Suzie Says... Let's Talk About Ankle Sprains and Exercises
Updated: Jun 29, 2020
Disclaimer: This article is intended to be for educational purposes only, and does not constitute medical advice or replace professional assessment. Please seek a professional assessment before undertaking a new exercise program especially if you have any medical conditions, any previous or current injuries or other health / physical concerns. If you undertake any of the exercises within this article you do so at your own risk.
Any website pages/links added are also for education purposes only and are not under my control and may change or be removed at any time.
An ankle sprain, in particular spraining the outside of your ankle (lateral ankle sprain) is the most common ankle injury that people suffer from. You may 'go over' on your ankle stepping off a step, walking on cobblestones, hiking the Inka Trail, putting your foot down in the wrong place, going over on high heels, stumbling home after a few too many drinks with new found friends...the list goes on! In my opinion it's never 'just a sprain' that should be 'pushed through'. If left untreated it can lead to chronic ankle instability causing long-term issues like ankle osteoarthritis.
So, who is most likely to get an ankle sprain?
If you've had a previous ankle injury on the same side, or even on the other ankle you are more predisposed to a future ankle injury. Also, if you have reduced ankle movement or a hypermobile ankle you have an increased risk of injury. Those who are active, especially if you like field or court sports you are more likely to have an ankle injury, but there's a huge number of people that injure their ankles and suffer an ankle sprain in normal daily activity as well. If you like riding off-road, hiking, or other extreme sports where your feet are required to take load on uneven surfaces, and you wear crappy boots with rubbish ankle support, don't be suprised if at some point you also end up with an ankle sprain.
It's a massive finacial burden on health services, especially when not treated correctly the first time around.
Ankle sprains can be graded on a three point grading scale like this:
Grade I Mild - Little swelling and tenderness with little impact on function. Grade II Moderate - Moderate swelling, pain and impact on function. Reduced proprioception, Range of movement (ROM) and instability. Grade III Severe - Complete rupture, large swelling, high tenderness loss of function and marked instability.
I would always recommend seeing a physiotherapist if you have an ankle sprain, especially if you have a severe/grade 3 sprain. About 10% of people who go over on their ankle will have a fracture, so if it's bad, get it checked!
What to do if you've just sprained your ankle
You can use the P.O.L.I.C.E. principles when you sustain an acute injury which stands for Protection, Optimum Loading, Ice, Compression and Elevation.
In order to protect the ankle you may need to use crutches and initially rest the injured ankle, however, as 'optimum loading' suggests, you need to not just completely immobilise the joint but gently mobilise it so that you don't lose movement and too much strength and end up with a stiff ankle. Optimal loading means 'replacing rest with a balanced and incremental rehabilitation programme where early activity encourages early recovery' (Bleakley et al., 2012). Obviously, what you should be doing is best determined by a physio, however some of the gentle movement exercises listed below can be done in the early days if you do not have access to a physio, especially if you're travelling in the back of beyond. I have written a little bit about ice therapy below, and this is based on how I would normally advise people in clinic and also based on the findings of an article published by Bleakley et al. (2006) on the use of ice (see reference below).
Compression can be created by using an elastic bandage or tubi-grip...whatever is easiest to find. Obviously you need to check it's not too tight on a regular basis, and make sure your toes are still the right colour, i.e. not bright white or red. You can squeeze your toe(s), they will go white with the pressure, and then let it go. The blood should flow back into the area almost immediately and your toe should then look a 'normal' pinky colour again. These are often readily available at pharmacies and you can ask them for the best advice for whatever compression garment you buy. If there's a language barrier, Google it and often pages can be translated quite easily these days.
Finally elevation. Basically lift your ankle up on some pillows and have a lay down...and no, I don't mean be a complete lazy arse for several weeks, but getting some good periods of elevation can help a lot.
NSAID's (Non-steroidal anti-inflammatories) have been shown to help, however as a physiotherapist I cannot recommend taking these or dosage, however any pharmacist can advise you, and in general, even in the smallest of towns there's always some kind of pharmacy.
Use of ice
Have a plastic ice bag completely filled with water, place it in a freezer, and remove when frozen. Before application, hold the pack under hot water for 30 seconds and wrap it in a single layer of towelling (moistened until just dripping wet). Apply the ice to the area of injury for 10 minutes. Remove it, and then rest the ankle at room temperature for 10 minutes. Reapply the ice for a further 10 minutes. Repeat this intermittent ice therapy every two hours. This is particularly useful within the first 72 hours of injury.
You can also use ice for 20 minutes (same method as described above) every two hours if this is easier, however intermittent ice therapy (2 x 10 minute applications) has been found to reduce pain with activity better within the first week of injury (Bleakley et al., 2006).
Do you need a brace or support?
