In our previous blog we looked at the structures causes and risk factors involved in lateral ankle sprains. In this blog we look at the essential components of getting your recovery and rehabilitation on point so that your ankle won’t worry you again.
Why its important to get your sprained ankle rehab right?
The ankle is a complex joint, it has to function as both a mobile structure that can adapt to changes in the surface terrain and also act as a stiff structure so it can behave like a spring to help us push off the ground.
Furthermore the ankle needs to be able to change between these roles very very quickly. So its imperative we get it back to full function to avoid further potential injuries.
1. Stronger ankles are happier ankles, importance of strength exercises after ankle sprains.
We need to get the ankle stronger to cope with forces that are coming in multiple directions as well as being able to push us forwards as we walk or run.
Exercises are usually graded depending on the severity and stage of recovery. As a rule of thumb the in the early stages we use easier and less complicated exercises that focus more around the and progress to more complex exercises that may include jumping and landing drills in the later stages of rehab.
2. Ankle Strengthening through full range of available movement:
You need the ankle to be strong and capable through the entirety of its range not just in a foot flat on the floor position.
We need to consider the movements available at the ankle when choosing exercises. Most people concentrate on dorsi-flexion and plantar flexion in the sagittal plan, (up /down).
There are other we need to consider, especially the frontal plane where lateral movements occurs. The diagram to left shows these as inversion and eversion at the ankle joint.
In mid to later stage rehab it’s important to retrain the lateral movements of the ankle in different ranges of plantar flexion and dorsiflexion. This easily accomplished with the use of wedges or slanted boards.
Doing strength work in these different ranges of ankle motion will help it cope with the demands of our lifestyle.
Level 1. Acute early stage ankle mobility, stability and strength.
In the initial early stages most exercises are done with the foot in its planta grade or neutral position i.e flat on the floor. This allows for us to strengthen the muscles surrounding the ankle and ligament complex in its safe zone so to speak.
Here are some exercises you can do in the few weeks following an ankle sprain:
- Range of motion for the ankle: dorsiflexion, plantarflexion, inversion and eversion.
- Single leg balance +/- foam
- Calf raises
- Monster walk
The video below shows the practical applications of these exercises.
Level 2: Mid stage strength and stability for ankle sprains
In later stage rehab once the ligament has healed its important to retrain the ankle on different surfaces to retrain its ability to cope with uneven ground and also address more complex movements available at the joint.
Exercises that require increased ranges of plantar flexion and dorsiflexion or use combinations of plantar flexion and inversion are introduced in mid to late stage rehab. This can be done with the use of wedges or slanted boards.
You need the ankle to be capable through the entirety of its range not just in a foot flat on the floor position.
Here are some slightly harder versions of exercises we may give you in the beginning to mid phase of recovering from an ankle sprain:
- Single leg calf raise
- Calf raise with inversion
- Step up
- Step down
- Foam twists and rotation slope
The video below again will show you the exercises:
Its not just about the muscles of the foot and ankle that need to be considered but the whole lower limb and even the core muscles in the trunk.
3. The kinetic chain and ankle sprain rehab
As the song goes “the ankle bone is connected to the knee bone”, we need to use exercises that not only challenge the muscles around the foot and ankle but challenge the movement patterns at the whole lower limb.
Often this is referred to as the closed kinetic chain, (CKC), these types of exercise also help retrain balance and coordination and can also be more specific in their movement patterns.
4. You may be surprised but the core exercises can help after ankle sprains
A stronger core or hip is also important in controlling the body from going too far over the ankle when it rolls underneath us.
Also using the side plank exercise in your rehab not only trains a strong core but will help strengthen the ankle as well on the supporting leg.
This may prevent or at least reduce the injury potential: read more here.
5. The foot intrinsic muscles are important in retraining after an ankle sprain
The small muscles of the foot play a very important role in the function of the whole ankle / foot complex. The are part of the system that helps you with the ability to change direction quickly and also absorbing force and controlling subtle joint movement. We go into how to strengthen these muscles in greater depth here.
6. Balance and proprioception exercises after an ankle sprain.
Proprioception is an aspect of training that many people neglect – it can be described as the ability to know where your joints are in space. It is an incredibly important function of the ligaments in the ankle complex.
Proprioceptive training has been shown to reduce the rate of recurrence of ankle injury in people who have experienced previous injury.
There’s a quick basic test you can do on yourself at home called the star excursion balance test, (SEBT), or a shorter form called the ‘Y’ test. The SEBT tests your dynamic control and balance of your hip knee and ankle and can also be used as an exercise to improve balance and proprioception.
We have a look at the SEBT and how to perform it here:
7. Retraining the ankle as an effective spring.
This type of stiffness is the spring like quality of the ankle complex, as opposed to a stiffness meaning lack of movement.
Stiffness in this regard is the ability to absorb landing forces and propel us forwards or suddenly change direction. We use plyometric type exercises to retrain this quality.
Below are examples of exercises that help retrain this spring like quality of the ankle.
Level 3: Dynamic strength, stability and proprioception training for the ankle
Here’s an example of higher level balance and jumping related exercises for those wanting to get back to sports or running.
Returning to sport or hobbies after ankle sprain.
There’s our top 7 exercise tips for sprained ankles. By addressing these you will be in the best position to get back to sport and activities you love. They are also very useful in the prevention of ankle and lower limb injuries.
So if you’re about to start your sporting season (Netballers, Basketballers, footballers – I’m looking at YOU!) and you don’t want an injured ankle use these tips.
Last but not least I’ll leave you with this fact:
The biggest predictor of an ankle injury is not sufficiently rehabilitating a previous ankle injury !
Make an appointment to get set up with an ankle ‘PRE’-habilitation program and make this year the year you don’t sprain an ankle!
Cheers
Dave
References:
Pourkazemi, F., Hiller, C. E., Raymond, J., Black, D., Nightingale, E. J., & Refshauge, K. M. (2018). Predictors of recurrent sprains after an index lateral ankle sprain: a longitudinal study. Physiotherapy, 104(4), 430-437
Gabriella Sophie Schiftan, Lauren Ashleigh Ross, Andrew John Hahne
The effectiveness of proprioceptive training in preventing ankle sprains in sporting populations: A systematic review and meta-analysis
Journal of Science and Medicine in Sport, Volume 18, Issue 3, 2015, pp. 238-244
Doherty, C., Bleakley, C., Hertel, J., Caulfield, B., Ryan, J., & Delahunt, E. (2016). Recovery from a first-time lateral ankle sprain and the predictors of chronic ankle instability: a prospective cohort analysis. The American journal of sports medicine, 44(4), 995-1003.
Smith, B. I., Curtis, D., & Docherty, C. L. (2018). Effects of hip strengthening on neuromuscular control, hip strength, and self-reported functional deficits in individuals with chronic ankle instability. Journal of sport rehabilitation, 27(4), 364-370.
Hubbard, T. J., & Hertel, J. (2006). Mechanical contributions to chronic lateral ankle instability. Sports medicine, 36(3), 263-277.