deeper into your squat 
• Keep the weight in your heels and spine upright as squat as deep as possible
• Return to the starting position and repeat
• Continue for 10-15 repetitions for 2-3 sets total
• Don’t forget to switch and repeat the other foot

To progress, you can try adding more dynamic ankle motion with a calf raise (heel off the ground) at the top of each repetition.

Benefits of Exercise for Ankle Impingement Syndrome

Exercise is a crucial part of an ankle recovery program. A well-balanced program will restore strength, flexibility, and coordination that are necessary for pain free use. The hope is to be able to manage your symptoms conservatively to avoid surgery, like an arthroscopy. The benefits of regular exercise for the ankle are endless, including:

• Increased pain free ankle range of motion
• Prevent build up of scar tissue
• Functional foot, ankle, and lower leg strength for daily activities
• Improved blood flow to promote healing and reduce swelling of surrounding soft tissue
• Better joint mechanics to promote ankle stability and reduce pain and unnecessary tissue irritation
• A boost in overall quality of life

What to Avoid

In general, to promote optimal recovery, simply avoid any move that increases your pain, aggravates symptoms, and causes ankle instability. This most often means that you will avoid end-range of motion and high impact moves like jumping or running until your symptoms are better managed.

If you are having trouble tolerating any exercise, consider other treatment modalities for chronic ankle pain relief before and after your exercise program.

More Ways to Treat Ankle Impingement Syndrome

Considering Physical Therapy

If you’re not sure where to start or how to progress, scheduling a round of physical therapy is a great option for a personalized program and treatment plan that you can feel confident in. Additionally, if your symptoms aren’t improving or getting worse, make sure to get a hold of your doctor as soon as possible for appropriate medical advice. They may need to do additional testing, such as an x-ray, to rule out issues like fracture or bone spurs.

With the right understanding and exercise program, you can feel in control of the recovery process for ankle impingement. Try out the exercises, stay in touch with your doctor or physical therapist, and you will notice a gradual change in your symptoms in no time.

Sources:

http://www.myactionpt.com/physical-therapist-s-guide-to-ankle-impingement

https://www.active.com/fitness/articles/5-exercises-to-prevent-an-ankle-injury

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