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One of the most common sports injuries, 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.
If you suspect an ankle sprain, there are things you can do immediately after being injured to protect your ankle. Once the initial injury begins to heal, use exercises to rehabilitate your ankle and get back to the activities you love.
Ankle Sprain Causes and Grades
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)
For immediate relief, you can use the R.I.C.E. treatment plan: rest, ice, compression, and elevation.1 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, or if you are unable to bear weight on the injured ankle within 48 hours, seek medical treatment for a complete evaluation.
Ankle Sprain Rehab
After the initial 24 to 48 hours of rest and icing, slowly begin bearing weight over several days as tolerated. Avoid full weight bearing during this phase. Gradually progress to full weight bearing. Try to use a normal heel-toe gait.
Start doing rehabilitation exercises as soon as you can tolerate them without pain. Range of motion (ROM) exercises should be started early in the course of treatment. Gradual progression to other weight-bearing exercises should follow shortly after.
Assessment of the Ankle Joint
After an ankle injury, the joint should be assessed for misalignment or structural defects caused by the sprain. A physician will check the joint and test for weakness or deficits in soft tissues (tendons, ligaments, and cartilage).
Your injury may require taping or bracing. If a fracture or dislocation is suspected, an MRI or an X-ray will confirm the diagnosis and determine the most appropriate treatment.
Any ankle injury that does not respond to treatment in one to two weeks may be more serious. Consult a physician for a thorough evaluation and diagnosis.
Types of Rehab Exercises
Specific exercises are prescribed to help restore ankle stability and function. These exercises are progressive (they should be done in order) and are generally prescribed for range of motion, balance, strength, endurance, and agility.
- Range of motion (flexibility) exercises
- Progressive strength exercises
- Balance (proprioception) exercises
- Progressive endurance exercises
- Agility (plyometric) 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. Your physical therapist can design the best program for your specific injury and your limitations.
Flexibility and Range of Motion 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.
- Towel stretch: The towel stretch is a simple and effective way to improve the flexibility of your calf muscles. While seated on the floor, simply wrap a towel around the ball of the foot and gently pull the towel so the toes and ankle flex up.
- Standing calf stretch: Stretching your calf muscles is important to help loosen the muscles and prevent further injury. While facing a wall, place one leg behind. Lean toward the wall until you feel a slight stretch in the calf of your extended leg.
- Achilles soleus stretch: Slowly stretching your Achilles tendon can help you prevent injury and keep the tendon flexible. To stretch your tendon, stand an arm’s length away from the wall and place one leg back. Keeping the leg slightly bent at the knee, slowly lean forward and press your heel to the floor.
- 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 and Endurance Exercises
Once you have a good range of motion, joint swelling is controlled, and pain is managed, you can 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 curls: To perform a towel curl, you will need to be 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. Then, do the action in reverse to push the towel away from you. Repeat 10 times, several times a day.
- Isometric exercises: Gently push against an immovable object in four directions of ankle movement—up, down, inward, and outward. Hold for 5 seconds. Repeat 10 times, several times a day.
- Tubing exercises: Use elastic tubing to create gentle resistance. 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 and repeat several times a day to build endurance.
- Toe raises: Stand with your heel over the edge of a step. Raise up on the ball of your foot, hold for 3 seconds, and slowly lower your heel to the starting position. Perform 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 1 minute on toes and heels alternating for 5 to 10 minutes. Perform several times per day.
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 balance: Try to stand on one leg for 10 to 30 seconds. Increase the intensity by doing this with your eyes closed.
- One-leg squat: Stand on the affected leg with your foot pointing straight ahead and the knee of the other leg slightly bent. Extend your arms for balance if necessary. Lift the non-supporting foot slightly off the floor and lower to a squat position.
- Balance board ball toss: While balancing on a wobble board, balance board, or BOSU, 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: Stand on the affected leg and raise the other leg slightly. As you squat, reach toward the floor with the hand opposite your standing leg.
Once you have regained balance, strength, and control, you can begin working on agility.
- Lateral step up and down: Step up sideways to a step bench and then step down sideways.
- Plyometric exercises: These can include single-leg hops (hop forward and concentrate on “sticking” the landing), single-leg spot jumps (hop from spot to spot on the floor), or reactive spot jumps (place numbered pieces of tape on the floor and as a partner calls out a number, hop to that number).
- Sport-specific skills and drills: Sport-specific drills can be added as long as return to sports guidelines are followed.
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