Ankle Sprain Ankle Injuries

Ankle Sprain: The Ultimate Guide to Ankle Injuries and Recovery

As you may know, an ankle sprain is a common injury, especially for those that play sports. What many people don’t know is, those that sprain their ankle once are at a significantly higher risk to have more ankle injuries. Many times, those that sprain their ankle don’t seek out medical attention after their injury. No worries because that’s why I’m here to give you information to fix your ankle sprain and prevent them from recurring in the future.

The majority of ankle sprains occur when you roll your ankle inwards, also known as inversion ankle sprains.

When you roll your ankle like the picture above we tend to have a TON of swelling, this is a normal part of the inflammation process but can be nerve racking when it swells up like this…

My younger brother’s ankle after right after rolling it…ouch!

After you roll your ankle you want to ensure you don’t have an ankle or foot fracture which I discussed in a blog post here. If it’s been determined you just have an ankle sprain, then it’s time for Step 1.

PRICE Protocol

Many of you may be familiar with the RICE protocol but I like using PRICE which stands for Protection, Rest, Ice, Compression, Elevation:

Protection – this means you want to do everything you can to not further injure your ankle. For example, returning to play basketball too soon or any other activity which increases your chance of rolling your ankle again. Depending on the severity of your sprain, you may benefit from using crutches for a SHORT period of time; no more than several days after the injury occurs. I will touch on this later as to why this is so important, but my general recommendation is if you can grit the pain then walk with an ankle brace or walking boot. The ankle brace doesn’t have to be anything fancy, I really enjoy these braces which can be found at any local drug store.

Rest – this one is pretty self-explanatory and goes back to protection. The ankle must deal with the inflammation process and you mustn’t do anything to re-aggravate your ankle sprain. Therefore resting from your activity of choice is required, BUT this rest period will only be for a few days.

Ice – ice is a great tool to assist with pain/inflammation and should be done for 10-20 min periods, 2-3 times per day until your swelling has dissipated.  

Compression – this is where ace wraps become your best friend. These can be purchased at any pharmacy for a few dollars and should be worn at all times. The key is to wrap your ankle as snug as possible without causing numbness, tingling, or a feeling cold in the toes. It should look like this.

 

 

Elevation – this is another fantastic tool to utilize during downtime in order to decrease swelling. So when you’re watching another season of House of Cards on Netflix get your ankle above your heart and begin performing ankle pumps. Ankle pumps are easy, just point your ankle downwards like a ballerina, then bring your toes up to the starting position, and repeat. There is no limit as to how many of these you can do, but this should be done relatively pain-free.

STOP LIMPING….WALK NORMALLY!

This step (get it?) can make all the difference in the world. For the more severe ankle sprains you may have to use the PRICE protocol for a longer period of time but as the swelling decreases the sooner you can get back to walking normally the better. “But, Mat, it hurts! I must be making it worse!” Yes, it does hurt but as long as you don’t re-roll your ankle you aren’t damaging the healing tissue. In fact, walking without a limp will desensitize your pain eventually decreasing your pain over time.  

Disclaimer:*** The following exercises should not be taken as medical advice and should not be treated as such.

STRENGTHEN THE ANKLE

Now we have approached the fun part. It’s time to get your ankle more stability and strength. Try to do these exercises in order and as you feel better progress to the next exercise. This requires some therabands which you can find at any sporting good store or Amazon. The general recommendation is to not progress to the next exercise until you can perform many reps, PAIN-FREE. Ready? Good!

Ankle Inversion/Eversion Strengthening with a Theraband

These first two exercises are used to strengthen the smaller muscles surrounding the ankle. The goal is both of these exercises should be pain-free and to hold each exercise for 1 minute holds. I prefer 1 minutes holds to get better muscle activation and endurance. Watch the video below on performing this exercise properly.

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👣ANKLE SPRAIN SERIES👣 Ankle sprains are common but how do you rehab them? Today, I'm showing two exercises you can do after your swelling begins to decrease. • • • 🔹All that's needed is a theraband which can be found at any drug store. These exercises are used to help strengthen the small stabilizer muscles of the ankle. • • • 🔹On the left, the foot is directed downwards and inwards…sorta like a ballerina 👯‍♂️. I'm pointing 👉🏻 to exactly where you should be feeling it while performing this exercise. • • • 🔹On the left the foot is directed down and out. I am pointing 👉🏻 to where you should be feeling it when doing this exercise. • • • 🔹Major 🔑 is these should both be pain free and you should be able to hold it for 1 minute consecutively. Give it a try and let me know how it goes!

