Treating a sprained ankle the RIGHT way early on, means a stronger ankle, faster recovery and less chance of re-injury. In this series, I will tell you what a sprained ankle involves, the most effective self-treatment and the best rehab exercises to get you back out there!
This post will take you through early, middle and late stage rehab exercises as well as self treatment advice for a lateral ankle sprain so that you can get on with life. Alternatively, you can skip the hassle and get all the extras in one document by downloading our comprehensive Sprained Ankle Recovery Guide
Stage 1: Acute Ankle Sprain, the First 72 Hours
First of all, a little information about what a sprained ankle involves, but if you are in the know about Sprains already, skip the info and scroll down to Self-Treatment.
Sprained ankles are known by a few different names:
- Twisted ankle
- Rolled ankle
- Lateral ankle sprain
- Inversion ankle sprain
- Torn lateral ankle ligament
The most common type of sprained ankle is the lateral ankle sprain (85%), and that is what we are going to discuss and sort out today. The other 15% is made up of high ankle sprains and medial ankle sprains and the advice below is quite effective for those injuries also.
As with everything on this website, the rehab regimen does not claim to replace or be better than the best practice of going and seeing a doctor or physical therapist.
Mechanism of injury:
The plain and simple is that a sprained ankle is typically when your foot is forced inwards (inversion) and down at the same time.
This often happens when changing direction, turning and/or on uneven surfaces). This puts the ligaments under too much stress too fast which causes a tear of one or more of your ankle ligaments.
Quick anatomy:
The lateral (outer) ankle has 3 ligaments supporting, with the weakest of these (and so most often injured) being the Anterior Talofibular Ligament (ATFL).
The ATFL is the Ligament at the front of the ankle shown here and in most simple sprains, this is the one torn with or without the ligament below it.
Sprained ankle recovery time:
The general recovery time is 2-6 weeks (if looked after properly). Keep in mind, even if it feels bad now if you do all the right things you will be one of the 95% who returns to sport and activity within 6 weeks.
Not taking ankle rehab seriously often leads to far too many chronic ankles, long-term disability and other injuries so YOU NEED TO TAKE THIS SERIOUSLY!
Note: it is important to rule out fractures early on. An accurate way of doing this is using the Ottawa ankle rules, or going to see your local Physio for a quick assessment – These rules are great for minimizing unnecessary X-rays. If clear of fracture, conservative rehab is typically the way to go – surgery is rarely needed or the first port of call (1).
Sprained Ankle Self-Treatment
Initial management: In the first 72 hours it is very important to follow the RICE and HARM principles – This will take weeks off your recovery.
Summary:
- Do POLICE
- Don’t HARM
- Protect
- Keep Moving
- Foot Paddling
- Footwear
1. Do: POLICE
This has changed from the previous RICE recommendation, see more on this HERE.
Note: Don’t wear compression at night time
2. Don’t: HARM
- Heat
- Alcohol
- Running
- Massage
HARM increases blood flow to the area, worsening inflammation and so causing more secondary damage and a longer healing time.
3. Protect:
Braces have been proven to reduce re-injury rate and improve recovery so check out your options here. Using a functional ankle brace at all times during the day is now a go-to treatment for sprained ankles for the first 6 weeks and then up to a year after injury as needed.
You can see an update on the Clinical Best Practice Guidelines from the British Journal of Sports Medicine HERE if you want more detail on that. Basically, Lace-up ankle braces are a brilliant way to protect the ligaments and reduce re-injury rate and preferred over moon boots or nothing.
4. Keep moving (within reason of course)
It is important not to baby sprained ankles and start weight-bearing through them as soon as possible. This helps to normalize movement and decrease the loss of muscle activity.
If necessary you may need to be on crutches for the first 24-72 hours then move to partial weight-bearing and then full weight-bearing.
5. Foot paddling
This is a great exercise to do in these early days – In sitting or lying, simply point your toes up then down repeatedly in a pain-free range.
You can try doing small circles with your foot also, remember not to push into pain. Do this every 1-2 hours (little and often)
6. Footwear:
Wearing good supportive footwear with heel and arch support(such as your runners) is great as this takes the pressure off the injured ligaments and lets them heal well.
DO NOT WEAR HIGH HEELS (Please!).
Now that you have taken care of your sprained ankle in the first 48-72 hours by doing everything mentioned above. Let’s start on the next stage below.
You can download our comprehensive Sprained Ankle Recovery Guide, with all of this great information.
Stage 2: Early Rehab and Sprained Ankle Treatment
How to get a sprained ankle stronger, recover quicker and get back out there faster and better than ever!
Note: You still use ice after the first few days whenever it is sore or swollen.
Following on from the stage 1 rehab (above) about what to do in the first 72 hours, here we will cover a comprehensive rehab regime that will help the majority of you recover from an ankle sprain in weeks, not months.
Your body adapts to the forces that go through it. Progressively load your ankle, it will adapt and be better for it!
