ankle sprain rehab cover

Ankle Sprain Rehabilitation Protocol

Ankle sprains are one of the most common injuries in sports and a proper rehabilitation program can ensure optimal recovery and a speedy return to play. Ankle injuries may include lateral ankle sprain, medial ankle sprain, and recurrent ankle sprains. This rehabilitation program is also appropriate for folks with other foot and ankle conditions such as posterior tibial tendon dysfunction, peroneal tendonitis, tibialis anterior tendonitis although there may be more targeted programs. Ideally, this program is performed under the supervision of an athletic trainer or physical therapist although that may not always be possible or necessary.

Key objectives of any ankle sprain rehab program include strengthening the key muscles of the foot and ankle, allowing for healing of any ligamentous injuries, increasing flexibility, promoting recovery of proprioception, balance and eventually return to play.

Phase 1

Immediately following the injury, the athlete should discontinue the offending activity or sport, use ice, ibuprofen and tylenol to help begin the recovery process. Depending on the severity of injury, immobilization with a boot, air cast or lace up ankle brace may be required. As soon as the athlete can begin tolerating pressure on their foot, they can begin the first step of the protocol.

Towel Crunches. Spread your toes out on the floor over the flat towel. Pull it toward you using your toes until the towel is fully gathered around your foot. You can repeat this 10 to 15 times.

Ankle Pumps. Point your toe down as far as you can and then bring your toe as high as you can. Repeat 15 to 20 times.

Towel Stretches. Sit down with your injured leg stretched out in front of you. Loop a towel around the plantar surface of your foot, pull back and hold for 20 seconds. You can repeat this with your knee bent to 20-30 degrees. Repeat this movement 3 to 5 times.

Phase 2

When the exercises in Phase 1 become too easy and are relatively pain free, you can move on to Phase 2. With the exception of the slant board stretch, these movements are all non weight bearing. 

Ankle Circles. This can be done with the foot hanging off the end of the table, with your leg crossed or even standing on your other leg. Perform 20 circles rotating your foot clockwise. Repeat the 20 circles counter-clockwise.

Alphabet. Pretend you are writing the letters of the alphabet with your foot. Repeat this twice.

Marble Pickup. Attempt to grasp the marbles between your first and second toe. Pick them up and put them in the cup or transfer to another pile. Repeat this 15 to 20 times.

Slant Board Stretch. Stand with heels flat on the slant board leaning forward with knees bent. Your should feel a stretch. Hold for at least 20 seconds and repeat 3 times.

Wall Slides. Lie on your back with your affected foot flat against the wall. Starting at about 90 degrees, slide your foot down to your buttocks and back up. Repeat this 20 times.

Isometric Inversion. While seated, put the inside part of your foot and ankle directly against the leg of a table, chair or closed door. Pull inward with your foot against the object, causing contraction of your muscles without moving your foot or ankle. Hold this for 5 to 10 seconds and then relax. Repeat 10 times.

Isometric Eversion. While seated, put the outside part of your foot and ankle directly against the leg of a table, chair or closed door. Pull outward with your foot against the object, causing contraction of your muscles without moving your foot or ankle. Hold this for 5 to 10 seconds and then relax. Repeat 10 times.

Theraband Movements. Place a rolled towel under your leg if possible. Anchor the band to a door or table leg. Pull your toes towards your face (dorsiflexion), push down (plantarflexion), turn it inwards (inversion) and turn it out (eversion). Repeat this 10 times for each movement. Do the full circuit 3 times.

Lace Up Ankle Brace

Ankle Air Cast

Tall Walking Boot

Ankle Ice Pack

Phase 3

You can move to phase 3 when you can stand on your affected ankle without any pain.

Calf Raises. Start by standing on both feet, stabilize yourself with a chair or table. Rise up on both toes, hold for 3 to 5 seconds and go slowly back down. Perform this for 3 sets of 10 reps. As it gets easier, switch to single leg calf raise.

Heel and Toe Walking. Walking on your heels for 30 steps and then on your toes for 30 steps. 

Toe Raises. Stand in a neutral weight bearing position. Rock back on your heels so your toes come off the ground and hold for 3 to 5 seconds. Repeat this for 10 reps and perform 3 total sets. 

Single Leg Balance. Stand on the affected limb and maintain a balance without any support. You can slightly bend your knee. Hold for 30 seconds. As this gets easier, perform it with your eyes closed. You can further challenge yourself with various balance devices.

Phase 4

When you can perform these weight bearing, non-ballistic movements without pain, you can move to phase 4.

foot and ankle rehab double leg vertical hop

Double Leg Hops. Standing on both feet, perform vertical hops or jumps for 20 to 30 reps. This should also be performed in the forward-backward direction and side-to-side or laterally (see illustration).

Single Leg Hops. When you can get through double leg hops, switch to single leg hops. Stand on the affected limp and follow the same progression of vertical jumps, forward-backward and side-to-side. Perform 20 to 30 reps.

Return to Play

Athlete should be able to perform the following including (a) progress from simple to complex tasks, (b) perform at least 90% of function of unaffected ankle, and (c) progress through sport specific tasks.

– More Ankle Pain @ Sports Med Review

– More Ankle Pain @ Wiki Sports Medicine