Have you ever heard that sometimes it’s easier to treat a broken ankle than a sprained ankle? Well, that can be true!
Ankle sprains are often multi-factorial in nature. In this blog, we are solely going to focus on lateral ankle sprains. These occur when you roll your ankle inward and injure tissue structures on the lateral side of the ankle. They often happen during sporting events such as soccer and basketball, but can also happen if you simply misstep while walking or hiking.
The structures impacted by a lateral ankle sprain include the anterior talofibular ligament(ATFL) and the calcaneofibular ligament(CFL). These ligaments attach to your outer ankle bone, anatomically known as your fibula. The Peroneal musculature and tendon structures are also often impacted during lateral ankle sprains. As you can see in the photo to the right, these structures all sit in a similar location and play a supportive role in ankle health.
Ankle sprains are graded on a scale from 1-3 based on their severity. Grade 1 is mild, grade 2 is moderate, and grade 3 is severe. As you can probably assume, the recovery time for a Grade 1 sprain is significantly less than a Grade 3 sprain. However, it should be noted that not every ankle sprain will rehabilitate the same and some do take longer than others.
Your medical provider will often discuss your level of sprain when evaluated. If you have not been evaluated here are some pointers on grades of ankle sprains:
– Grade 1: Your ankle will be sore and maybe slightly swollen with no real bruising. You can normally walk, and it feels better within a few days. In this case, the ligaments are often overstretched, not torn.
– Grade 2: Your ankle will be sore, and moderately swollen and there may be slight to moderate bruising. Walking may be difficult for the first several days and crutches may be required. In this case, there is partial tearing of the ligamentous structures supporting the ankle.
– Grade 3: Your ankle will be very sore with severe swelling and widespread bruising. You may have heard a pop during the injury. In this case, there is likely a full tear of the ankle ligaments. Your ankle may feel unstable and you may require crutches for a period of time.
Now, some ankle sprains are associated with fractures. Some rules of thumb to seek further medical attention post-ankle sprain include the following:
So, now to the fun part. What do you do if you have an ankle sprain? This is a short guide regarding how to progress activity when dealing with a sprained ankle. However, please note that if you have a complex sprain, we recommend being treated by a local physical therapist.
Ankle Sprain Guidelines (Watch this video for a run down!)
Steps 1-3 are used in the acute stage of ankle sprain rehabilitation:
The protection phase normally lasts 1-3 days! I’m sure you’ve heard the term R.I.C.E (rest, ice, compress, elevate) before. However, now we go with a bit more of a proactive approach to this phase utilizing the acronym P.E.A.C.E (protect, elevate, avoid anti-inflammatories, compress, and educate) and L.O.V.E (load, optimize, vascularize, and exercise). You don’t have to refrain from all activity; however, if you realize your pain and swelling are getting worse, it’s time to take a break! Also, you don’t have to ice as often as once believed!
Continuing to move your ankle is important within a pain tolerance of 0-4/10. Movement helps to flush out swelling and improve function. Performing tasks such as ankle windshield wipers (side-to-side), ankle pumps (up and down) and ankle ABC’s (write the ABC’s with your ankle) are great early exercises that emphasize movement!
Do not underestimate the power of walking! Normalizing walking mechanics is one of the most important parts of ankle sprain rehabilitation. Walking also helps your ankle to move through its range of motion. If you require crutches to walk, we recommend slowly progressing to walking without them. That may require walking with one crutch for a bit to assist in walking normal again! Once your walking a bit better, It’s time to progress your activity.
Steps 4-9 are used to normalize function and assist in return to sport activity:
Restoring ankle strength and movement is imperative post lateral ankle sprain. We recommend performing exercises that target the stabilizing muscles of the ankle. This includes 4-way banded ankle exercises. Also, when it comes to mobility, make sure you’re working on dorsiflexion as it is often impacted during lateral ankle sprains. This can include something such as a ½ kneel to wall, or even putting your foot on a chair and letting your knee move slightly over your toe.
Working on balance is a staple post ankle sprain! It’s also everyone’s least favorite to do. Start simple by practicing standing on one leg for 20-30 seconds at a time. Once you can perform that for 3 x 30 seconds without needing assistance, try it with your eyes closed! After that, it’s time for dynamic balance. That means balancing on one leg while moving or while doing something such as throwing/bouncing a ball.
Functional strength training is imperative post ankle sprain. This includes things such as squats, deadlifts, calf raises, single leg calf raises, step-ups and step-downs, lunges and so forth! We always say start with exercises that do not significantly increase your swelling or push your pain above a 4/10!
Before you run, it’s important to be able to perform tasks required to run! We recommend beginning with some gentle plyometrics called pogo hops. These are small, repetitive hops that can be performed on two legs, one-leg and in multiple directions. We recommend progressing as follows: double limb, double limb multi-directional, single-limb, single-limb multi-directional. To run well, its important to perform single limb pogo hops for 30 seconds on each leg! Then we recommend returning to run in walk: run increments before adding in any intensity!
If you’re looking to get back to a multi-directional sport (soccer, tennis, baseball, basketball, etc.), it’s important to participate in agility work prior to returning to the field. Some of our go-to exercises include things ladder drills, acceleration and deceleration asks, and change of direction drills such as the T-Drill or X-Drill. After you feel comfortable drilling without your ball or stick, it’s time to add in some sport-specific drills! Just remember, no-contact before contact! If you have questions on these, don’t hesitate to ask!
Finally, we’re talking return to return to play! When we say play, that means you can get back on the field, get on the side of a mountain, join your team, and get back to doing what you love. However, you can’t just jump in full force. We recommend beginning with small increments 5-10 minutes at a time. Make sure that before you play full-contact you begin with no-contact or neutral drills if you are a field athlete. If you are simply looking to get back wo weightlifting or hiking, same principles apply! Start light, start easy and progress from there!
Well folks, we hope this helps with your ankle sprain rehabilitation. The progressions may not always be clear cut, so this is where we do recommend seeking out assistance if necessary. Remember, these things take time based upon severity. So just because your friend healed in a week, it doesn’t mean you will to!