Rehabilitation of a Sprained Ankle

Posted On: May 1, 2020

Many people who lead active lives have experienced an ankle sprain. There are a lot euphemisms for this injury. I’ve heard “I rolled my ankle,” “twisted my ankle” or “tweaked my ankle.” Many of these individuals have this occur multiple times.

A proper exam is always required. I remember a stud Lake Forest football player who had been in therapy for six months when his dad approached me to see if this seemed right. I told him, “Not in my experience.” He brought his kid in for an exam. I examined him and could see that he had a very tender bone in his ankle. I ordered an MRI that revealed that he had a fracture.

Most often the ligaments on the outside of the ankle get injured (the anterior talofibular ligament and the calcaneofibular ligament).  If it is a first time injury, there is frequently profuse swelling. Weight bearing is typically painful initially.

After I examine the new (“acute” in medical lingo) ankle sprain. I start these individuals with relative rest, ice, compression and elevation (see my blog on inflammation). Rest is relative and these individuals usually do well in an ankle stirrup brace (I use Aircast in my office). This may make walking easier. I tell them to start icing the ankle 10 minutes on and 10 minutes off for an hour or two. While they are icing they should wrap the ice in an Ace bandage and lay down with their foot above their heart. Pumping the ankle down and up repeatedly will help move the fluid away from the ankle.

In one to three days it is time to start strengthening the ankle using a therapy band. The patient is to do 3-5 x10 repetitions of pointing the toes in the band, pulling the toes back with the band tied off and looped around the foot and pulling back/up and out with the band tied off and looped around the foot.

The patient then is moved into balancing on one foot, progressing to standing heel raises with two feet and then one. Other areas are strengthened, such as the muscles around the hip. Balancing exercises are given, using varying degrees of challenge to match where the patient is in their progress.

Finally patients are moved into more advanced functional activities like running, cutting, leaping and landing. This phase is the most fun and as it gets into sport specific drills. Patients are often chomping at the bit to return to play.

The whole process can take two to four months to complete. I always encourage my patients to continue to work on strength and balance to try and prevent reoccurrence of the injury. If anywhere along the line the patient isn’t responding, I examine them and may turn to advanced imaging like an MRI.

As always one should see a chiropractor or a physical therapist who is experienced in orthopedics and sports injuries to establish a proper diagnosis and direct care.

Stay well and stay active.

Dr. J