The Overlooked Connection Between Ankle Sprains and Glute Dysfunction
Discover how ankle sprains may affect glute strength, hip stability, and movement patterns, and why addressing these connections can support better recovery.
MOVEMENT & OPTIMAL FUNCTION
Robert Inesta
10/16/20268 min read
When patients come to my office with an ankle sprain, they're often surprised when I begin examining and treating their hips and pelvis as well. After all, it's their ankle that hurts, not their hips.
The body doesn't function as a collection of isolated parts, as we often picture it. An injury in one area can influence function, including movement, muscle activation, and stability elsewhere, sometimes long after the original injury has healed.
One particularly interesting and often overlooked example is the relationship between ankle sprains and the gluteal muscles.
Research suggests that ankle injuries can be associated with changes in how the muscles around the hips activate and coordinate movement. These changes may contribute to ongoing instability and potentially increase vulnerability to future injuries.
In many of my articles, including one exploring hip function and injury risk in golf and tennis, I discuss how restricted hip movement or dysfunction may contribute to problems elsewhere in the body.
But the relationship can work in the opposite direction as well. An injury at the ankle may influence hip muscle function, illustrating how interconnected the body's movement systems really are.
Understanding this connection may help explain why some people continue to experience problems long after what seemed like a relatively minor ankle sprain.
Why Ankle Sprains Can Become a Recurring Problem
Ankle sprains are among the most common musculoskeletal injuries, particularly in sports involving running, jumping, cutting, and sudden changes in direction, such as basketball, soccer, and football.
Most ankle sprains involve damage to the ligaments along the outside of the ankle, usually occurring when the foot suddenly rolls inward. The severity can range from mild stretching or partial tearing to a complete tear of a ligament.
Although many ankle sprains improve with time and appropriate care, the disappearance of pain and swelling doesn't necessarily mean that normal function has been fully restored. As I discuss in my article on preventing an acute injury from becoming chronic, how we approach recovery after the initial injury can influence longer-term function.
In fact, some research estimates that approximately 40% of people who experience an ankle sprain may develop chronic ankle instability (CAI), although estimates vary depending on the population studied and how chronic ankle instability is defined.
Chronic ankle instability is characterized by symptoms such as:
Repeated ankle sprains
Episodes of the ankle feeling unstable or "giving out"
Impaired balance and coordination
Persistent discomfort or swelling
Decreased confidence in the ankle during physical activity
Why does this happen? There is more to the clinical picture than just the ligaments.
The Overlooked Connection Between Ankle Sprains and the Glutes
The gluteal muscles, commonly referred to as the glutes, consist of the gluteus maximus, gluteus medius, and gluteus minimus.
These muscles are essential for hip movement, pelvic stability, balance, and coordinated lower-extremity function.
The gluteus maximus is particularly important for hip extension and power generation, while the gluteus medius and minimus help stabilize the pelvis and control hip movement during activities such as walking, running, and standing on one leg.
But what do these muscles have to do with an ankle sprain?
More than most people realize.
When an ankle is sprained, the injury doesn't simply affect the ligaments. Depending on the injury, surrounding connective tissues, joints, and nerves may also be affected. These changes can disrupt the sensory information being transmitted from the ankle to the central nervous system.
This information, known as proprioception, helps the brain recognize where the body is positioned in space and coordinate appropriate muscular activation patterns.
Think of proprioception as the body's internal positioning system. It allows you to walk on uneven ground, maintain balance, and make rapid adjustments without consciously thinking about every movement.
When that sensory feedback is disrupted, the nervous system may change how it recruits and coordinates muscles throughout the lower extremity, including the glutes.
What Does the Research Show?
An interesting 1994 study published in the International Journal of Sports Medicine examined muscle activation in individuals with a history of severe ankle sprains.
Researchers found that participants with previous ankle injuries demonstrated delayed activation of the gluteus maximus compared with individuals without those injuries.
These findings suggest that a previous ankle injury may be associated with changes in muscle recruitment farther up the lower extremity, even after the original injury has healed.
