Why Does Chronic Ankle Instability Return?
- Wasatch Foot & Ankle
- 1 day ago
- 5 min read
Chronic ankle instability occurs because an initial injury likely created three things you have not fully addressed:
Mechanical laxity Neuromuscular dysfunction Changes in Movement Patterns
As long as one or all of those problems remain, it’s only a matter of time before you sprain your ankle again—probably during some normal activity you don’t think twice about.
How do you know when your ankle is ready to fully return to sport? Here are the most common challenges that lead to recurring ankle sprains, plus a simple framework for eliminating them.
Why Does My Ankle Keep Spraining?
While your ankle is healing from an inversion sprain, your lateral ligament complex lengthens (especially the ATFL).
As a result of being stretched past its normal resting length, you experience:
Increased movement at the joint
Greater inversion forces during activity
Less stability from passive restraint
When you suffer subsequent ankle sprains, additional capsular stretching and scar tissue forms that is weaker than normal tissue. During times of muscular fatigue or when unexpected forces are applied, your dynamic stabilizers (muscles) cannot react with enough force to prevent excess inversion… and your ankle gives way again.
Mechanical Laxity vs. Functional Instability
Mechanical Laxity
Positive anterior drawer test or talar tilt test
Demonstrable looseness on physical exam
Ligaments don’t provide enough passive support
Places you at risk for re-injury during cutting motions, deceleration, landing, or stepping on uneven ground.
Functional Instability
Muscles react too slowly to stabilize the joint
Poor awareness of ankle position
Weak balance skills
You may even feel like your ankle is unstable when diagnostic tests show it to be "normal." This is often the missing link to recurring injuries.
Neuromuscular/Poor Proprioception
Proprioception is your body’s ability to sense its position in space. When you repeatedly sprain your ankle, the mechanoreceptors (nerve cells) in your ligaments become damaged. This causes:
Slower contraction of muscles that stabilize the joint (peroneals)
Weaker corrective response to initiate ankle eversion
Impaired ability to maintain stability when standing on one leg
Your body can no longer rely on subconscious stability and must depend on vision and conscious muscle contraction to prevent inversion… which doesn’t work when you have to move quickly or react to unpredictable situations.
Slow Peroneal EMG Response
When peroneal muscles fire too slowly, your body can’t arrest ankle inversion in time. Studies show this is a leading cause of recurrent ankle sprains.
Brain “Misfires”
Did you know your brain actually changes how it represents your ankle joints after repetitive injury? Advanced imaging demonstrates altered brain activation within the sensorimotor network. This proves proprioceptive training must reestablish INSTINCTIVE/reactive stability, not just muscular strength.
Contributing Factors From Traditional Rehab Programs
The problems listed above are usually caused by focusing on the wrong things during rehab. In the beginning stages of injury, most programs appropriately emphasize:
Pain management
Decreasing swelling
Regaining normal ROM
However, many will stop there without incorporating:
Training through unexpected loss of balance
Sport-specific agility progressions
Dynamic strength under load
Objective return-to-play criteria
Criteria I’m talking about? Single-leg hop test symmetry, time-to-stability testing, etc. Once an athlete meets those requirements as well as clinical standards for strength and balance, they have a MUCH lower chance of reinjury.
You can be as strong as the next guy, but if you lack neuromuscular control of that strength, it’s meaningless. You’ll continue to sprain your ankle because a powerful co-contraction occurs… WITH NO COORDINATION.
Open Yourself Up to Contributing Factors
Are you guilty of only looking at your ankle when it comes to rehab? I used to be this way until I learned how everything is connected.
Weak hips/core muscles
Hip abductors help stabilize your body in the frontal plane. If they’re weak, your ankles will have to compensate by providing stability they’re ill-equipped to handle.
Lack of dorsiflexion
If you’re “chunky” around the ankles, you’re more prone to invert when you land.
Poor landing mechanics
Toeing out, stiff landings, and landing on your lateral foot border can all contribute to chronic ankle instability.
Focus on improving your control up-top and fine-tuning your movement mechanics to place LESS demand on your ankles.
Structural Adaptations to Repeated Sprains
Aside from the ones mentioned previously, repeated ankle sprains can lead to osteochondral lesions of the talus (OCLs).
Osteochondral Lesions (OCL’s)
When your ankle rolls, the talus (instep bone) is typically what rolls with it. Depending on the forces at play, you can develop lesions to this cartilage that result in:
Swelling that won’t go away
Catching/popping with activity
Osteoarthritis
Impingement
Synovial hypertrophy, scar tissue buildup, or even bone spurs on the tibial plafond (front of shin bone) can cause your ankle to feel unstable.
These are just a few reasons why having weight-bearing x-rays or even an MRI may be necessary if you continue to have chronic ankle instability.
Poor Confidence/Psychological Readiness
The fear of reinjury itself can create a situation where you brace for your next injury.
Movements are more tentative, which decreases physiological joint unloading
Co-contraction dials down your ankle’s ability to stabilize
You may unconsciously avoid exercises that challenge your balance
Restoring confidence and gradually exposing yourself to the demands of your sport is key to breaking the chronic ankle sprain cycle.
Steps to Break the Cycle of Recurrence
In summary, here are the FOUR things you should address with any rehab program if you want to get rid of your stubborn ankle instability:
Mechanical Assessment
Integrity of ligaments
Structural alignment
Integrity of adjacent cartilage
Progressive Neuromuscular Retraining
Balance board work
Reactive/unpredictable step training
Dual task training
Train on different surfaces
Strength + Coordination
Peroneal strengthening
Single leg control drills
Eccentric calf raises
Objective Return-To-Activity Criteria
Single leg hop test symmetry
Time to stability testing
Fatigue resistance testing
External Support While Progressing
Wear a lace-up brace during high-risk activities
At WFI, we address chronic ankle instability with both an objective structural and functional assessment to determine if rehabilitation or operative management is the best course of action for you.
Conclusion
You keep getting recurring ankle sprains because your ligaments took longer to heal, your brain stopped reacting properly, and you continued moving incorrectly.
Until you improve:
Joint stability
Passive
Reactive
Control of your hips/legs
Movement mechanics
And believe in your body’s ability to perform
You will continue to battle bouts of ankle instability. It’s not just about feeling better.
FAQ
Q1: Why does my ankle keep giving way when it doesn’t even hurt?
A: Many times, pain has nothing to do with ankle sprains becoming chronic. It’s the delayed response time of your muscles that prevents excess inversion.
Q2: Can bracing help chronic ankle instability?
A: Temporary, but it doesn’t fix the neuromuscular reasons you keep spraining your ankle.
Q3: How long should you rehab an ankle before surgery is needed?
A: Give it at least 8–12 weeks of progressive, neurologically based training before even considering surgery. If you’re still having problems after that, seek help from a professional.
Q4: What are the best predictors of chronic ankle sprains returning?
A: Mechanical instability found on physical exam, slow personal EMG response, poor balance test performance, and returning to sports too soon.
Q5: At what point do you need ankle surgery for chronic sprains?
A: Surgery should be considered if there is provable mechanical instability with your ankle or if there is evidence of associated OCL’s or tendon pathology.