Ankle Sprains: Early Stage Rehab Exercises and Advice

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Ankle sprains can be one of the most troublesome injuries, especially if you have an active itinerary. Unfortunately, ankle sprains are quite common and can be caused by a number of things. You may experience a variety of symptoms including pain, swelling, bruising and limited movement.

 

You can expect the worst pain and swelling in the first 3-7 days, then it will gradually improve along with the bruising and swelling. It is normal for the pain to spike again once the swelling starts to reduce, when you start becoming more active on the ankle, and when you spend more time weight bearing through the foot or with the foot down without movement (e.g. at an office job or on a long journey).

 

Usually you will be able to start a simple exercise programme and start increasing your activity after around 3 days of rest but listen to your body…there’s no rush!

 

Important!

If you have a large amount of pain, swelling and/or bruising and are concerned, please seek medical attention as soon as you are able. You may require an x-ray to investigate for any fractures, especially if the injury is a result of trauma.

Top Tip

 

Remember R.I.C.E. (Rest, Ice, Compression, Elevation)

Rest does not mean stop moving completely. It means relative rest. When the pain in your ankle starts to increase you should sit and rest until the pain reduces again. Elevate your foot and use ice on the area of pain for 10-15 minutes (ensure no direct contact with the ice and skin and check skin regularly. Ice burn is possible so do not leave it on for too long!). If you do not have an ice pack, try and use something similar such as frozen peas in a tea towel or a frozen damp face cloth.

You may also find that compression helps i.e. using a bandage or tape around the ankle, however this may initially increase the pain. If you are doing physical activity or walking a long distance, you may find the extra support of a bandage useful. It can help to reduce the amount of swelling which in turn reduces the pain and increases the available movement.

There are 4 categories of exercises:

  • Range of movement
  • Stretches
  • Strengthening
  • Balance and control (Proprioception)

 

These are to be used as a guide only. If you are unsure of how to perform any of the exercises, please seek professional advice in person to ensure you are doing them correctly.

 

These exercises may be uncomfortable but should not be painful. If you start to experience a significant increase in pain whilst doing the exercises you should stop and rest immediately. If you have increased pain for more than 20 minutes after completing them, you should do less repetitions or sets next time.

 

As a baseline, each exercise should be completed as 3 sets of 10 repetitions unless otherwise stated. Remember: listen to your body. If it hurts, do less. Only progress onto the next stage when you are able to complete the baseline without an increase in pain.

 

Range of movement exercises for ankle sprains

These exercises will improve the amount of movement in your ankle and reduce swelling which should help to reduce pain. 

  1. Ankle Movements:

Try to gently move your foot in linear movements (toes up towards the ceiling and then down towards the floor) with your leg supported on a chair or bed. You could also try writing the alphabet in the air with your toes to encourage more circular movements.

https://youtu.be/Isb_PCm_yEM

  1. Knee Side to Side:

Sitting in a chair with your foot flat on the floor, slowly move your knee side to side. This encourages the muscles and ligaments around the sides of the ankle to move and stretch slightly.

  1. Weight Transfer:

Standing on both feet, put most of your weight through the non-injured foot and try to get the injured foot flat on the floor. Slowly and gently transfer your weight from one foot to the other and back again.

https://youtu.be/eDDQnpVDSi8

  1. Knee Bends:

With an even amount of weight through each foot, slowly bend your knees and straighten. Only bend as far as the pain allows.

 

http://https://youtu.be/PFB2eYS_LwE

Top Tip

Work on walking with an even and equal gait pattern (don’t limp). Sometimes using crutches can help in the first few days but try not to become reliant on them. The sooner you can start walking normally again the better.

Continue R.I.C.E (see step 2 above) until the ankle feels better. This may be for 6 weeks or more, depending on the severity of the sprain.

Stretches for Ankle Sprains

These exercises will work to increase range of motion, help reduce swelling, and prevent the Achilles tendon and calf muscles becoming too tight. The Achilles tendon attaches the muscles of your calf to the heel bone, where it merges into the plantar fascia. Any of these structures can become tight and cause pain in the underneath of your foot, your heel, or your calf muscles. It is usual to experience some tightness due to different gait patterns and compensatory movements from the pain. This can be either in the injured side or the opposite side.

 

Baseline = 3 x 30 second hold

 

  1. Towel Pull Stretch:

Sit with your leg out straight in front of you. Wrap a towel around the ball of your foot and gently pull so your toes move towards you. Hold for 20-30 seconds then relax. Only pull as far as the pain allows.

 

  1. Knee Bends:

With an even amount of weight through each foot, slowly bend your knees but hold for 20-30 seconds, then straighten your knees.

  1. Calf and Ankle Stretch:

Standing with your feet flat, take a small step back with the injured foot and repeat the above exercise. This will intensify the stretch in the calf and ankle so only move the foot back by a small amount each time. You may feel like there is a physical block in the ankle- this will reduce over time (it can take months- a year).

 

Strengthening Exercises for Ankle Sprains

 

Once your range of movement has improved and you can comfortable weight bear through the sprained ankle, you should start the strengthening exercises. Ideally you would use a resistance band, but if you are unable you could use a towel, belt, dressing gown cord, piece of rope, or whatever is long enough to hold onto and resist movements. If you are using a resistance band, start with the lightest resistance possible and only increase resistance when there is no longer discomfort caused by the exercise.

