REHABILITATION AFTER ANKLE SPRAIN
Dr. Abigail R. Hamilton, MD
GENERAL GUIDELINES
Ankle sprains are very common ankle injuries, usually the
result of the ankle turning inward. An ankle sprain occurs
when a ligament connect-ing the anklebones is stretched
or torn. If treated quickly and properly, most ankle sprains
heal completely, allowing a safe and early return to
activity. Recurrent sprains are common, so it is important
to strengthen the muscles that stabilize the ankle.
Contributing Factors to Ankle Sprains
• Muscle weakness or imbalance
• Inappropriate footwear
• Overweight
• Family tendency
• High-arch foot
• Previous injury
DEGREES OF SEVERITY OF ANKLE SPRAINS
Ankle sprains are graded as mild, moderate and severe. The more severe the sprain, the longer the
time to recover.
First Degree (Mild): This injury is the most common and usually the most minor. Ligaments
connecting the bones of the ankle are "stretched'', causing a small amount of injury to the, ankle
ligaments. There is slight swelling but no instability. With a first-degree injury, you can expect to be
back to sports within 1 to 3 weeks.
Second Degree (Moderate): When this injury occurs, the ankle, ligaments are more deeply torn,
resulting more pain and swelling. There is bruising of the skin and pain with walking. There can be
looseness and minor instability. A second-degree sprain may require the use of a protective brace
and 3 to 6 weeks of rest and recovery before you can return to full activity.
Third Degree (Severe): This injury results in a full tearing or rupture of an ankle ligament(s) usually
on the inner and outer side of the ankle. The ankle can be very swollen and weight-bearing is painful.
Crutches are often necessary and sometimes the ankle will be placed in a cast or cast-boot to allow
the injury time to rest and heal. Surgery is rarely necessary, but the, third-degree ankle sprain can
take many months to fully heal and may result in residual looseness of the ankle joint.
TREATMENT OF ANKLE SPRAINS
Treatment is divided into four stages. The rate of progress from one stage to the next depends upon the amount of
pain and swelling present, and whether an elastic bandage, tape, a brace or a cast was used to stabilize your ankle.
STAGE ONE: UP TO 72 HOURS
To reduce pain and swelling, apply ice to the ankle for 20 minutes every hour while awake. Crushed Ice application
in a plastic bag with a towel between the ice and your skin is a safe method to use. Compression of the ankle with an
elastic bandage will help to limit swelling. The ankle should be elevated, as much as possible, to a position higher
than your heart to reduce swelling. Tape, a splint, a brace or a cast may be applied to support or immobilize the
ankle.
STAGE 2: THE FIRST WEEK
You can walk and bear weight on the ankle as soon as it is comfortable. Crutches can be used as partial support
when you begin to walk. Continue using taping, bracing or a cast. Let pain be your guide as to how much activity is
enough
After an injury your ankle will get stiff It is important to maintain the full range of motion of your ankle. As an
exercise to increase the ankle motion, rest your heel on the floor and write the alphabet in the air with your big toe,
making the letters as large as you can.
STAGE 3: SECOND WEEK AND AFTER
After the pain and swelling have subsided, you should try to walk normally with a brace or elastic support.
Maintain ankle motion and strengthen the supporting muscles using theraband (elastic bands)
STAGE 4: VARIABLE
Your ankle should be strong when you return to full daily activity or sports. Returning too early to full activity may
lead to re-injury and a chronic problem
Criteria to return to sports activity: When you can stand on the toes of the injured ankle for 20 seconds and hop on
your toes 10 times you can begin to run. Initially you should jog in a straight line until your jog pain-free. As you
become stronger, you can progress to running a large figure-of-eight. You can return to sports practice when you can
run a zigzag pattern without pain or instability.
Your ankle should be protected with a lace-up or other brace support for a minimum of 6 months after injury for
any sport that requires pivoting. A Tri-Lok ankle brace can be obtained from our office for any sports that require
quick pivoting and especially are recommended for sports that require the use of cleats.
Shoes. Athletic shoes that fit well and stabilize your foot will help prevent re-injury. You should not wear running
shoes or sandals to play sports such as basketball, volleyball or tennis.
EXERCISE
The following exercises will strengthen the ankle muscles and re-develop the reflexes of the ankle. Following the
prescribed exercise program will restore normal ankle function and prevent re-injury and chronic problems. For
severe sprains we recommend formal physical therapy and exercises as directed by your therapist.
Ankle Eversion
With tubing anchored around uninvolved foot, slowly turn
injured foot outward. Repeat 30 times.
Ankle PlantarFlexion
With tubing around foot, press foot down. Repeat
30 times
Ankle Dorsiflexion
With tubing anchored on solid object, pull foot
toward you knee. Repeat 30 times.
Ankle Inversion
Cross legs with injured ankle underneath with tubing
anchored around uninvolved foot, slowly turn injured
foot inward. Repeat 30 times.
Calf Stretch
Keeping back leg (injured) straight, with the heel and foot flat on
the floor, lean into wall until a stretch is felt in the calf
Hold 15 to 20 seconds. Repeat 3 to 5 times.
Dorsiflexion Stretch
Standing with both knees bent and the injured foot forward, gently lean
forward, bending the injured knee over the ankle while keeping the heel
and foot flat on the floor. This stretch will be felt in the ankle close to
the heel or in the front of the ankle. Hold 15 to 20 seconds, Repeat 3 to
5 times.
Toe Raises
Stand facing a wall, hands on the wall for support and balance, keep the
knees extended fully. Tighten the quadricep to hold the knee fully
straight. Raise up on 'tip-toes' while maintaining the knees in full
extension. Hold for one second, and then lower slowly to the starting
position. Repeat 20 to 30 times. As you become stronger, you can raise
up on both legs, and lower down on just the injured side. Gradually build
so that you can raise up and down on just the injured leg.
Single -Leg Balancing
Attempt to balance on the injured leg while holding the uninjured foot in the air.
When you can balance easily, you can attempt to balance with eyes closed, or while
someone throws you a ball. Practice this exercise for 5 minutes.
