Science of Falling

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Improve Balance and Athletic Performance by Strengthening Weak Hips and Ankles

Brent Pritt

If you’ve ever dealt with recurring ankle sprains or nagging hip pain, you may have felt like fixing one issue only led to problems elsewhere. What you may not realize is that ankle instability and hip weakness are closely linked, working together in ways that might surprise you. Understanding this relationship is the key to building strength, preventing injury, and moving efficiently. This is true whether you're on the field, at the gym, or just navigating daily life.

In this article, we’ll explore how weak hips contribute to ankle instability and how ankle sprains can lead to hip weakness. We'll also discuss practical ways to strengthen both areas to improve balance, enhance athletic performance, and maintain long-term joint health.

The Shared Relationship Between Hip Weakness and Ankle Instability

Your hips and ankles might seem like distant cousins, but they play vital roles in stabilizing your body. Your lower limbs don’t operate in isolation. Your hips, knees, ankles, and feet work together to keep you upright and moving efficiently. (1, 2) When one part of this system falters, the others compensate, often leading to a chain reaction of instability and weakness. I often say the hip, knee, and ankle work like a family. If one family member isn’t pulling their weight, the whole system can turn into disarray.

Weak Hips Lead to Ankle Instability

The muscles surrounding your hips, particularly the hip abductors (like the gluteus medius and minimus on the outside of the hip), are critical for keeping your pelvis level and stabilizing your legs during movement. (3) When these muscles are weak, your body struggles to maintain balance, placing undue stress on your knees and ankles. (4, 5, 6)

Some studies have found that athletes with weak hip abductors may have poor postural control, leading to a higher risk of lateral (outside) ankle sprains. (5, 7) This can be especially true in sports like basketball, soccer, and tennis, where cutting and quick changes in direction are common and stability is greatly needed.

Even if you’re not an athlete, weak hips can make everyday tasks like walking on uneven ground or climbing stairs more challenging, leaving you vulnerable to falls and injuries. (8, 9)

Ankle Instability Can Lead to Hip Weakness

The relationship between your hips and ankles goes both ways. If you’ve ever sprained your ankle, you know it can affect your entire gait, or rather, your walking style. (10) This change in gait can be attributed to both the main injury and ensuing hip weakness. (10, 11, 12) Limping, shifting weight, and altered movement patterns weaken the muscles surrounding your hips over time. This imbalance sets you up for a vicious cycle of recurring injuries as both the hip and ankle aren’t doing their job appropriately.

In fact, research published in the American Journal of Sports Medicine found that individuals with chronic ankle instability (CAI), or rather consistent ankle problems, also exhibited decreased strength in their hip abductors (outside hip muscles). (13, 14) CAI disrupts the body's ability to stabilize the lower limb, further weakening the hips and perpetuating a feedback loop of instability and injury risk. (15)

The Role of Neuromuscular Control in Hip and Ankle Stability

It’s not just about muscle strength. Neuromuscular control, or your body’s ability to coordinate movement and react to changes in the environment, plays a significant role. For instance, when walking on uneven terrain or performing quick movements, your body relies on sensory feedback from your muscles and joints to make split-second adjustments. (16, 17) This process is termed sensorimotor adaptation.

In individuals with weak hips or ankle instability, this feedback loop is often compromised as the appropriate information doesn’t make it to the brain. (18, 19) For example, weak hips impair proprioception (your awareness of where your body is in space), which can hinder your ankles from making the quick corrections needed to prevent sprains. When your ankle is unstable after an injury, the damage reduces the sensory input your brain receives (reducing proprioception again), impairing your body’s ability to adjust its posture. This can affect not just your ankles but your entire lower body. A sprained ankle could turn into recurring injuries as neuromuscular control worsens. (20)

In simpler terms, if you're ankle or hip are injured your body and brain may not fully understand what's happening. Without complete information, you're more likely to get hurt again, and possibly in a way much worse than a simple ankle sprain.