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Single Leg Balance

This exercise is an extension of walking normally. By putting more weight on the affected leg, you are essentially forcing the ankle to improve balance and stabilization. Therefore, getting you back to your activity of choice faster. I recommend doing single leg balance whenever you are brushing their teeth to ensure you are working on it daily! You should be able to balance on your leg for 30+ seconds without difficulty so be sure to practice! If this exercise starts getting easy you can stand on a pillow or uneven surface to make it more challenging.

Heel Raises

This exercise is used to strengthen the calf muscles another important aspect in ankle sprain recovery. This exercise can be broken up into stages.

Stage 1 = Seated heel raises

These are the easiest to perform as it does not require to lift your body weight up against gravity. Start in a chair and with both feet on the ground and in a slow, controlled motion, push through the balls of your feet raising your heels off the ground as high as you can while keeping the balls of your feet on the ground. If you can perform 20-30 of these without difficulty then try with the sprained ankle. If you can do 20-30 without difficulty OR PAIN then it’s time for stage 2.

Stage 2 = Seated Single-Leg Heel Raises

Same as above but instead of both feet you will just use one foot as you cross your leg over your thigh (see video below. When you can do 20-30 reps for 2-3 sets consecutively with relative ease then it’s time for stage 3.

Stage 3 = Standing Two-Legged Heel Raises

This exercise is relatively easy. Stand with your feet shoulder-width apart, something stable close by to help with balance, and knees locked out. In a slow, controlled motion, raise your heels off the ground as high as you can go while keeping the balls of your feet planted. When you can do 20-30 reps for 2-3 sets consecutively with relative ease then it’s time for stage 4.

Stage 4 = Single-Leg Heel Raises

This is done just like the previous exercise except one leg is slightly lifted off the ground and with one foot you will perform heel raises. Some keys are to ensure the ankle motion is slow/controlled, you are reaching an appropriate height, and most important that it is pain-free. 

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👣Ankle Sprain Series 👣 Heel raises are a fantastic way to improve ankle/calf strength using this easy progression. • • • When recovering from an ankle sprain it's important to begin strengthening the ankle without aggravating the healing tissue. Video 🎥#1 are seated heel raises and the least demanding on the ankle. • • • The second video 🎥 is one legged and a bit more difficult. The bottom two videos are in standing and are more challenging on the ankle requiring to lift your body weight. • • • Try these exercises but make sure you move in a slow, controlled motion reaching as high as you can PAIN-FREE. Don't progress to the next exercise until you can do 20-30 reps without difficulty. Good luck!

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Star Excursions

This next exercise incorporates a more challenging movement that will demand ankle stability in different directions. Now pretend you are rehabbing your left ankle and you are standing on top of a clock. The left ankle stays planted with the left knee straight as the right leg is lifted off the ground with the knee straight. Then you will perform a single leg squat with your right heel tapping the imaginary clock at 12 then 2, 3, 4, and 6. Try this for a few rounds to really increase that strength!

Hopping

The next stage in ankle rehab is to begin some more explosive movements. To begin I would just hop up and down in place like you’re doing the jump rope. If this is easy/pain-free then it’s time to hop forward and back. When this becomes easy, try hopping side to side, and finally, start changing directions. Jump turn left, jump turn right, etc. As your ankle continues to get stronger then do everything I just mentioned but with only the affected leg.

Return to sport or activity

The final stage of ankle sprain rehab is to get back to the activity that you miss the most. Whether it be running, basketball, football, etc. The key is to go back to your sport progressively, meaning if you are a runner then start by running a short distance at 25% speed. If you are a defensive lineman, begin in the three-point stance and see if you can push off at 25-50% pain-free. At this point, pain is your guide; if it hurts you aren’t ready to go back to your activity.

As for ankle braces, after you’ve had one ankle sprain you are more likely to have another one (even less likely if you followed my program above). If you play a sport like basketball, I definitely recommend some ankle support in order to decrease your likelihood of another sprain. It doesn’t mean you should be wearing your brace 24/7, just during high impact activities.

Summary

If you go through this progression I have listed above, you should be significantly better after two to three weeks. But when in doubt, go see your local physical therapist to develop a plan specifically made for you. Those with severe sprains may take closer to one month but it’s important you perform the progression in its entirety listed above to decrease the risk of re-injury. In summary:

  • Use PRICE protocol to control inflammation
  • After the first few days depending on the severity of the sprain get rid of crutches and walk…without limping!
  • Start strengthening your ankle using the protocol above
  • Ease your way back to your sport or activity of choice

 

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