A 2021 study published in PLOS ONE also found altered muscle activation patterns in individuals with chronic ankle instability. Researchers observed changes in the timing and magnitude of muscle activation involving the hips, knees, and trunk, including reduced overall activation of the gluteus medius.
Interestingly, some of these neuromuscular changes were observed on both sides of the body, not simply the side with ankle instability.
These findings suggest that the effects of an ankle injury may extend well beyond the ankle itself.
It's important to distinguish between muscle weakness, reduced activation, and altered coordination. These are related but not identical problems. Not everyone with an ankle sprain develops gluteal inhibition, and research has not established that gluteal dysfunction is the primary cause of recurring ankle sprains.
Nevertheless, these findings highlight why evaluating the whole picture, especially the hips and pelvis, can be an important part of assessing ankle function.
How Glute Dysfunction May Contribute to Recurring Ankle Sprains
Consider what happens when you stand on one leg.
Your ankle-controlling muscles make small adjustments to maintain balance, but they don't work alone. The muscles around your hip and pelvis help control the position of your entire lower extremity.
The muscles throughout the lower extremity are also interconnected through layers of fascia and other connective tissues, helping them function as part of a coordinated movement system.
If the gluteal muscles aren't activating or coordinating effectively, your ability to control movement may be compromised.
For example, insufficient hip stability can allow excessive inward movement or rotation of the thigh during weight-bearing activities. This may alter the position of the knee and ankle and affect how forces are distributed through the lower extremity.
In someone who already has impaired ankle proprioception or ligament stability, these additional movement-control challenges may be particularly relevant.
This creates the possibility of a recurring cycle:
Ankle sprain → changes in local tissue function and sensory feedback → altered neuromuscular control → possible changes in hip muscle activation and balance → increased vulnerability to another ankle injury.
Of course, this is only one potential mechanism.
Chronic ankle instability can also involve ligament laxity, restricted ankle mobility, weakness of the local ankle muscles, impaired balance, and other factors.
The key point is that focusing exclusively on the ankle may overlook important contributors to overall stability.
Can Ankle Instability Contribute to Knee, Hip, or Low Back Pain?
Another interesting consideration is how an old ankle injury may influence other areas of the body.
We commonly think about problems in the lower back or pelvis contributing to pain farther down the leg. For example, nerve irritation originating in the lumbar spine can produce symptoms extending into the hip, leg, or foot.
But the relationship between different regions of the body can work in the opposite direction as well.
Ankle stiffness, instability, and altered movement patterns may change how forces are absorbed and transferred through the knees, hips, and pelvis. Over time, these compensations could potentially contribute to increased stress or discomfort elsewhere.
Some emerging research has also explored the relationship between chronic ankle instability and low back pain.
For example, a published case series described three patients with chronic ankle instability and low back pain, raising the possibility that peripheral nerve irritation associated with ankle injury may contribute to symptoms farther up the body.
Although these observations are intriguing, the research is still limited. We cannot conclude that ankle instability commonly causes low back pain, and many other explanations must be considered.
However, it reinforces an important clinical principle: When evaluating a persistent musculoskeletal problem, it's often helpful to look beyond the area where symptoms are being experienced.
A More Complete Approach to Ankle Sprain Recovery
Whether you're recovering from a recent ankle sprain or dealing with recurring instability from an older injury, rehabilitation should address more than simply reducing pain and swelling.
The goal is to restore mobility, strength, balance, and coordinated movement throughout the lower extremity.
Here are several areas I recommend considering.
1. Restore Ankle Mobility and Strength
The ankle itself still needs appropriate attention.
Following an ankle sprain, mobility restrictions, weakness, and lingering swelling can interfere with normal movement.
Depending on the severity and stage of healing, rehabilitation may include progressive weight-bearing, mobility exercises, strengthening of the muscles surrounding the ankle, and appropriate external support when needed.
More significant injuries should be professionally evaluated to rule out fractures or other complications.
2. Improve Gluteal Activation and Hip Stability
Because the hips play such an important role in controlling the lower extremities, I recommend assessing hip strength, mobility, and muscle activation when recovering from ankle injuries.