Strengthening the Entire Chain: What the Research Recommends

To break this cycle, it's important to strengthen both your hips and ankles. (21, 22, 23) Isolated exercises targeting just one area won’t provide the lasting stability needed for long-term improvement, although they aren’t a bad place to start in a rehab program. Strengthening the hips restores balance to the entire lower limb, while proprioceptive exercises help the ankle react more effectively to changes in position. (22, 23) Start in isolation and build into more integrated whole leg movements as your ability allows.

Here’s how you can take action to strengthen both areas:

Hip Strengthening Exercises:

Proprioceptive Ankle Training:

These exercises not only build strength but also improve neuromuscular control, ensuring your body can react quickly to changes in movement or terrain. More often than not, challenging single leg exercises will be the most effective and be the most efficient use of your time. If you want to dive a bit deeper on the power of single leg exercise learn more here.

Long-Term Benefits of Strengthening Your Hips and Ankles

Addressing both hip and ankle stability goes beyond injury prevention. It has far-reaching benefits for your overall movement quality and athletic performance.

1. Reduced Injury Risk

Strengthening your hips and ankles enhances your body’s neuromuscular control, significantly reducing your risk of falls, sprains, and other injuries. (25, 26, 27) This is particularly important for older adults, who are at higher risk for falls due to weakened proprioception and strength.

2. Improved Athletic Performance

Whether you're an athlete or an active individual, strong hips and stable ankles can boost your agility, speed, and power. (28, 29) With a solid foundation, you’ll be able to change direction more efficiently, land safely from jumps, and maintain proper posture during dynamic movements.

3. Enhanced Joint Health

Targeting these areas helps prevent long-term joint degeneration. (30, 31) By reducing compensatory movements, you alleviate the strain on your knees, lower back, and other parts of your body that may bear the burden of weakness elsewhere.

A Real-World Example: Case Study of a Basketball Player

Consider Kelsey, a former patient of mine and an avid basketball player who kept rolling her ankle during games. Despite using ankle tape and braces, she still found herself injured. After seeing a physical therapist, Kelsey learned that her hip strength, and overall coordination, was part of the problem. A targeted rehab program focusing on hip abductor exercises and proprioceptive ankle training helped her regain control of her movement. Months later, Kelsey was back on the court, and more importantly, playing injury-free with no ankle brace.

Kelsey’s story illustrates how addressing both the hips and ankles as a unit can lead to lasting results and prevent the cycle of recurring injuries.

Final Thoughts: Building a Strong Foundation

So, what’s the bottom line? Weak hips and ankle instability are two sides of the same coin. Focusing on just one area leaves gaps in your body’s stability and strength, making you more prone to injury. Whether you're an athlete or just looking to stay active and injury-free, strengthening both your hips and ankles is essential for building a solid foundation.

By incorporating hip abductor exercises and proprioceptive ankle training work into your routine, you can ensure your body moves efficiently as a system.

Now that you understand the connection between weak hips and ankle instability, it’s time to take action. Start incorporating targeted exercises into your routine to build a strong, stable foundation that will not only improve your athletic performance but also enhance your quality of life.

Ready to take the next step?

As a physical therapist and wellness coach, I can help you create a personalized plan to strengthen your hips, stabilize your ankles, prevent injuries, and age better than everyone you know through my online wellness coaching program. Don’t let weak hips or unstable ankles hold you back. Reach out today and start your journey toward better balance, performance, and overall health!

References

  1. Morasso P. Integrating ankle and hip strategies for the stabilization of upright standing: An intermittent control model. Frontiers in Computational Neuroscience. 2022;16. doi:10.3389/fncom.2022.956932

  2. Hampton L. Walking - muscles used. physio-pedia.com. Accessed October 8, 2024. https://www.physio-pedia.com/Walking_-_Muscles_Used

  3. Mansfield PJ, Neumann DA. Essentials of Kinesiology for the Physical Therapist Assistant E-Book. 3rd ed. Elsevier Health Sciences; 2019. https://www.sciencedirect.com/topics/neuroscience/hip-abductors#:~:text=Hip%20abductors%20are%20a%20group%20of%20muscles,like%20walking%20and%20standing%20on%20one%20leg.)

