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Rehabilitation for

Ankle Sprains

A

Ryan Harber, LAT, ATC, CSCS St. Vincent Sports Performance

nkle sprains are no stranger in the sports world. Sprains are classified into grades 1, 2, 3, which generally correspond to mild, moderate, or severe. More severe ankle sprain injuries, including complete tears of the ligaments and fractures of the bone may need different treatment and rehab than a simple ankle sprain. Athletes who have persistent symptoms should be evaluated by their doctor to ensure there is no more serious injury, such as a fracture or high ankle sprain that could be causing these problems. The most common symptoms of an ankle sprain are pain and swelling. Athletes often notice bruising over the area of injury. As gravity pulls the blood downwards, the bruising will move down the foot towards the toes in the days after the injury. See your doctor immediately if you notice any of the following: • Your foot bends at an abnormal angle. • Your foot is cool, pale, or changes color. • You feel numbness or tingling in your foot or toes that lasts after the initial injury. You should see your doctor after an ankle sprain if you notice any of the following: • Heard a “popping” sound at the time of injury. • Moderate or severe pain or severe swelling or bruising around your ankle. • Can’t walk or put weight on your affected foot, or your ankle feels unstable. • You have redness, swelling, or pain in your leg or groin. These can be signs of a blood clot.

• Rest: The first 24-48 hours after the injury is considered a critical treatment period and activities need to be curtailed. Gradually put as much weight on the involved ankle as tolerated and discontinue crutch use when you can walk with a normal gait - minimal to no pain or limp. • Ice: For the first 48 hours post-injury, ice pack and elevate the ankle sprain 20 minutes at a time every 2-3 hours. Frozen vegetables are a good alternative if you don’t have access to ice! • Compression: Using an Ace bandage, wrap the ankle from the toes to the top of the calf muscle. The wrap should be snug, but not cutting off circulation to the foot and ankle. • Elevation: Keep your ankle sprain higher than your heart as often as possible. Rehabilitation: 1. Range of Motion Exercises: Immobilization can cause significant problems after ankle sprains. ROM exercises should be implemented within 48-72 hours after injury because of the tendency of tissues to contract following trauma. • Achilles stretch: While seated or lying down, take a towel and loop it around your toes. Pull the ends of the towel, pulling your toes upwards, and feel the stretch in the back of the ankle. Perform this 3-4 times a day for several minutes.

Treatment: Early treatment of a sprain is the “RICE” method: St. Vincent Hospital and St. Vincent Sports Performance in Indianapolis, Ind., are official service providers to USA Gymnastics. Call 317-415-5747 or visit sportsperformance.stvincent.org 10

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• Towel Curls: Begin with foot flat on the floor. Keeping heel on floor, repetitively “scrunch up” the towel. Each time you curl your toes equals one repetition. Perform 3 sets of 20 repetitions, 3 times a day.

• Alphabet writing: While seated or lying down, write the alphabet (in big letters) in the air with your toes.

2. Muscle-Strengthening Exercises: Once range of motion is attained, and swelling and pain are controlled, the patient is ready to progress to the strengthening phase of rehabilitation. Strengthening of weakened muscles is essential to rapid recovery and important in preventing re-injury.

• Eversion: With pillow against wall, press outer border of foot into pillow.

• Inversion: Press inner borders of feet into pillow.

• Plantarflexion: Push foot into pillow.

A. Isometric exercises: Hold 5 seconds, then relax. Repeat 5-10 times. • Dorsiflexion: With rolled pillow between feet, squeeze feet together.

B. Resisted tubing exercises: Use an elastic band that is tied to a heavy object, resistance exercises should be done in all directions. Perform 20 repetitions, 2-3 times a day.

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• Heel and Toe Walking: Walk on your toes for one minute, then on your heels for one minute. Alternating walking on your heel and toes, work up to a total of 10 minutes, 3 times a day. Dorsiflexion

Plantarflexion 3. Proprioceptive Training: Proprioception is the sense of the relative position of your body and its limbs in space. As the athlete achieves full weight-bearing without pain, proprioceptive training is initiated for the recovery of balance and postural control.

Eversion

• Circular Wobble Board: In sitting position, rotate board clockwise and counterclockwise using one foot and then both feet; in standing position, rotate board using one leg and then both legs. Exercises can be performed with added weight / eyes open or closed. Perform 15-20 repetitions, 2 times a day.

Inversion • Toe Raises: Stand on a stair or ledge with your heel over the edge. Stand up on your tip toes, then in a controlled manner, let the heel rest down. Repeat 10-20 times, 4 times a day.

• Walking on Different Surfaces: Walk in normal or heel-to-toe fashion over various surfaces; progress from hard, flat floor to uneven surface – perform with eyes open or closed. Walk up to 50 feet twice per day. • Training for Return-to-Activity: Activity-specific exercises may include simply walking, jogging, or

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Common appearance of an acute Ankle Sprain hopping. Begin at very low intensity and duration, and slowly work-up. Never suddenly increase either the intensity or duration of your activity. • Jogging: Do 50% jogging and 50% running in forward and backward directions; run in a pattern (e.g., circle, figure-eight). Slowly increase intensity and incorporate activity-specific exercises. Increase distance in increments of 1/8th mile. • Jump Rope: Simple jumping in place or with a rope. Add side-to-side jumps and eventually single leg hops as the athlete progresses. The athlete should let pain be his/her guide as he/she progress through this entire program. Once these activities can be done at full speed with no pain, athletes can resume their sport. More specific exercises can be given by a coach, certified athletic trainer, or physical therapist that is familiar with the physical demands of the sport.

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Ankle Sprains