Ankle sprains are extremely common in soccer players across all participation levels, even professional soccer.

They’re usually mild sprains, which can have you limping off the field and sitting on the sidelines for a few days. However, the more mild sprains you endure, the more likely a moderate-severe sprain could happen.

If you or someone you know has trouble with ankle sprains, read up! It can save you from a season on the bench.

Understanding Ankle Sprains

Ankle sprains account for 17-20% of all injuries in soccer, and hamstring strains follow just behind. (3)

Those who suffer from an ankle sprain are also vulnerable to reinjury. In fact, an ankle sprain makes you three times more likely to suffer another one. (1)

Those odds suck, right?

What Structures Are Involved?

You have ligaments on the inside and outside of the ankle that passively stabilize the joint. When you sprain your ankle, you injure one or more of these structures.

The outer ligaments are the most commonly injured when you “twist” your foot inward. The anterior talo-fibular ligament is usually the victim.

But, sometimes, you can twist your ankle and injure a muscle.

Your peroneal muscles, situated on the outside of the ankle and foot, also get stretched when you roll your ankle inward. An ankle sprain that also involves the muscles can lead to strain, big tear, or avulsion fracture of the muscle’s bony attachment site from the rest of the bone.

The next level of severity? Ankle fractures through the tibia, fibula, or both. Not fun.

What Happens To My Ligaments During a Sprain?

When you suffer from a sprain, the ligament is overstretched and damaged.

Unfortunately, ligaments don’t heal as well as muscle or bone due to relatively poor blood supply. Larger injuries can take a long time to heal completely. This is why recurrence is so high.

One of the ankle ligament’s protective super powers is also affected after a sprain.

Ligaments have special cells that detect position in space, or proprioception. They send quick live messages to the brain about foot placement. If the ligament is affected, these cells are also impacted. Impaired proprioception can decrease awareness and prevent your body from recovering the foot when it’s in a vulnerable position.

What Puts Me at Risk?

There are certain factors that have been shown to increase your risk for an ankle sprain.

Studies have shown that these are the risk factors: (2, 3, 5)

• Previous ankle sprains
• Weak hip abductor muscles: glute medius and minimus
• Poor single-leg balance
• Fatigue during games

These situations are shown to increase risk: (2, 4)

• Fatigue during the second half of games
• Games on bad fields
• Inadequate warm-up before competition

Ankle sprains occur most during a game vs during training. One study showed that the most commonly injured player was the center midfielder(s), and 80% were atraumatic. (4)

If MOST of the ankle sprains are atraumatic, it means that the player’s body failed to protect the ankle from its own forces (or a bad field).

Guess what that really means?

Those injuries are preventable!

How to Prevent an Ankle Sprain

Knowing the risk factors is the first step. If hip abductor weakness, poor single leg balance, fatigue, and poor warm-up are controllable factors… let’s eliminate them.

Hip Abductor Weakness

Hip abductor weakness has been identified as a predictor of noncontact ankle sprains. (5)

Your hip abductors are your glute medius and minimus. They control your leg/hip at the pelvis.

When your leg is unattached to the ground, your hip abductors move the leg sideways. But that’s not when ankle sprains occur.

Ankle sprains happen when the foot meets the ground and it accepts force. If the ankle doesn’t get help from other parts of the body, it can’t accept all the force from cutting. The hip abductors need to kick in.

When your foot is on the ground, the hip abductors help buffer the force by almost pushing the ground away from the pelvis. Coupled with a slight knee bend and a strong core, you’ve got a good cutting form.

Single-Leg Balance

Improving single-leg balance, AKA neuromuscular control, can greatly reduce occurrence of leg injuries. (4)

Since cutting, running, and essentially all of soccer is performed on a single-limb at a time, single-leg balance and control is incredibly important to protect the leg from injury.

Fatigue

It’s been shown that ankle sprains occur later in games, although there is no definitive reason.

The best assumption is that fatigue sets in at the second half, which leaves players vulnerable to injury.

We know that’s plausible because other research shows an association between poor sleeping habits, depression/anxiety, and increased injury risk. (3)

Sleep is a fantastic recovery tool which is often overlooked. Poor sleeping habits contribute to fatigue and inefficient muscle recovery, as certain hormones that contribute to recovery need sleep to release.

