Exercise Rehabilitation For Ankle Sprains
When prescribing ankle exercises, we must take into consideration the multiple structures that are involved in performing and coordinating ankle motion. To attain a full resolution from an inversion sprain, we must be sure to consider multiple muscles and complex fascial layers, all of which work together across numerous joints.
To do this, we must be sure to address three essential components: strength, flexibility, and proprioception.
Strengthening the Ankle
Strengthening exercises are essential! Manual therapy, by itself, will not fully prevent an injury from returning without the addition of strengthening exercises. This is because the type and quality of tissue remodeling that occurs after an injury is dependant on the type of forces that are applied to that tissue. When appropriate strengthening exercises are applied, the collagen remodels to withstand the stresses that are placed upon it. The possibility of re-injury is very high without appropriate strength training.
Strengthening exercises for an inversion sprain can be subdivided into several categories depending on the stage of the injury. The following subcategories describe stages from non-weight-bearing to full-weight-bearing. Note: These are examples of possible recommendations, but actual exercise recommendations will vary from case to case.
1. Active Range Of Motion (AROM) – Non-weight bearing exercises
a. Four basic foot motions – Perform the following four basic motions: plantar flexion, dorsi flexion, inversion, and eversion. Perform these foot motions slowly, holding the end range of each position for 5-10 seconds. Repeat the action several times.
b. Alphabet exercise – Use your foot to draw the letters of the alphabet in the air, allowing your ankles to rotate with each motion
2. Isometric strengthening of the ankle – Isometric exercises are performed in static positions (unlike dynamic exercises which are performed through a range of motion).
a. The Isometric Four – In this exercise, you need to resist each basic motion (plantar flexion, dorsi flexion, inversion, and eversion) of the ankle. For example:
· Start with your ankle in neutral position, with your foot braced against a wall or table.
· Then, without allowing your foot or ankle to move, try to perform each of the four basic actions. This causes all the muscles involved in the action to contract.
· Hold this contraction for 5-10 seconds and relax for about 10 seconds.
· Repeat this process for 4-8 repetitions, slowly increasing the number of repetitions.
· Repeat this routine for each of the four basic actions.
3. Resisted Strengthening of the Ankle – using Theraband or Tubing
a. Four-Way Resisted Tubing – In this series of exercises, we recommend using a theraband or tubing as you perform each of the four basic ankle motions. For example, with the inversion action:
· Attach a theraband around your ankle and attach the other end to a table or door.
· Against resistance, roll your foot inward (invert your ankle) and hold for 3 to 5 seconds.
· Repeat for 10 to 15 repetitions, increasing the number of sets from 1 set/day to 4 sets/day as you increase your ankle strength.
· Repeat this routine for each of the four basic ankle actions.
4. Partial Weight Bearing Ankle Exercise
a. Shifting Your Weight – In this exercise, lean against a counter or table, and try shifting some of your weight onto the injured leg. Start with just a few seconds of weight, and then increase this time, as the ankle permits. Repeat this exercise about 10 times. Be careful not to do too much, too soon.
5. Full Weight Bearing Ankle Exercises
Once the injured ankle is able to bear the full weight of your body, there are many exercises that will help to further strengthen the ankle. One of my favorites is the Eccentric Calf Raise.
Eccentric Calf Raises - One Legged
(Actually…these are calf drops, not raises)
(Actually…these are calf drops, not raises)
In this exercise, the rising up portion is not that important. The key lies in the slow lowering of the body, as this builds strength without causing further injury to the body.
· Stand on the edge of step or curb, heels hanging over the edge of the step, and rise up on both legs in a classic calf raise.
· Now, using only one leg, slowly drop down to the starting position for a count of three
· Do 5 to 15 repetitions in each set. Start with two sets and gradually increase to 4 sets as your ankle strength increases.
· Allow your ankle to build up its strength slowly. Do not increase your repetitions and sets until you can complete each repetition with perfect form, and without pain.
Once you are able to properly perform full weight bearing exercises, you should consider beginning a routine that exercises your full body. These exercises should activate the knee, hip, and core.
In Part Six of Ankle Sprains we will cover stretching and proprioceptive exercises for resolving ankle sprains.
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