Ankle Sprain Rehab

Ankle sprains are one of the most common musculoskeletal injuries, however most people assume they can recover from them on their own. Unfortunately, one quick roll of the ankle can result in significant instability, decreased range of motion, and loss of strength causing increased risk of re-injury if left untreated. As a result, there is an increased pain when resuming activities due to poor ankle function.

In this blog, we will discuss the common mechanism of a lateral ankle sprain and some important things to consider when rehabbing from this injury. Firstly, it is recommended to be evaluated and treated with the supervision of a medical rehab professional, such as a Physical Therapist, to ensure individualized progression specific to your injury. Secondly, this blog is meant to be a resource to gather more information about your injury, but should not be substituted for specific medical advice from a qualified professional. 

ankle sprain

Anatomy of Lateral Ankle Sprains

There are three types of sprains that are classified as inversion (lateral), eversion (medial), or high ankle (syndesmotic). Lateral ankle sprains occur when your foot rolls inward causing stress to the outside of your ankle. The stress on your lateral ankle causes microscopic trauma to the lateral ligaments, including: the anterior talofibular ligament, the calcaneofibular ligament, and the posterior talofibular ligament. The most commonly sprained ligament in the body is the anterior talofibular ligament. Recovery time is determined by the grade of the sprain. The higher the grade the more significant the severity of injury to the ligaments. 

Tissue Healing Times

Tissue Healing Times
Ankle Sprain Rehab

Do I Need an X-ray?

We can determine the need for an x-ray by using the Ottawa Ankle Rules. This helps to improve diagnostic accuracy and limit the need for unnecessary x-rays to patients without a fracture. 

We are looking for bony tenderness to palpation at specific spots. If any of these signs are positive, then we are unable to rule out the presence of a fracture and will require an x-ray. Another sign that an x-ray is necessary is the inability to bear weight on the injured leg at time of injury or when presenting in the clinic. If you have recently rolled your ankle, but cannot bear weight for more than four steps, you should seek an x-ray to determine whether a fracture is present. 

Rehab Exercises for Lateral Ankle Sprains

  • Pain Management
    • The primary goal during the first 24-48 hours is to manage pain and swelling to protect the injured area.
    • Classic RICE method of treatment during acute phase – Rest, Ice, Compression, Elevation
  • Range of Motion
    • May begin at about 48-72 hours after injury
    • Focus on gentle range of motion in all directions within minimal pain
    • Need to regain full ROM, especially ankle dorsiflexion
    • Be sure to move the foot/ankle as much as possible with minimal pain to not cause further damage
    • Examples: ABCs, Ankle Pumps, Ankle Circles, In/Out
  • Ankle Joint Mobility – Clink the link for ankle mobility exercises
    • Dorsiflexion locks your foot into the ankle joint and allows for increased bony stability
      • Lacking this range of motion makes you more susceptible to re-injury
    • Example: knee to wall
  • Ankle Strength Training
    • Restore full strength through ankle musculature including calf, inverters, and everters
    • Strength of the surrounding ankle muscles helps to increase resistance to external forces and provide dynamic control to prevent future ankle sprains
    • Examples: bands, heel raises

Stability and Training

  • Single Leg Stability
    • Important to re-establish balance and proprioception to improve body awareness
    • Poor balance can increase the risk of rolling onto the lateral ankle causing re-injury
    • Stand on one foot with good stability prior to progression of strength training, running, cutting, and jumping
    • Example: Single Limb Stance with Eyes Open → Closed
  • Functional Strength Training
    • Double Limb and Single Limb Dynamic Strengthening
    • Combines aspects of balance, mobility, ROM, and strength to improve function
    • Increase capacity to load the ankle and decrease risk of re-injury
    • Increases strength to prepare for higher level plyometric movements
    • Examples: Squats, Step Downs, Lunges
  • Return to Sport
    • Preparation for the demands of sport
    • Improves ligament, tendon, and muscular capacity for loads/stress to reduce risk of injury
    • Enhances movement patterns for optimal force production and shock absorption
    • Increases POWER
    • Jumping – Double Limb and Single Limb Plyometrics
    • Sprinting
    • Cutting and agility drills
    • Hop Testing – measures functional capacity to hop on one foot
      • Helps to determine readiness to return to sport
      • Not the only measure to determine clearance for return
        • Equal strength, ROM, joint mobility, balance, functional strength, hop testing, and proper movement literacy combine to determine medical clearance

Rehabilitation

In conclusion, the main idea of this blog is the rehab from a lateral ankle sprain. If you have sprained your ankle, it is recommended to be evaluated and treated with the supervision of a Physical Therapist. This is to ensure individualized progression specific to your injury. Typically, you would experience dysfunction from an injury whether it occurred recently or a long time ago. Proper rehab will help to enhance performance and decrease your risk of re-injury. Come in to see us at Symmetry Physical Therapy and we can create a treatment plan unique to you to get you back as soon as possible!

Written By: Team Symmetry


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