A Guide to Sprained Ankle Rehab

Understand ankle sprains and how to rehab them with a precise guide from STACK Expert Chris Costa.

Sprained Ankle

Ankle sprains are often worse than fractures. But a methodical approach to sprained ankle rehab can expedite the healing process.

Types of ankle sprains

Many ankle sprains occur through a process known as eversion. This is when the foot rolls toward the outside. With an inversion sprain, the ankle twists inward.

The ATF (anterior talo fibular) ligament, located where the ankle meets the top of the foot, is the most common site of the injury.

Inversion and eversion sprains can be equally painful, and they both fall on a graded scale measuring the severity of the sprain. Grade I affects only a few threads of the ligament. Grade III is a complete rupture of the ligaments with possible dislocation.

What happens in most cases is a stretching of the ligaments beyond their normal range of motion, causing pain, swelling and immobility.

Steps to take

If you suspect you have a sprained ankle, you should see a doctor for an examination, diagnosis and determination of a correct course of action. Only severe Grade II to Grade III sprains require surgery. Lesser sprains can heal over time on their own.

Generally, expect six to eight weeks for full recovery. Sometimes these types of injuries can require more time. I sprained my ankle 13 weeks ago and I'm still not fully healed.

Let's assume you have a Grade I eversion sprain to the ATF only. This injury should heal in six to eight weeks if you follow a strict protocol. You want to take these measures:

  • Isolate the injury.
  • Avoid any weight-bearing activity; it can increase pain, edema and swelling.
  • RICE — Rest, Ice, Compression and Elevation. Ice for 20 minutes on and one hour off (as recommended by many health care professionals). Avoid direct contact with the skin. Use a barrier such as a towel to prevent frostbite. Compression supports the joint during healing and reduces swelling. Elevation reduces blood flow to the injury, thus limiting swelling.
  • Bracing. Once you've reached a point where you can bear weight, you may want to try a brace. At this point, the ATF has not fully healed, even though you can put weight on it. Another roll will put you back to square one. This could take a week—or it could be up to six weeks before you can safely walk on the injured foot.
  • The best kind of braces support the sprain and the sole of the foot to truly isolate any movement within that joint.
  • Crutches or a boot are also an option.
  • Physical therapy. I highly recommend PT while trying to regain strength. Resistance band exercises that target rotating, flexing and extending the ankle are good, as are hip pattern exercises. Much sprained ankle rehab occurs with weight-bearing exercises on the injured ankle and by working the opposite leg. This process forces the muscles of the injured leg to fire isometrically to address instability.

Remember that even though you feel better, your ankle may not be ready for full activity. If your exercises have not been weight-bearing, the muscles supporting the ankle have not been working. There is likely some atrophy. They need to be retrained to support and stabilize the ankle. Muscles support joints. Trained muscles help joints heal more quickly than poorly trained muscles, and your ankle will respond more quickly to rehab.

Sprained Ankle Exercises

Calf Raises

These can be done anywhere, without equipment. Training the largest muscles in the posterior of the calf helps to support the ankle and create force that is delivered through the Achilles tendon.

To recruit maximum muscle fiber, rise up on the toe forcefully. Bring yourself slowly back down to the floor.

Eight to 10 reps should begin to tire the posterior calf muscles. Add 3 sets (depending on what other leg exercises you're doing), and you should be sufficiently attacking the calf.

Tibialis Anterior Flexion

The tibialis anterior on the front side of the shin is a primary mover in ankle flexion.

You'll need a resistance band or tube and something/someone to pull the band toward the ground while you complete this movement.

While resistance is pulling the foot down, you build muscle recruitment by creating enough force to flex the foot toward the front of the shin.

Perform 10 reps. Focus on quick force for a total of 30 reps per minute. Complete three sets with at least one minute of rest between sets.

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