Ankle Sprain Rehab Exercises to Get You on Your Feet Quickly

Use this basic program for a Grade I ankle sprain

Injury
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An ankle sprain is one of the most common sports injuries. Learn what you can do immediately after being injured to protect your ankle. Then see the exercises you can use as you heal to rehabilitate your ankle and get back to the activities you love.

Causes and Grades

An ankle sprain occurs when the ligaments surrounding the ankle joint are stretched or torn as the ankle joint and foot is turned, twisted, or forced beyond its normal range of motion.

The most common cause of an ankle sprain in athletes is a missed step or a missed landing from a jump or fall. Ankle sprains vary in severity and are classified by the degree of severity.

  • Grade I: Stretch and/or minor tear of the ligament without laxity (loosening)
  • Grade II: Tear of ligament plus some laxity
  • Grade III: Complete tear of the affected ligament (very loose)

Immediate Treatment

For immediate relief, you can use the R.I.C.E. treatment plan: rest, ice, compression, and elevation. While there is general agreement that the best approach to an ankle sprain is immediate rest, there is some conflicting advice about what comes next. Until definitive answers are available, the following approach is still the most widely recommended:

  • Rest: Avoid weight bearing for 24 hours or longer for a severe sprain. You may need to use crutches.
  • Ice: Apply ice (bagged, crushed ice wrapped in a thin towel) to the ankle joint. To avoid frostbite, ice should not be left in the area longer than 20 minutes at a time. Ice for 20 minutes every two hours for the first 24 hours to control swelling.
  • Compression: Wrap the ankle with an elastic bandage (start at the toes and wrap up to the calf) to help prevent swelling and edema.
  • Elevation: Raise the ankle above the hip or heart to reduce swelling.
  • If the swelling doesn't subside in 48 to 72 hours, seek medical treatment for a complete evaluation.
  • If you are unable to bear weight on the injured ankle within 48 hours, seek medical treatment.

Ankle Sprain Rehab

After the initial 24 to 48 hours of rest and icing, you slowly begin weight bearing over several days as tolerated. Continue using crutches to avoid full weight bearing during this phase. Gradually progress to full weight bearing as tolerated. Try to use a normal heel-toe gait when you start weight bearing. Continue using an ankle brace to protect the joint from re-injury.

Start doing rehabilitation exercises as soon you can tolerate them without pain. Range of motion (ROM) exercises should be started early in the course of treatment. One simple ROM exercise is to draw the letters of the alphabet with your toes. Gradual progression to other weight-bearing exercises should follow shortly after. Any ankle injury that does not respond to treatment in one to two weeks may be more serious. Always consult a physician for a thorough evaluation and diagnosis.

1. Assess Joint Alignment: After an ankle injury, the ankle joint should be assessed for misalignment or structural defects caused by the sprain. A physician will generally check the joint alignment and test for weakness or deficits in soft tissues (tendons, ligaments, and cartilage).

If there are any deficits in these areas, your injury most likely will require taping, bracing or, in severe sprains, surgery. If a fracture or dislocation is suspected, an MRI or an X-Ray will confirm the diagnosis and determine the most appropriate treatment.

2. Assess Joint Stability: Once joint alignment is corrected, joint stability is addressed. Specific exercises are prescribed to help restore ankle stability and function. These exercises are progressive and generally prescribed for each of the following areas:

  1. Range of Motion | Flexibility Exercises
  2. Balance | Proprioception Exercises
  3. Progressive Strength Exercises
  1. Progressive Endurance Exercises
  2. Agility | Plyometric Exercises

3. Ankle Sprain Rehab Exercises: The following exercises can be used to rehab a Grade I ankle sprain. If your sprain is more severe, you should follow the plan prescribed by your physician and physical therapist. You should always work with your own physical therapist to design the best program for your specific injury and your limitations.

Flexibility Exercises

As soon as you can tolerate movement in the ankle joint and swelling is controlled, you can begin gentle stretching and range of motion exercises of the ankle joint:

Range of Motion Exercises

  • Toe Circles: Move your ankle through its entire range of motion (up and down, in and out, and in circles). Move only the ankle and not the leg.
  • Alphabet Exercise: With your leg extended, try to write the alphabet in the air with your toes.

Strengthening Exercises

Once you have a good range of motion, joint swelling is controlled, and pain is managed, you may begin strengthening exercises.

  • Step Ups: Begin on a short step and slowly step up in a controlled manner while focusing on contracting the muscles of the foot, ankle, and leg. Turn around and slowly step down in the same manner. Repeat 20 times several times per day.
  • Towel CurlsWhile seated and barefoot, place a small towel on a smooth surface in front of you. Grab the towel with your toes. Keep your heel on the ground and curl your toes to scrunch the towel as you bring it toward you. Let go and repeat until you've moved the towel to you. Repeat the action in reverse to push the towel away from you.
  • Isometric ExercisesGently push against an immovable object in four directions of ankle movement—up, down, inward, and outward. Hold for five seconds, Repeat 10 times, several times a day.
  • Tubing Exercises: Use elastic tubing to create gentle resistance as you move through a full range of motion. Wrap the elastic band around the ball of the injured foot and resist the band as you move your ankle up, down, inward and outward. These exercises incorporate the four movements of the foot: inversion, eversion, plantar flexion, and dorsiflexion. Perform three sets of 15 repetitions for each movement.
  • Toe RaisesStand with your heel over the edge of a step. Raise up on the ball of your foot, hold for three seconds and slowly lower your heel to the start position. Repeat 20 repetitions several times a day.
  • Heel and Toe Walking: Walk on your toes for 30 seconds. Switch and walk on your heels for 30 seconds. Build up to one minute on toes and heels alternating for 5 to 10 minutes. Perform several times per day.

Proprioception Exercises

After you are able to place your full weight on the injured ankle without pain, you may begin proprioceptive training to regain balance and control of the ankle joint.

  • One-leg BalanceTry to stand on one leg for 10 to 30 seconds. Increase the intensity by doing this with your eyes closed.
  • One-leg Squat
  • Balance Board Ball Toss: While balancing on a wobble board, balance board, or Bosu Ball, catch and toss a small (5 pound) medicine ball with a partner.
  • Balance Board with Half-squats: While balancing on a wobble board, perform 10 slow, controlled half-squats.
  • Step up onto Balance Board: Place a balance board (or soft pillow or foam pad) 6 to 8 inches higher than your starting point. Step up 10 times.
  • Step down onto Balance Board: Place a balance board (or soft pillow or foam pad) 6 to 8 inches lower than your starting point. Step down 10 times.
  • One-Leg Squat and Reach

Agility Exercises

  • Lateral Step Up and Down: Step up to a step bench sideways and then step down sideways.
  • Plyometric Exercises:
    • Single Leg HopsHop forward and concentrate on "sticking" the landing.
    • Single Leg Spot Jumps: Hop from spot to spot on the floor.
    • Reactive Spot Jumps: Place numbered pieces of tape on the floor and as a partner calls out a number, hop to that number.
  • Sports-specific Skills and Drills: Sports-specific drills can be added as long as the return to sports guidelines are followed.

Sources:

Anderson MK, Barnum M. Foundations of Athletic Training: Prevention, Assessment, and Management. Philadelphia: Wolters Kluwer Health; 2017.

Sprained Ankle. American Academy of Orthopaedic Surgeons. http://orthoinfo.aaos.org/topic.cfm?topic=a00150.

Tiemstra JD. Update on Acute Ankle Sprains. American Family Physician. 2012 Jun 15;86(120:1170-6.

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