Written by Christopher Ioannou, BSc (Hons) Sports & Exercise Science
Featuring Dr. Peter Francis, PhD in Exercise Science

Reading Time: 12 minutes

Table of contents

Introduction
The Prevalence of Ankle Sprains in Sporting Activities
Peter Francis’ Talk on Even Ground and the Modern Shoes
The Three Main Causes of Ankle Sprains in Sport
How to Strengthen Your Ankles to Prevent Sprains
Wobble/Balance Board Training
How to Make a DIY Balance Board
Balance Beam Training
Exercising Health Design 3-in-1 DIY Balance Board

Introduction

In this blog post we’ll cover the 3 main reasons why lower limb injuries, such as ankle sprains, are so common in sport.

We'll then cover all the things one has to do to overcome these issues and strengthen one’s ankles, including exercises you can do in the comfort of your own home using a simple plank of wood and some PVC pipe.

So, this is going to be both an educational and a practical article.

The Prevalence of Ankle Sprains in Sporting Activities

A literature review of 227 studies across 70 different sports in 38 countries found the ankle joint to be the second most common injury site after the knee, and the ankle sprain to be the most common type of ankle injury [1].

It has also been found that, once an ankle sprain occurs, it is more likely to reoccur—and that 20–50% of sufferers will end up with functional ankle instability [2][3], which is a fancy way of saying weak and unreliable ankles for athletic activities.

Now, to tackle this problem effectively, we have to first identify the common causes of ankle sprains and then find the solutions to them.

The best way to start is to ask one of the world’s experts on these issues. So, that's what we did by interviewing Dr. Peter Francis, a world renowned Sports and Exercise Scientist who specialises in biomechanics and sport rehabilitation.

In his 2020 paper published in The British Medical Journal of Sports & Exercise Medicine, Dr Francis mentions how, due to rapid advancements in the way we have lived over the past 100 years, there is now a huge mismatch between cultural and evolutionary biology.

In our podcast with Dr. Francis, we asked him to elaborate on this issue, and to explain how it can cause lower limb injuries like ankle sprains.

Peter Francis’ Talk on Even Ground and the Modern Shoes

The Three Main Causes of Ankle Sprains in Sport

So, there are three important points that Dr. Francis made here:

1. Lack of Movement Variability

The human body is made to move in a variety of different ways. So when you isolate your activity and are hyper focused on one specific sport, like road running, for example, then you overwork one dimension of your body. This not only increases your risk of developing overuse injuries, but it also leaves your body ill-prepared for any unknown territory.

So, let’s say you try a different sport that involves a lot of rapid changing of direction, and speed variation with a bit of jumping, like basketball.

Well, your lungs may hold up, but I can't make the same prediction for your ankles.

2. Lack of Surface Variability

There is a lack of variability in the surfaces one plays on in most sports.

Think of track and field, tennis, basketball, soccer, football… and the list goes on. All the courts, pitches, tracks and arenas are perfectly levelled ground, which lacks variability.

So again, any variation from this norm, like let’s say; running a trail, may leave one vulnerable to ankle sprains due to ones lack of preparedness to running on anything other than perfectly levelled ground.

I guess it is no surprise then that world record marathon runner, Eliad Kipchoge, spends a great portion of his training off-road.

3. Wearing the Wrong Shoes

Finally, to take Dr. Francis' last point, one then sticks one’s perfectly-engineered foot and ankle — made up of 26 bones, 33 joints and over 100 muscles and pieces of connective tissue, all meant to move the foot across the full spectrum of human motion — into a regular shoe, which is stiff, built up with arch support and does not allow freedom of motion.

The consequence, unfortunately, is that movement variability is then lowered even further.

Well, with this much manipulation and control, it’s no wonder our bodies break down as soon as they are pushed even slightly out of their comfort zones.

And this is where the mismatch between evolutionary biology and cultural evolution, as presented by Dr, Francis, can now be understood.

Fortunately, each one of these issues can be minimized in the following ways:

How to Strengthen Your Ankles to Prevent Sprains

1. Play a Variety of Sports

The first step is to introduce other sports into your routine.

So, if you are a track and field runner, for example, playing a bit of tennis or basketball here and there can get you running not just in straight lines at a constant pace, but shuffling side to side, changing direction and varying your running pace.

This variability alone can go a long way toward stimulating and strengthening your ankles and feet musculature.

2. Exercising on Various Surfaces

The next step is to exercise on various terrains and surfaces. So, running on grass, sand, uphill, downhill and on trails can all add diversity to your training.

However, a quick disclaimer here: Introducing any new variable into your training, such as surface variation, needs to occur slowly.

I've personally made the mistake of deciding to do a mountainous trail run after being restricted to road running for a few months, only to then sprain my ankle 2km into the trail. What I should have done is walked the trail a few times, then introduced a few interval runs and finally ramped up the volume as I got used to the terrain.

I guess sometimes we need to learn lessons the hard way.

3. Training Barefoot

Moving on to the next step, which is by far the lowest hanging fruit on this tree and something anyone can do immediately, and that is to train barefoot and/or substitute regular shoes for barefoot-style shoes.

As Dr. Francis mentioned in our interview, modern footwear has a highly supportive and regular interior, which acts as a barrier between you and the ground, thereby disconnecting you from feeling and reacting to the little diversity that is left in our modern environment.

In our full interview with Dr. Francis, he mentioned that by wearing minimalist footwear, which is thin and flexible, one starts feeling and responding to the ground again.

He gives the practical example of walking over the reflective blocks on a zebra crossing.

