Protect Your Ankles and Knees This Basketball Season: An Athletic Trainer's Guide for Players and Parents

By Jena K Phillips, LAT · Core Elite Health Services, LLC

Texas high school girls basketball season starts today, October 21, and the boys start on October 28. Players will cut, jump and land hundreds of times every practice, and most of that load goes through the ankle and the knee.

I've spent 30+ years as an athletic trainer. This guide for players and parents covers the three injuries I see most in basketball, what causes them, and a 10-minute standing routine to lower your risk.

Start with the floor: ground reaction force

Every time your foot hits the court, the court pushes back. That push is called ground reaction force (GRF). It's Newton's third law: you push into the floor, and the floor pushes back equally.

GRF is how you jump, sprint and cut. When you land, that same force travels back up through your foot, ankle, knee and hip, and your muscles have to absorb it.

Two things matter:

• Direction. When your knee stays lined up over your foot, the force travels through your leg the way it was built to handle it. When your knee caves inward, the force twists through the knee instead.
• Time. A soft landing that bends at the ankle, knee and hip spreads the force over a longer moment. A stiff, straight-legged landing takes it all at once.

Coach yourself with one cue: push the floor away. Most of the routine below trains exactly that.

The three injuries to know

Lateral ankle sprain

This is the most common injury in basketball. A lateral ankle sprain happens when the foot rolls inward (inversion) while the toes are pointed down (plantarflexion). In basketball, it usually happens when you land on someone else's foot after a rebound or a shot.

The ligament hurt most often is the ATFL (anterior talofibular ligament), a small band on the outside front of the ankle that connects the fibula (the outer lower-leg bone) to the talus (the top bone of the foot). In a worse sprain, the CFL (calcaneofibular ligament) just below it can be injured too.

The biggest risk factor for an ankle sprain is a previous ankle sprain. Ligaments heal, but balance and strength around the ankle don't come back on their own. Retraining the ankle is not optional.

ACL tear

The ACL (anterior cruciate ligament) sits deep inside the knee. It keeps the shinbone from sliding forward and twisting under the thighbone. Most ACL tears in basketball are non-contact, meaning no one hit the knee. They happen during:

• Landing from a jump, especially on one leg
• Cutting or planting to change direction
• Stopping suddenly (deceleration)

The common pattern is a landing or plant with the knee fairly straight and the knee collapsing inward. That inward collapse is called dynamic knee valgus. Picture the knee dropping toward the other knee while the foot stays planted. Female athletes tear their ACL at a higher rate than male athletes in the same sport, so girls starting today should begin prevention work now.

The good news: research on prevention warm-ups built around balance, strength and landing training shows they can meaningfully reduce non-contact ACL injuries when athletes do them consistently.

Patellar tendinopathy ("jumper's knee")

The patellar tendon connects the kneecap (patella) to the shinbone. Tendinopathy means the tendon is irritated and not handling its load well. Players usually feel it just below the kneecap, during or after jumping, or when going down stairs.

It often shows up early in the season, when jumping volume climbs to daily practice levels. Complete rest calms the pain, but it doesn't make the tendon stronger, so the pain tends to come back when you return. Steady, controlled loading, like the split squats and calf raises below, is what helps a tendon build capacity.

The 10-minute standing routine

Do this before practice as part of your warm-up, or on its own three to four days a week. Everything is done standing and weight-bearing, because that's how you play. Wear your basketball shoes.

1. Knee-to-wall ankle rocks: 10 each side Stand facing a wall in a short lunge, front toes a few inches from the wall. Keeping your heel down, drive your knee forward over your middle toes until it touches the wall. Rock back and repeat. If it's easy, scoot your foot back. Compare sides: a stiff ankle often pushes extra stress up to the knee.

2. Calf raises: 15 each side Start with both feet, then progress to one foot. Rise up for one count, lower slowly for three. Do half with a straight knee and half with the knee slightly bent to work both calf muscles.

3. Single-leg balance with reaches: 5 reaches each direction, each leg Balance on one foot with a soft knee. Reach your free foot forward, out to the side and behind you, touching lightly and returning to center. Keep your standing knee over your middle toes. This retrains the small reflexes around the ankle, often called proprioception (your body's sense of where your joints are).

