Ankle Sprain Rehabilitation

Acute stage ankle sprain rehabilitation

Decreasing pain and swelling

This should start as soon as possible after you have injured the ankle. This phase can last from 2 days to 2 weeks or more depending on how bad the injury is.

Protection

Protect the ankle from further injury by resting, avoid weight bearing and use an ankle support or taping technique. The Open basketweave taping technique also accomplishes early medial and lateral protection while allowing up and down movements.

Rest

Rest is essential. Use crutches with partial weight bearing to get about with if necessary for the first few days. A healing ligament needs a certain amount of stress to heal properly but overdoing it early on in the rehabilitation process can prevent healing. Full weight bearing should be introduced as soon as pain allows.

Isometric exercises are static exercises or those which involve no movement. They can be done in the early stages but only in the up and down plane (plantar flexion and dorsi flexion) as this is unlikely to stress the injured ligaments. Avoid inversion and eversion (turning tha ankle) though as this will stress the injured ligaments.

Ice / Cold therapy

Apply ice or cold therapy throughout the rehabilitation process. Apply ice for 15 minutes every hour initially for the first day then reduce this to 4 to 5 times a day from then on. In the acute stage ice will constrict blood vessels and further bleeding. Longer term benefits include reduction of pain and muscle spasm.

Ice should not be used for longer than 15 minutes as prolonged cooling has the reverse effect of increasing blood flow. Long periods of cooling can also cause nerve palsy. Ice should be used for as long as it is beneficial. As soon as the rehabilitation process plateaus the therapist may decide to alternate hot and cold to progress further.

Compression

Putting a compression bandage on immediately may also help prevent swelling but this should only be applied for 10 minutes at a time to avoid stopping circulation. A tube grip or elastic ankle support can provide mild compression throughout the healing process to help reduce swelling.

Elevation

Put your feet up and read all about your injury! Elevating the leg will help swelling drain away from the site of the injury. Elevate the leg while icing and for 10 minutes after.

Phase 2 - Rehabilitation Phase

The rehabilitation phase begins when swelling starts to decrease and pain lessens. This means the ligaments have reached the point in the healing process where they are not in danger of being re-injured from mild stress.

Improve mobility and flexibility.

• For the first 2 to 7 days after injury you can start to move the ankle straight up and down but do not turn it in or out. This will help increase mobility and start to strengthen it up. Do as much as pain will allow. Try 2 sets of 40 reps whilst the ankle is iced and elevated and build up on that.
• Manual joint mobilization can be carried out by a sports injury professional in the anteriorposterior direction (forwards and backwards).
• Seated wobble board exercises may be beneficial for an ankle that has reduced mobility. Initially plantar flexion / dorsi flexion and then progress to inversion / eversion as pain allows.
• As swelling and pain lessen you can start to invert and evert the ankle (move the soles of you feet inwards and upwards and the outwards and upwards). This will start to put more stress on the damaged structures so be careful not to do too much. See mobility exercises.
• Stretching the calf muscles and achilles tendon several times a day is important. There are a number of methods which can be used for stretching the calf and achilles, including using a slant board.

Strengthening the ankle joint

• Again as the ankle improves you can start to do strengthening exercises where you pull the foot and toes up and hold for 10 sec's and then push down and hold for 10 sec's. This can also be done for inversion and eversion as pain allows. Try 3 sets of 10 reps twice a day and build on that.
• If you see no further improvement with ice alone then start to alternate it with heat. Apply a warm pack (or hot water bottle - ensuring something is covering the skin to prevent burns) for 5 minutes, followed by a cold pack for 5 minutes. Repeat this again so that the whole process last 20 minutes.
• Strapping and taping may still be beneficial here to provide compression and support the ankle as you return to full weight bearing.
• You should be able to maintain fitness by swimming or cycling as pain allows.

Re-establish co-ordination and proprioception

• Proprioception exercises are thought to be important in avoiding recurrent ankle sprains. The neuromuscular control you have over your muscles will have been damaged when you injured the ankle as these small sensors are located in ligaments and tendons. Balance type exercises can be used to improve this function and help avoid future ankle injuries. An ankle wobble board can be used, intially in a sitting position, followed by standing on both legs and progressing to single leg balancing. Wobble board exercises.
• If you don't have a wobble board, simply balancing on one leg can be effective. Once you can manage this, you can challenge your balance by moving your arms, twisting your body and bending the knee. For a real challenge, try to balance with your eyes closed!

Return to full fitness / functional training

 In order to start the functional rehabilitation phase (activity and sports specific training) it is important the athlete has full range of motion and 80 to 90% of pre-injury strength. When you can comfortably do all of the above then you are ready to start phase 3 and begin your return to activity.

• Cardiovascular exercise is important and should begin as soon as possible after injury depending on what pain will allow. It is important that the athlete maintain some kind of CV exercise not just for the physical benefits but for psychological well being as well. Stationary cycling, hand cycle ergometer, running in water and swimming are all possibilities depending on severity of injury and what pain will allow.
• Running may begin as soon as walking is pain free. Ankle taping can be very beneficial when starting running training particularly during early sessions until confidence, proprioception and strength has returned. A laced ankle brace can also provide support and is less expensive in the long run, particularly if laxity in the ligaments means a support needs to be worn permanently.
• Running should begin on a clear flat surface such as a running track. Grass or bumpy surfaces will increase the risk of re-injury. Jog the straights and walk the curves.
• Speed should be gradually increased over time to a sprint.
• Sports specific drills using cones can be introduced. Changing direction, running in a figure of 8 pattern and zig zagging between cones.