Sprained ankle treatment needs to include:
- Proprioception exercises
- Range of motion exercises
- Strengthening exercises
1. Proprioception Exercises: Retraining for a sprained ankle
Proprioception is the ability for you brain to know where you body is in space.
If this is decreased, you have poor balance and increased chance of re-injury. Sprained ankles are the worst injury in the body for impaired proprioception and needs to be addressed.
Note: If you aren’t sure what proprioception is – extend one arm out to the side, close your eyes and mirror it exactly with the other arm – you could do this with your eyes closed because of your proprioception.
Single leg standing (SLS):
Begin by standing on one leg on a solid surface (you can put one finger on the wall for balance if you need to start with) and aim for 1 minute.
When you can do this comfortably for 60 seconds, step it up by performing SLS on a folded up towel.
A Folded towel is great to use as you can easy progress this by doubling it up again and again and then finally rolling it up to make it much harder.
Progressing each time when you can easily do it for 60 seconds.
NOTE: Have a bench in front or to the side to grab onto if need be – but only if you have to!
You can also use Wobble boards, Bosu balls and balance boards when towels become too easy (or boring!)
2. Range of motion Exercises
Calf Stretch
The best way to do this is by dropping your heel of a step and holding for 1 minute as shown in the picture to the right. Make sure this stretch is within the pain-free range.
Lunge Stretches and accessory glides
See this video for great mobilization techniques. Remember not to push into too much pain!
3. Strengthening Exercises
Heel Raises
Begin using both feet and progress to one foot as pain and strength allows. Perform 30 with one finger against a wall for balance. Also known as Calf Raises.
Single Leg Squat/Pistol Squats
As soon as you can, begin doing these to maintain and increase the strength in your entire lower limb! do 2 x 12 on each side and begin by only bending a small distance – Give it a go!
Ankle Eversion Training
See this video on how to do this important exercise with a Theraband or similar elastic band.
Stick to this Rehab program for the full 6 weeks for best results and make sure to keep challenging and progressing yourself!
Stage 3: End Stage rehab – “Bulletproofing” after an Ankle Sprain
Research-based and very easy, with great results
You can also head over to our rehab guides page to get all three levels and much, much more in an eBook!
These are the rehab exercises that you need to get your ankle 100% and to minimize chance of re-injury which is far too common.
This ankle sprain rehab is aimed at improving range, balance and strength with simple, effective home exercises.
Too many people simply sprain re-injure their ankle is the full rehab isn’t followed through with and actually 33% still have pain remaining after one year!.
On top of this, a history of ankle sprain ( you have injured it before) is the single most predisposing factor for ankle injury.(2,4)
Our bodies are great at healing by themselves but if you don’t push your ankle to regain strength and range – you leave yourself at high risk of re-injury
This means after you have an ankle sprain it is very important to rehab it right as you have a high chance of ongoing symptoms and re-injury. Remember, the research shows that the majority of grades I, II and III lateral ankle ligament ruptures can be managed without surgery – so get started as soon as possible for best results.(3)
First, Some Quick Tests:
Here is a great little test to see if your ankle range is back to it’s best. The other easy test to see if you need to do the level three exercises is to balance on the balls of your foot, one leg at a time – you should be able to do this for at least 30 seconds and you should be even between legs.
Stage 3 ankle sprain rehab has 3 main goals:
- Achieve full range of motion
- Have good ankle and leg control through this range
- Full strength of the ankle stabilizers
To get there, here are the exercises that you need to do:
Toe balance
This is a great balance exercise to strengthen your ankle in this vulnerable position and better yet, it is simple and you can do it anywhere.
Stand on the ball of your foot. You will most likely need to start with one finger on the wall for balance.
Goal: 1 minute each side
Make it harder: Do some one leg standing and toe balance on one of my favorite rehab equipment: a BOSU Ball
X excursion exercise – Balance re-training
This exercise has come about from a well-used test within the health industry – the Star Excursion Balance Test. The great thing about the tests we use as physiotherapists is that they really do challenge you, which make them great as exercises also as if your body is challenged, it is going to adapt to improve.
Ankle stretch
Along with the classic calf stretch, this one is great for getting full range in your ankle and making sure you are even. This only needs to be done if you can’t point your foot down evenly after 6 weeks – you don’t need to do it earlier.
Hold for one minute.
Ankle self-mobilization
In Conclusion
Putting in the time to rehab your ankle fully is so important, not only will it decrease or get rid of any pain but it will improve your mobility and performance. Even just working on retraining your balance decreases your chance of re-injury by 22-33% – nothing to scoff at right!(5)
So write the exercises down, favorite this post and make it a routine.
Return to Sport:
As a simple rule, once both sides are even, you can get back to training and playing. So to test yourself out, see how far you can single leg jump and make sure both legs are within 5cm of each other and then do the X-excursion exercise as above and again, make sure both sides are within 5cm of each other. If they aren’t even, keep working at it.
Also if you are returning to sports such as basketball or volleyball etc that require a lot of jumping, twisting and hopping, or if you have sprained your ankle more than once, it is definitely worth your while looking into getting a good lace-up Ankle Brace.
Yours in health,
Shaun