4. Lateral lunges: 8 each side Step wide to one side, sit your hips back and bend that knee, keeping it lined up over your foot. Push the floor away to return to center. This builds the side-to-side strength you use to defend.

5. Split squats: 8 each leg Stand in a long stride. Lower straight down until your back knee nearly touches the floor, taking three seconds on the way down. Drive up through your whole front foot, front knee tracking over your toes. Slow lowering is especially helpful for a sore patellar tendon.

6. Landing mechanics drills: 5 two-foot, then 5 each single-leg From standing, do a small jump and "stick" the landing. Land softly on the balls of your feet, then let your heels come down. Bend at the ankles, knees and hips together. Keep your knees over your toes. Hold for two seconds. Once two-foot landings look clean, do single-leg hops in place and stick them the same way. Quiet landings are good landings.

7. Lateral hops and skater bounds: 6 each side Start with small side-to-side hops over a line. Then progress to skater bounds: push off one leg, bound sideways, land on the other leg and stick it for two seconds before going back. Keep the landing knee over your foot. Control first, distance last.

Have a parent watch from the front or record a quick phone video. If the knee drifts inward, slow down and make the movement smaller until it lines up.

How much discomfort is okay?

Some soreness is normal when you start something new. Use this rule:

Manageable discomfort is okay. Sharp pain, or pain that's worse the next morning, means back off.

Backing off means fewer reps, a smaller range of motion or less jumping for a few days, not stopping all movement.

If an injury does happen: RICE vs. M.E.A.T.

Many families learned RICE: Rest, Ice, Compression, Elevation. The doctor who coined RICE later revised his view, and many clinicians now favor keeping injured tissue moving within comfort.

I use M.E.A.T.:

• Movement: gentle, pain-free motion early, to keep the joint from stiffening.
• Exercise: progressive loading to rebuild strength and balance, guided by your athletic trainer or physical therapist.
• Analgesics: pain relief as recommended by your physician.
• Treatment: hands-on care and a plan from a licensed professional, such as an athletic trainer, physical therapist or physician.

See a physician right away if a player can't take four steps on the injured leg, felt or heard a "pop" in the knee, has a knee that swells quickly, or feels the knee give way. Those signs need an evaluation before any return to play.

Braces, sleep and building up

• Ankle braces: for players with a history of ankle sprains, a lace-up brace during practice and games can reduce the chance of another one. It works best alongside the balance work above, not instead of it.
• Sleep and fuel: tired legs land poorly, and landing form breaks down late in practice.
• Build up gradually: if you didn't play much this summer, be patient for the first two weeks. Your tendons need time to catch up to your lungs.

Resources if you're dealing with an injury

If your athlete is coming back from ACL reconstruction, my ACL Return-to-Play Playbook: 5 Phases from Surgery to Sport lays out a criteria-based return to sport that tests the whole leg: knee, ankle and hip. It includes a what-to-expect guide for parents and an athlete page, and it's built to use with your athlete's athletic trainer or physical therapist. It doesn't replace the surgeon's clearance.

If your player wants to understand ankle sprains the way athletic trainers do, or is thinking about a future in sports medicine, my Ankle Sprains & Special Tests study guide covers sprain types, the ligaments involved, injury grades and the Ottawa ankle rules.

If your player is coming back from an ankle sprain, my book Back on the Court, Built to Last walks you through every phase, from the first days to full return to sport.

The short version

1. Push the floor away. Ground reaction force drives every jump and landing.
2. Know the big three: lateral ankle sprains (ATFL), non-contact ACL tears (landing and cutting with the knee caving in) and patellar tendinopathy.
3. Do the 10-minute standing routine before practice or three to four days a week.
4. Keep knees over toes on every landing, lunge and cut.
5. Manageable discomfort is okay. Sharp pain, or pain that's worse the next morning, means back off.
6. If something gets hurt, keep it moving with M.E.A.T. and get evaluated by a licensed professional.

This article is for education only and is not medical advice. Talk with your athletic trainer, physical therapist or physician about your own situation.