 

As a baseline, each exercise should be completed as 3 sets of 10 repetitions unless otherwise stated. Remember: listen to your body. If it hurts, do less. Only progress onto the next stage when you are able to complete the baseline without an increase in pain.

 

  1. Resisted Plantar-flexion:

Sit on the floor with a cushion or towel under your lower leg to keep your ankle off of the floor. Put the band around the ball of your foot and push away whilst holding on to it. Initially do not hold the foot down position, but as a progression you should hold the resisted position for 5 seconds.

  1. Resisted Dorsi-flexion:

Tie your band to a table leg or something sturdy and sit on the floor. Loop the band over the end of your foot and move your ankle so your toes move towards you. Initially do not hold the foot up position, but as a progression you should hold the resisted position for 5 seconds.

  1. Resisted Inversion:

Tie your band to a table leg or something sturdy and sit on the floor. Loop the band over the end of your foot and move your ankle so your toes move inwards towards your other foot. Initially do not hold the foot in position, but as a progression you should hold the resisted position for 5 seconds.

  1. Resisted Eversion:

Tie your band to a table leg or something sturdy and sit on the floor. Loop the band over the end of your foot and move your ankle so your toes move outwards away from your other foot. Initially do not hold the foot out position, but as a progression you should hold the resisted position for 5 seconds.

 

Balance and control exercises for ankle sprains

 

These are also strengthening exercises, but the main goal of these are to increase the control of the muscles and proprioception of the ankle. To put it extremely simply, they “re-connect” your ankle to your brain. This means you will have more control over the movements and subconscious reactions that your ankle is capable of. This will reduce the chance of spraining the ankle again in the future- woohoo!

 

1: Single leg stand (baseline 3 x 10 second hold)

 

  1. Hold on to a stable surface. Stand on the painful leg and lift the other foot off the ground for as long as you can. Try to increase the amount of time you are able to stand on it for, up to 10 seconds.
  1. Without holding on to anything, stand on the painful leg and balance for as long as you can. Make sure you are next to something you can hold on to for balance if required. Try to increase the amount of time you are able to balance for.

 

  1. Without holding on to anything, stand on the painful leg on a folded towel/ a cushion and balance for as long as you can. Make sure you are next to something you can hold on to for balance if required. Try to increase the amount of time you are able to balance for.
  1. You can also try these exercises with your eyes closed which will challenge your balance more. Please make sure the space around you is safe and open your eyes if you feel like you might fall!

 

 

Important!

Before starting the next 2 sets of exercises please watch this video. It is important to keep you ankles in good alignment. This means having your feet parallel to each other (facing forwards in a straight line like the number 11), and keeping good alignment when going up and down on tip toes. 

 

2: Double Calf raises:

  1. Stand with both feet parallel, more weight through the non-painful side. Slowly raise both heels and go up onto tip-toes, transfer your weight to be equal through both sides, then slowly lower your heels. Transfer more weight to the non-painful side to resume the start position.

 

 

 

  1. Stand with both feet parallel, weight equally through both feet (or slightly more on the non-painful side to start with if needed). Slowly raise both heels and go up onto tip-toes, then slowly lower your heels to the start position. Try to keep the weight even through both sides throughout the whole movement.

 

 

  1. Stand with both feet parallel, slightly more weight through the painful side. Slowly raise both heels and go up onto tip-toes, then slowly lower your heels to the start position. Try to keep the same weight distribution throughout the whole movement.

 

 

  1. Repeat number 2 and hold the heel raise for up to 10 seconds.

 

https://youtu.be/EvTxCvtquoU

 

  1. Repeat number 2 but starting with your heels lower than your forefoot e.g. standing on a step with your heels off the edge.

 

 

  1. Repeat number 3 and hold the heel raise for up to 10 seconds.

 

 

  1. Repeat number 3 standing on an unstable surface e.g. a folded towel or a cushion. Make sure you are next to something you can hold on to for balance if required.

 

 

3: Single calf raises:

  1. Hold on to a stable surface. Stand on the painful leg and lift the other foot off the ground. Slowly lift your heel and go onto tip toes and slowly lower again.
  2. Without holding on to anything, stand on the painful leg and lift the other foot off the ground. Slowly lift your heel and go onto tip toes and slowly lower again.

 

 

     3. Repeat number 2 and hold the heel raise for up to 10 seconds.

     4. Repeat number 2 but starting with your heels lower than your forefoot e.g. standing on a step with your heels off the edge.

 

This is the basic rehab programme which should be enough for non-athletic people. If you are an active/ athletic person usually and would like to return to sport, you may require some more advanced exercises after completing these exercises. This will include more dynamic exercises with things such as change of direction and more impact through the ankle. I will do a separate post for these.

 

If you have tried this exercise programme and have any feedback or questions, please do get in contact!

 

I have sprained my ankles a couple of times and dislocated an ankle through sport…following this programme every time improved the healing time drastically. It may still take between 6 weeks – 9 months to return to normal depending on how bad the sprain was, what your baseline level of activity is, and other factors such as comorbidities.

Top Tip

I recommend walking as much as possible (pain permitting) during your rehab stage, using pain relief as needed, and using a support or strapping for more strenuous activities. The main thing is to LISTEN TO YOUR BODY. “No pain no gain” is NOT true in this case and you should definitely rest if you’re hurting.

 

Best of luck to you and your beautiful colourful swollen ankle!