Exercises such as bridges, side-lying hip abduction, controlled squats, and single-leg strengthening can help develop strength and coordination around the pelvis.
The goal isn't simply to build stronger glutes. It's to improve how effectively these muscles work together with the rest of the body during functional movement.
3. Retrain Balance and Proprioception
Balance training is one of the most important components of ankle sprain rehabilitation.
Simple exercises such as standing on one leg can help challenge the body's ability to maintain stability.
As function improves, exercises can progress to more demanding activities, such as reaching in different directions while balancing, controlled hopping, and sport-specific movements.
These exercises help retrain the sensory and motor systems responsible for responding to changes in position and movement.
Research supports proprioceptive and balance-focused exercise programs as important tools for reducing the risk of recurrent ankle sprains.
For those interested in building a foundation of balance, coordination, and functional movement, my free 10-Day Basics of Functional Stability and Posture Series includes simple exercises such as single-leg standing that can be practiced at home. If you're dealing with an acute ankle injury though, seeking individualized professional guidance is recommended.
4. Address Myofascial Restrictions and Movement Limitations
In my clinical practice, I evaluate the muscles and connective tissues of the lower extremities, hips, and pelvis.
Injuries and the compensatory movement patterns that sometimes follow them can be accompanied by areas of tension, tenderness, and restricted mobility.
Hands-on techniques such as Stecco Fascial Manipulation and Active Release Techniques may be useful for addressing clinically identified soft tissue restrictions, helping manage pain, and improving movement.
These treatments can complement an active rehabilitation program, although research has not established that they specifically reverse gluteal inhibition caused by ankle sprains.
5. Consider Acupuncture or Dry Needling as an Adjunctive Treatment
Acupuncture and dry needling may also be useful as complementary treatments during ankle injury recovery.
In my clinical practice, I've found these techniques helpful for addressing pain, muscle tension, and movement restrictions that can interfere with rehabilitation.
There is also emerging research suggesting that dry needling may influence ankle proprioception and function.
For example, a 2024 randomized clinical trial involving 36 patients with chronic ankle sprain and instability found that dry needling of the peroneal muscles improved certain measures of ankle joint position sense and patient-reported function compared with sham treatment. However, improvements in functional performance tests did not persist at the one-month follow-up.
A separate 2015 randomized clinical trial also found that adding dry needling to a proprioceptive and strengthening exercise program improved pain and function in people with chronic ankle instability.
Although these findings are encouraging, more research is needed to determine the long-term benefits of dry needling and whether it can directly influence altered gluteal activation associated with ankle injuries.
Acupuncture and dry needling are best considered adjuncts to an active rehabilitation program that includes strengthening, mobility, balance, and proprioceptive training.
Don't Overlook the Hips When Recovering From an Ankle Sprain
An ankle sprain may seem like a relatively minor injury, especially once the initial pain and swelling subside.
But the effects can sometimes extend beyond the injured ligaments, influencing balance, muscle activation, and movement throughout the lower extremity.
Research examining chronic ankle instability suggests that altered hip muscle function may be one part of this process.
This doesn't mean that every ankle sprain causes gluteal inhibition or that weak glutes are responsible for every recurring ankle injury, but it does mean that a more comprehensive approach to recovery may be beneficial.
If you've experienced an ankle sprain, particularly if you've had repeated injuries or ongoing instability, don't overlook the importance of hip function, balance, and coordinated movement.
Sometimes, improving function requires looking beyond the area where the original injury occurred.
Think whole picture. That's a key factor in helping the body recover, adapt, and function at its best.
Dealing With Recurring Ankle Sprains or Instability?
If you've experienced repeated ankle sprains, ongoing instability, or difficulty returning to normal activity, a more comprehensive evaluation may help identify factors contributing to the problem.
At Berkshire Functional Chiropractic & Acupuncture in Great Barrington, MA, I combine myofascial treatment, chiropractic, acupuncture and dry needling, and individualized movement strategies to address musculoskeletal problems from a whole-body perspective.
Contact me to schedule an appointment and learn how we can work toward improving your mobility, stability, and function.
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