Remember! Our guides are to be used following an assessment with a qualified medical professional. Do not attempt these exercises if you have not been given a formal diagnosis, or given consent to complete these exercises by a Physical Therapist.

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Ankle Sprain Physical Therapy Guide

What Is An Ankle Sprain?

Ankle sprains continue to be the most common injury sustained in the lower limb. There are traditionally three major types of sprain of the ankle: medial, lateral and anterior. Damage to the lateral ligaments of the ankle, particularly the anterior talofibular ligament is very common on excessive inversion (rolling your ankle inwards). Ankle sprains vary according to severity of the injury: grades 1,2 and 3. Pain and swelling is often evident immediately after injury with the more severe ankle sprains. Grade 3 sprains are the worst, and the damage to the ligaments often make the ankle very unstable, which can make the ankle prone to repetitive ankle sprains.

What Causes An Ankle To Sprain?

A sprained ankle injury is very common in sports and activities that require rapid changes in direction, especially if these take place on uneven surfaces. The usual mechanism of injury is over inverting the ankle, or in layman’s terms, twisting your ankle underneath your body. This causes a stretching or breaking of the ligaments in the ankle that provide support and stability. In severe cases a complete tear of the ligaments can result in dislocation and fracture of the ankle bones. Swelling and bruising usually appears rapidly, although can occasionally be delayed for some hours.

What Are The Symptoms?

Ankle sprain pain is typically presented as pain on the outside of your foot and lower leg – the pain may also travel up towards your knee in more severe cases. The condition can occur to people of all ages and occupations. It is common in sport but can also be cuased by little things such as inappropriate footwear.

The most common symptoms are:

  • Ankle swelling.
  • Tender to touch.
  • Bruising.
  • Pain.
  • Inability to put weight on the injured ankle.
  • stiffness.
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Ankle Braces

Ankle braces are carefully designed to provide support and stability to the injured ankle joint and prevent re injury of the ankle ligaments. We find that they are fantastic injury prevention device for patients who are at risk of worsening the injury by further twisting their ankle.  

You can buy our favourite ankle brace here!

What Are My Treatment Options?

There are many treatment options available to people who sprain their ankle, however the most important thing to do is to get an assessment from your medical professional. The management of ankle sprain injuries of all three grades follow the same principles. After reducing the swelling and bruising through rest & time, the aims are to restore range of motion, muscle strength and balance.

Rest & Time

First things first, you need to stop doing the thing(s) that caused the injury in the first place and prevent agitating it further. Immediately following the ankle sprain you can commence the RICE protocols:

  • Rest. Rest, relax and protect the ankle. Stop, change, or take a break from any activity that may be causing your pain or soreness.
  • Ice. Cold packs will reduce pain and swelling. Apply the ice or cold pack for 10 to 20 minutes, 3 or more times a day. Do no place ice packs directly on to skin, wrap them in a towel first to avoid ice burn!
  • Compression. Wrapping the ankle with an elastic bandage or ankle brace, will help decrease swelling and provide structural support to the ankle joint.
  • Elevation. Elevate the ankle on pillows while applying ice and anytime you are sitting or lying down to reduce levels of swelling in the injured area.

Physical Therapy

Once pain and swelling has subsided you can commence a sport / activity specific rehabilitation programme that focusses on improving range of motion, strength and also reduces you future chances of re-injuring!

Ankle Sprain Exercises

1) Resisted ROMs

It’s a great idea to strengthen the muscles in your foot and lower leg to provide support and stability to the ankle joint, and the easiest way to do so is by using a resistance band! Your ankle moves in multiple directions but for the sake of this guide we will be completing dorsiflexion, plantar flexion, inversion and eversion (ankle up/down/side to side). Check out DoctorJo’s video for a full description here!

How to do it:

  • Sit on the floor with a block under your achilles with a theraband tied around your injured foot, holding the other end of the band in your hands.
  • Slowly push and pull your foot towards/away from you forcing your ankle into multiple different directions.
  • Slowly let your foot return to the starting position

Repeat 15 reps, three times throughout the day.

2) Proprioception Exercise

This is the number 1 exercise that will seriously progress your rehabilitation and improve your balance, agility and co-ordination following an ankle sprain. Proprioceptive exercises will force your body to control the position of the ankle joint. The unpredictable movements of the wobble cushion teach your muscles in your ankle to react without having to think about these movements.

How to do it:

  • Place a pillow or better yet, a wobble cushion on the floor in front of you.
  • Stand onto the wobble cushion whilst holding onto something sturdy.
  • Slowly try to remove any support you are holding on to and maintain your balance.
  • Try to hold your balanced position for 30 seconds.
  • To progress this exercise (very high level) you can start lunging or squatting on the wobble cushion.

Repeat for 5 reps, 3 times a day.

3) Lunges

Not only a fantastic hip muscle strengthening exercise but perfect for ankle balance and co-ordination.

How to do it:

  • Keep your upper body straight, with a good posture. Always engage your core muscles.
  • Step forward with your injured leg, lowering your hips until both knees are bent to a 90-degree angle
  • Slowly reverse back to your starting position.
  • To progress you can use weights, or lunge in varying directions.

Repeat for 12 reps, 3 sets,  2 times a day.

4) Agility Drills

Once you have successfully completed your rehabilitation and your Health professional agrees your are ready to return to sport, you need to start completing some sport-like drills. There are hundreds of agility drills you can complete that are available on youtube, our favourite involve ladder drills! You can buy our favourite ladder here! 

Check out Xceleration Fitness for 25 agility ladder drills!

5) Calf Stretch

Your calves are located in the back of your lower leg below your knee, and are responsible for movements in which your foot points downwards (such as applying the brakes in your car).

How to do it:

  • Sit on the floor or on your bed with a towel or a resistance loop band wrapped around your injured foot.
  • Slowly pull the band towards you forcing your ankle into dorsiflexion (toes pointing towards you)
  • Pull until your feel a comfortable stretch in your calf muscle and hold for 15 seconds.

Repeat 5 times, three times throughout the day.

6) Soleus Stretch

The Soleus stretch targets the Soleus muscle which is deeper, underneath the larger Gastrocnemius muscle. Bending the knee relaxes gastrocnemius, allowing Soleus to be stretched by itself.

How to do it:

  • Standing with one leg in front of the other, have something in front of you to hold on to.
  • Bend both knees, focusing on the front knee.
  • Move your weight forwards onto your toes ensuring you don’t lift off your heel.
  • Hold for 15 seconds.

Repeat 5 times, three times throughout the day.

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Taping And Strapping

There are some great advantages to strapping up the ankle joint before and after injury! Rest is an important part of the recovery process and slightly immobilising the painful structures with a strap is certainly an advantage to allow better healing times. When performing any activities that put the ankle at risk, a strap could be seen to help avoid re-injury by giving proprioceptive feedback to your ligaments. Check out our favourite tape here!

Ankle Sprain Prognosis

A Sprained Ankle is one of the most common musculoskeletal injuries sustained in the US. A sprain results when the ligaments of the ankle joint are stretched beyond their limits. In severe sprains, the ligaments can be partially or completely torn. It is imperative therefore that you are assessed by you health care professional when you become injured. Most ankle sprains make a full recovery on there own without complications, however the time taken to fully recovery entirely depends on the type of sprain, and whether or not your successfully complete your rehabilitation programme. RICE and exercises should be commenced immediately for a better outcome to improve your range of motion, strength and balance. This in turn, will prevent your from re-injuring yourself in the future.