'Crutches, braces and supports, traditionally associated with rest, may have a greater role in adjusting and regulating optimal loading in the early stages of rehabilitation' (Bleakley et al, 2012). External bracing or taping has been found to be much more effective than casting or full immobilisation, and these things also allow some movement and/or weight bearing, which has been shown to have a positive effect on ankle sprains.
It has been found that exercise therapy and taping/bracing are effective in the management of acute and recurrent ankle sprain however ultrasound therapy, acupuncture and manual therapy do not seem to be effective in the treatment of recurrent ankle sprain (Doherty et al, 2016). Here are some exercises that may help with ankle strength and stability, and prevent future injury.
Please note, if you have just had an ankle injury please try an get it properly assessed before undertaking new exercises, and do not do any exercises which cause you pain. I would not recommend undertaking a new exercise programme which has not been tailored to your specific injury if it is an acute injury, and definitely not in the case of a grade 3 (severe) injury.
Ankle mobility, calf stretching, and basic proprioceptive exercises can help during the first few days of injury (from day 2-3 onwards) in mild to moderate sprains i.e. grade 1 and grade 2 sprains, along with the use of ice therapy.
Some basic early exercises (from day 2-3) are:
Sit or lie down with your leg out in front of you. Circle your ankle in one direction about 30 times and then go in the opposite direction. Repeat this 2-3 times. Do not continue if it is painful, just do as much as comfortable.
Non-weight bearing calf stretches
Sit down with your legs out straight in front of you. Use a towel or belt to put around the ball of your foot.
To stretch your large (gastroc) calf muscle, keep your leg straight and gently pull your toes towards you holding each end of the belt/towel in your hands. Only pull until you get a gentle but not painful stretch in your calf. Hold 20-30 seconds then release. Repeat this 4-5 times on both sides - it's important to keep your good ankle mobile as well while you're not doing so much.
To stretch your smaller (soleus) calf muscle, bend your knee a little and gently pull your toes towards you holding each end of the belt/towel in your hands. Only pull until you get a gentle but not painful stretch in your calf. Hold 20-30 seconds then release. Repeat this 4-5 times on both sides - again it's important to keep your good ankle mobile as well while you're not doing so much.
Seated heel raises
Sit on the edge of a chair with your feet flat on the floor. Slowly lift your heels as far as you can off the floor leaving your toes in contact with the floor at all times, then lower again. Repeat this 8-12 times as comfortable. Rest and then repeat 2-3 more times so long as it's not painful.
Move your ankle inwards, outwards and upwards (inversion, eversion and dorsi-flexion) with or without assistance (e.g. using a towel).
Sitting with your legs out straight, sat on a bed or chair, gently move your feet outwards without moving your legs and keeping your knees still and in line. Then relax back to the start position. Repeat this 8-12 times as comfortable. Rest and then repeat 2-3 more times so long as it's not painful.
Next move your feet inwards, again keeping your legs still. Then relax. Repeat this 8-12 times as comfortable. Rest and then repeat 2-3 more times so long as it's not painful.
Finally move your feet up towards you as far as possible then relax them back down. Repeat this 8-12 times as comfortable. Rest and then repeat 2-3 more times so long as it's not painful.
If this is too difficult to start with use a towel or belt to assist the movement. It is important that you do not lose movement in your ankle and then get the muscles working correctly early on.
Heel slides seated or lying down
Sit on a chair with your feet flat on the floor. Initially you can place a plastic bag under your feet to help the movement. Slowly slide your feet backwards under the chair as far as comfortable without causing pain and then slide them forwards again. If this is too easy you can remove the plastic bag. If you do not have access to a chair without anything blocking the movement of your feet then lay on your back and slide your feet up as close to your bottom as possible.
Repeat this 8-12 times as comfortable. Rest and then repeat 2-3 more times so long as it's not painful.
Sit on a chair with your feet flat on the floor. Place a towel, teatowel or other fabric under your feet and then practice scrunching it up using your toes and then releasing after a couple of seconds. Practice for 30-60 seconds. Relax and then repeat upto 3 times so long as it's not painful.
Toe stretches seated
Place your foot over your knee and use one hand to hold your toes and stretch them back. Hold this stretch for 30 seconds then relax. Repeat the stretch 3-4 times.
Elevate your leg and use ice after you do your exercises, rather than using ice immediately before your exercises. If you get increased swelling after exercise you may be doing to much so ease off a little. If things are not improving at all after a week and you have not yet had a professional assessment of your ankle, get it assessed properly.
Exercises to start when comfortable:
Single leg stand
This is nice and simple and can be done whilst brushing teeth, waiting for the kettle to boil etc. Stand on one leg. Keep your balance. That is it! Make sure you have something sturdy close by to hold if needed.
If you're getting good at this then try closing your eyes when you do it. Practice on each leg individually for as long as able. 1-2 minutes maybe. To start with make sure you are holding onto something sturdy.
Single leg stand passing and object or clock-face
If you need more challenge when doing the single leg stand then try passing an object around your middle while trying to keep your balance on one leg, or use o