An ankle sprain is such a common injury that many people tend to just ice and hobble along until they feel ready to get back to their favorite activities. In order to prevent this type of injury or lingering pain from becoming chronic, it is important to take an active role in your recovery.
Exercises that focus on range of motion, strength and balance can help you recover quicker and stronger.
About Ankle Sprains
Ankle sprains are graded into various categories and each grade of ankle sprain will usually have a different time frame on how soon it is safe to return to activity. The type of activity is also a factor, as sports that involve twisting/turning will require greater strength and stability than, for example, jogging or hiking.
Grades of ankle sprain:
- Grade 1 sprains are light sprains that usually allow return to sport in 2-3 weeks.
- Grade 2 ankle sprains involve greater injury to the ligament and can take up 4-6 weeks to allow full return to sport.
- Grade 3 injuries are more severe in nature and often involve full tearing of the ligament and possible bone fracture. The length of time to recover from grade 3 ankle sprains could be 3 months or more.
All of these time frames are variable on case by case.
Before returning to activity, whatever grade of sprain it is, it’s important that you have undergone some rehab to ensure safe transition to your activity and minimizing the risk of re-injury. With any ankle sprain, there are a number of core areas that need to be trained to a sufficient level that is appropriate to the demands of the sport/activity you engage in. The demands of running, hiking, trail running and soccer all vary in how they stress the ankle joint. It is important that your therapist ensures you follow through to end stages of rehab as returning too soon to your activity may result in re-injury.
Key Requirements for Returning to Activity
Range of Motion:
- Maintaining range of motion is vitally important. In severe ankle sprains a period of immobilization might be required but once allowed you should start to move your ankle as soon as possible. Your physical therapist will be able to provide exercises and perform manual techniques that can expedite the process. Lacking range of motion can put unnecessary stress on other ankle/lower limb structures when your return to sport.
- It is vitally important that your ankle strength returns to a safe level before returning to sport. Your ligament needs to be stressed appropriately throughout the rehab cycle to ensure that the new collagen (material ligaments are made up of) being laid down gets stronger and heals in an organized fashion. This ensures that the ligaments will reach a high level of tensile strength and this can prevent further injury. Strong muscles, ligaments and tendons will allow you to perform maximally when returning to activity.
- The level of strength required within an ankle varies between different activities. Simple theraband exercises might be enough in the early stages but weighted single leg calf raises and single leg hopping exercises may also be included in the program depending on the requirements of the goal activity.
- If you have been immobilized or non-weight bearing or even if you were walking with a limp in the initial stages of the sprain, you may have developed weakness further up the chain in your lower limb. It is vital that these areas are screened and if deficits are noted, exercises should be prescribed to address areas of weakness.
Balance and Proprioception:
- Many people can have very strong ankles with good range of motion and feel ready to return to sport. However, without good balance and proprioception you are at increased risk of re-injury. When you sprain a ligament it affects some of the receptors within the tissue that provide feedback to your brain. These are important as they provide valuable information to your joint on how to protect itself in situations where you run the risk of injury. Balance and proprioception allows you to run down an uneven trail and prevent you falling. It allows you to be able to correct your foot position when you feel like you might be about to go over on your ankle. This is most often not a conscious thing that you do but an automatic loop that goes through your brain.
- Balance and proprioception exercises are also progressed through grades of difficulty and initially might be standing on one leg on level ground and eventually end up standing on a foam cushion or balance board with eyes closes. Hopping on one leg through obstacle courses and other single leg hopping exercises are also another good way to work on your ankle proprioceptive system.
- Some people feel more confident if they have some support around their ankle when returning to their activity. This is usually a short term strategy and it is important that you do not become dependent on these. In certain circumstances where the ligaments are very lax, wearing a supportive brace might be a good idea. However, your physical therapist or doctor will advise you on this.
- It is common for some residual swelling to remain within the ankle joint in the latter stages of rehab. Mild swelling that does not affect function or cause pain might be fine and you can still return to activity. However, ideally you should not have swelling after activity and this is indicative of good healing. Again, consulting with your physical therapist or doctor is vital on returning to activity.
- It is recommended that you would have a full functional screening by your physical therapist before return to activity. In these tests your PT will test all the various aspects of your activity and ensure that your ankle is able to cope with demands of the movements adequately to ensure that that risk of re-injury is minimized.