  4. Rowe J, Shafer L, Kelley K, et al. Hip strength and knee pain in females. North American Journal of Sports Physical Therapy. Published online August 2007:164-169. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2953297/

  5. Powers CM, Ghoddosi N, Straub RK, Khayambashi K. Hip strength as a predictor of ankle sprains in male soccer players: a prospective study. Journal of Athletic Training. 2017;52(11):1048-1055. doi:10.4085/1062-6050-52.11.18

  6. Jaraczewska E. Common Hip pathologies- functional impairments and management. Physiopedia. Accessed October 8, 2024. https://www.physio-pedia.com/Common_Hip_Pathologies-_Functional_Impairments_and_Management#:~:text=A%20study%20found%20that%20proximal,the%20development%20of%20compensatory%20movements.

  7. Domínguez-Navarro F, Benitez-Martínez JC, Ricart-Luna B, Cotolí-Suárez P, Blasco-Igual JM, Casaña-Granell J. Impact of hip abductor and adductor strength on dynamic balance and ankle biomechanics in young elite female basketball players. Scientific Reports. 2022;12(1). doi:10.1038/s41598-022-07454-3

  8. Piva SR, Teixeira PEP, Almeida GJM, et al. Contribution of hip abductor strength to physical function in patients with total knee arthroplasty. Physical Therapy. 2011;91(2):225-233. doi:10.2522/ptj.20100122

  9. Gafner SC, Bastiaenen CHG, Ferrari S, et al. <p>The Role of Hip Abductor Strength in Identifying Older Persons at Risk of Falls: A Diagnostic Accuracy Study</p> Clinical Interventions in Aging. 2020;Volume 15:645-654. doi:10.2147/cia.s246998

  10. Punt IM, Ziltener J, Laidet M, Armand S, Allet L. GAIT and physical impairments in patients with acute ankle sprains who did not receive physical therapy. PM&R. 2014;7(1):34-41. doi:10.1016/j.pmrj.2014.06.014

  11. Son SJ, Kim H, Seeley MK, Hopkins JT. Altered walking neuromechanics in patients with chronic ankle instability. Journal of Athletic Training. 2019;54(6):684-697. doi:10.4085/1062-6050-478-17

  12. Moisan G, Mainville C, Descarreaux M, Cantin V. Lower limb biomechanics in individuals with chronic ankle instability during gait: a case‐control study. Journal of Foot and Ankle Research. 2021;14(1). doi:10.1186/s13047-021-00476-6

  13. Dennis HE, Lee H, Han S, Hopkins T, Seeley M. Chronic ankle instability patients demonstrate decreased rate of torque development in ankle eversion, hip abduction. Medicine & Science in Sports & Exercise. 2023;55(9S):410-411. doi:10.1249/01.mss.0000983672.68532.03

  14. McCann RS, Bolding BA, Terada M, Kosik KB, Crossett ID, Gribble PA. Isometric hip strength and dynamic stability of individuals with chronic ankle instability. Journal of Athletic Training. 2018;53(7):672-678. doi:10.4085/1062-6050-238-17

  15. Jaber H, Lohman E, Daher N, et al. Neuromuscular control of ankle and hip during performance of the star excursion balance test in subjects with and without chronic ankle instability. PLoS ONE. 2018;13(8):e0201479. doi:10.1371/journal.pone.0201479

  16. Afschrift M, De Groote F, Jonkers I. Similar sensorimotor transformations control balance during standing and walking. PLoS Computational Biology. 2021;17(6):e1008369. doi:10.1371/journal.pcbi.1008369