Stressors that cause anxiety, especially on a daily basis, tend to increase risk of injury and could be tied to sleep patterns. However, exercise can decrease stress and improve anxiety.

An important note that isn’t mentioned often enough: If soccer is a stressor at a young age, perhaps it isn’t the right sport… or there’s not enough cross-training in your training regimen.

Warm-Ups

A great, comprehensive warm-up is key to preventing injury. The best warmup proven to reduce lower-limb injury in athletes is the FIFA 11+. (1)

FIFA 11+ is so important and underused that I’m making this entire line a link straight to it.

If your coach isn’t already implementing this, send him/her the link ASAP.

Research has shown that it can reduce the risk of multiple injuries, like ankle sprains and ACL tears.

Since we’re talking about ankle sprains, you should know that the general protocol decreases injury risk by 36% which is a heck of a lot.

A Great Exercise for Hip Abductors and Single-Limb Balance

The best way to approach physical risk factors is by performing exercises that combine them. This makes it more applicable to a game situation.

Here’s an excellent example of an exercise that kills two birds with one stone. Tackle hip abductor strength and single-limb stability at once.

Runner’s Clams

Suggested dosing: 2×15-20

Start with one leg propped behind you while balancing on the other.

Shift 90% of your weight to the balancing leg. Keep a slightly bent knee.

You are focusing on stabilizing yourself on the balancing foot while opening and closing the hip on the other leg.

Both legs are working, but the leg that is balancing should be working the hardest.

Don’t let your balancing leg fall inward and keep your heel and toes on the ground.

CHALLENGE: Perform this exercise while the balancing foot is on its toes.

I’ve Already Had Multiple Ankle Sprains. Now What?

If you’ve already had multiple ankle sprains, you might have chronic ankle instability.

This means that you’re now very prone to sprained ankles or other ankle/foot injuries. Remember, the biggest risk factor of an injury is having had one already.

Bring it up to the doctor/pediatrician and get a physical therapist to fully assess the body for factors that may have left you vulnerable to sprains.

It’s never too late to work on your vulnerabilities. You can still improve how your body protects the ankle by strengthening the right muscles and improving your movement patterns.

Go Prevent Injury!

Now that you have the tools, go use them!

If you know someone who may need to see this, send them the link.

If you like evidence-based injury prevention, sign up for our newsletters so you never miss a beat.

P.S. Stop icing your sprains and start moving them.

CITED REFERENCES

1. Attar, W. S. A. A., Khaledi, E. H., Bakhsh, J. M., Faude, O., Ghulam, H., & Sanders, R. H. (2022, June 23). Injury prevention programs that include balance training exercises reduce ankle injury rates among soccer players: A systematic review. Journal of Physiotherapy. Retrieved August 8, 2022.
2. de Noronha, M., Lay, E. K., Mcphee, M. R., Mnatzaganian, G., & Nunes, G. S. (2019). Ankle Sprain Has Higher Occurrence During the Latter Parts of Matches: Systematic Review With Meta-Analysis, Journal of Sport Rehabilitation, 28(4), 373-380.
3. Kolokotsios S, Drousia G, Koukoulithras I, Plexousakis M. Ankle Injuries in Soccer Players: A Narrative Review. Cureus. 2021 Aug 16;13(8):e17228. doi: 10.7759/cureus.17228. PMID: 34540455; PMCID: PMC8445148.
4. Manoel LS, Xixirry MG, Soeira TP, Saad MC, Riberto M. Identification of Ankle Injury Risk Factors in Professional Soccer Players Through a Preseason Functional Assessment. Orthop J Sports Med. 2020 Jun 24;8(6):2325967120928434. doi: 10.1177/2325967120928434. PMID: 32637431; PMCID: PMC7315686.
5. Powers, C.; Ghoddosi, N.; Straub, R.; Khayambashi, K.; Hip Strength as a Predictor of Ankle Sprains in Male Soccer Players: A Prospective Study. J Athl Train 1 November 2017; 52 (11): 1048–1055.