While a thick layer of EVA foam does little to send sensory information to the brain and ankle about this obstacle in the road, barefoot shoes allow these signals to be transmitted naturally.

Remember, we communicate with the terrain through our feet, which are the only contact points we have with the ground during bipedal movements. Therefore, we need to ensure that the feet have enough ground feel to sense everything.

In this way, our body, including our supportive structures around our ankles, can then respond appropriately. These findings have been validated in several studies.

One such study, which got me really excited because it was conducted in my homeland, South Africa, took high-level netball players who were randomly split into two groups after testing their ankle stability, agility and speed.

One group then performed an eight-week training program barefoot, while the other group performed the same program wearing regular training shoes. At the end of the intervention, ankle stability, agility and speed were retested for both groups.

Astonishingly, the barefoot group improved almost two times more than the shoe-wearing group in most of the tests [1] [7].

So how cool is that? The same program, just done without shoes, yielded almost double the positive results.

However, there is another disclaimer here. The authors of this study did an important thing. They didn’t throw their subjects straight into the deep end by making them train exclusively barefoot from day one. Instead, they allowed only five minutes of barefoot exercise in session one and then slowly ramped up the time until their athletes were doing full training sessions barefoot by week eight.

By having this smart transition period, the researchers managed to prevent any of their netball players from getting injured, which is the only real risk one has when first starting to train barefoot.

This is the main reason for which we have developed the Barefoot Shoes Transition Program, which is designed to help someone carefully adjust to running barefoot or in barefoot shoes using specific supplementary exercises and smart programming.

Anyway, now we get to the most exciting portion of this blog post, so follow to the end because I'm going to show you how to make your own ankle-strengthening exercise devices.

Wobble/Balance Board Training

You see, through all my research, I found a method of incorporating all three ankle-strengthening principles mentioned in this post, namely: Movement Variation, Surface Variation and Barefoot Movement, into one training protocol, which can be done in the comfort of your own home.

It is called wobble board or balance board training. What it essentially entails is placing a wooden board on top of a yoga block or pipe, on which you have to stabilize and balance yourself.

Unlike many other lower limb exercises, balance training is performed in weight-bearing positions, which are excellent for improving ankle stability [4].

It is no wonder, then, that in a study in which a group of volleyball players participated in a balance-board exercise intervention, they incurred significantly fewer ankle injuries than the group that had done no balance board training [3].

In fact, several studies have shown that balance board training does not only improve static and dynamic balance, but also reduces the risk of incurring sports injuries [5].

Furthermore, balance and coordination training has been shown to provide improvement in cases of functional ankle instability and excessively pronated, flat feet [4][6].

Great, so it is obviously a useful tool. But there is just one problem. These balance boards are pretty expensive and it might be difficult to get them shipped to your country, because they are relatively large.

How to Make a DIY Balance Board

So, I took matters into my own hands. I acquired a cheap plank and screwed two smaller planks on either side of it. These smaller bits act as safety stoppers when I’m on the roller. I then used my existing foam roller and yoga block to balance on.

As an alternative to the foam roller, I got my hands on a PVC water pipe off-cut.

However, because there was no rubber on the PVC, it tended to slide about on the floor, which was hazardous for me while standing on top of it. A simple fix is to just lay a rubber gym mat underneath, or use it on a carpet.

There you go: for a fraction of the cost, you can make a basic DIY balance board.

But I didn't stop there. I thought, if this was so easy to make, what other apparatus can I build to strengthen my ankles?

Balance Beam Training

Naturally, I made a balancing beam.

This beam is so simple; it is just made of a heavy duty PVC water pipe, which can be found everywhere in the world—and very cheaply too.

The build consists of one long piece for the crossbeam, four shorter pieces for feet, two even smaller pieces for the uprights, two T-pieces for supports, two elbow joints to connect everything together and four end caps to finish it off.

Balance beam training is super useful for single leg balance and stability, which has been found to be a problem for those who have weak ankles and are prone to getting ankle sprains [4].

Single leg stability work is also essential for all activities that involve running, because the running motion is made up of a continuous sequence of single leg supports.

But, hold on! I didn’t stop there either. I thought, if I'm going to have these items in my gym, then I must make them look the part and see if there is yet another use for them.

Exercising Health Design 3-in-1 DIY Balance Board

So, with the help of my grandfather, an engineer and DIY extraordinaire, we converted these cheap and effective yet pretty ugly ankle-strengthening and exercise tools into something we are proud to put in our gym.

Furthermore, we designed it in such a way that the balance beam comes apart, attaches to the balance board and transforms into a handy standing desk.

And better still, the design and materials are so lightweight and modular that all the parts can be easily pulled apart, placed in your luggage and taken with you on all your travels.

We essentially replaced an expensive Wobble Board, Balance Beam and Standing Desk that would collectively cost $250 or more on Amazon with a three-in-one device that will cost you between $25 and $70 for the materials, depending on how many of the extra features you want to add to your board and beam, such as rubberizing and painting it.

So, my team and I have described all the steps you need to take to build this product in an-easy-to-follow and fun tutorial, so that you can make one for yourself at home.

We’ve also included tutorials of the 30 best exercises to do on the balance board and beam to strengthen your ankles to help you prevent sprains and other injuries. These include beginner to advanced ankle-strengthening exercises.

Link to the 3-In-1 DIY Balance Board Tutorial + 30 Exercises

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How to Strengthen Your Ankles to Prevent Sprains and Injuries (Exercises Included)

Introduction

The Prevalence of Ankle Sprains in Sporting Activities

Peter Francis’ Talk on Even Ground and the Modern Shoes