  17. Nordin AD, Rymer WZ, Biewener AA, Schwartz AB, Chen D, Horak FB. Biomechanics and neural control of movement, 20 years later: what have we learned and what has changed? Journal of NeuroEngineering and Rehabilitation. 2017;14(1). doi:10.1186/s12984-017-0298-y

  18. Hu X, Feng T, Li P, Liao J, Wang L. Bilateral Sensorimotor Impairments in Individuals with Unilateral Chronic Ankle Instability: A Systematic Review and Meta-Analysis. Sports Medicine - Open. 2024;10(1). doi:10.1186/s40798-024-00702-y

  19. Tan J, Li J, Lei J, et al. Effects of whole-body vibration on sensorimotor deficits and brain plasticity among people with chronic ankle instability: a study protocol for a single-blind randomized controlled trial. BMC Sports Science Medicine and Rehabilitation. 2023;15(1). doi:10.1186/s13102-023-00698-0

  20. Lin JZ, Lin YA, Tai WH, Chen CY. Influence of Landing in Neuromuscular Control and Ground Reaction Force with Ankle Instability: A Narrative Review. Bioengineering. 2022;9(2):68. doi:10.3390/bioengineering9020068

  21. Kaminski TW, Hertel J, Amendola N, et al. National Athletic Trainers’ Association Position Statement: Conservative Management and Prevention of Ankle Sprains in Athletes. Journal of Athletic Training. 2013;48(4):528-545. doi:10.4085/1062-6050-48.4.02

  22. Yeum WJ, Lee MY, Lee BH. The Influence of Hip-Strengthening Program on Patients with Chronic Ankle Instability. Medicina. 2024;60(8):1199. doi:10.3390/medicina60081199

  23. Su Y, Li W, Pan C, Shi Y. Effects of combination of strength and balance training on postural control and functionality in people with chronic ankle instability: a systematic review and meta analysis. BMC Sports Science Medicine and Rehabilitation. 2024;16(1). doi:10.1186/s13102-024-00845-1

  24. Lazarou L, Kofotolis N, Pafis G, Kellis E. Effects of two proprioceptive training programs on ankle range of motion, pain, functional and balance performance in individuals with ankle sprain. Journal of Back and Musculoskeletal Rehabilitation. 2017;31(3):437-446. doi:10.3233/bmr-170836

  25. Lin CWC, Delahunt E, King E. Neuromuscular training for chronic ankle instability. Physical Therapy. 2012;92(8):987-991. doi:10.2522/ptj.20110345

  26. Yalfani A, Azizian M, Gholami-Borujeni B. Neurofeedback training can increase the effectiveness of neuromuscular training on balance and limit of stability of athletes with chronic ankle instability: three arms and single-blind randomized control trial. Sport Sciences for Health. Published online May 9, 2024. doi:10.1007/s11332-024-01212-w

  27. Smith BI, Curtis D, Docherty CL. Effects of hip strengthening on neuromuscular control, hip strength, and Self-Reported Functional Deficits in individuals with chronic ankle instability. Journal of Sport Rehabilitation. 2017;27(4):364-370. doi:10.1123/jsr.2016-0143

  28. Yılmaz O, Soylu Y, Erkmen N, Kaplan T, Batalik L. Effects of proprioceptive training on sports performance: a systematic review. BMC Sports Science Medicine and Rehabilitation. 2024;16(1). doi:10.1186/s13102-024-00936-z

  29. LaPlaca DA, Seedman J. The importance of the foot and ankle in athletic performance. Strength and Conditioning Journal. 2020;43(3):67-79. doi:10.1519/ssc.0000000000000598

  30. Salman LA, Ahmed G, Dakin SG, Kendrick B, Price A. Osteoarthritis: a narrative review of molecular approaches to disease management. Arthritis Research & Therapy. 2023;25(1). doi:10.1186/s13075-023-03006-w

  31. Masson AO, Krawetz RJ. Understanding cartilage protection in OA and injury: a spectrum of possibilities. BMC Musculoskeletal Disorders. 2020;21(1). doi:10.1186/s12891-020-03363-6