19 Aug Early Ankle Sprain Rehab
Just sprained your ankle? You’re not alone. Ankle sprains are one of the most common injuries in all of the sports, so if you’re one of the few that has never experienced an ankle sprain until now, consider yourself lucky! While they can initially be very painful and limiting, most respond very well to structured ankle sprain rehab program. With a solid plan (like the one detailed here), you will be well on your way back to sports and activity in no time!
What’s an Ankle Sprain?
An ankle sprain is an injury to the ligaments of the ankle. Ligaments connect bones to other bones and prevent excessive movement on one bone on another. While the ankle is full of tons of ligaments, the most commonly sprained ligaments in the ankle are all on the lateral or outside portion of the ankle. These ligaments include the anterior talofibular ligament (ATFL), posterior talofibular ligament (PTFL), and the calcaneofibular ligament (CFL) and typically are described based on what bones they connect to.
In general, ankle ligament injuries are classified into three grades representing increasing severity.
- Grade I = mild ankle sprain
- Grade II = moderate ankle sprain
- Grade III = severe ankle sprain; full ligament tear
These grades are typically only assessed through imaging, although a full tear can be assessed by a trained physical therapist or orthopedist. Understand, however, that most ankle sprains do not require imaging. Imaging (like x-rays) should only be used if a fracture is suspected. Even if the ankle sprain looks very bad with tons of bruising, you should only seek out imaging based on the Ottawa Ankle Rules below:
Ankle X-ray Screening Questions
- Can you take 4 steps (its okay if need to limp)? NO? –> GET AN XRAY
- Do you have tenderness/pain around your medial or lateral malleoli (the little bone bumps on either side of your ankle)? Specifically the backside of the bones? YES? –> GET AN XRAY
- Do you have tenderness/pain around the base of the 5th metatarsal (bump on the lateral/outside portion of your foot; halfway between your heel and your little toe)? YES? –> GET AN XRAY
- Do you have tenderness/pain around the navicular bone (bump on the medial/inside portion of your foot?) YES> –> GET AN XRAY
Move over R.I.C.E
The old adage of Rest, Ice, Compression, and Elevation (RICE) for ankle sprain rehab is far outdated. Complete rest is one of the worst things you can do following an ankle sprain, and instead, a new acronym called P.O.L.I.C.E is now the recommendation. Rest is replaced by Protection, and Optimal Loading. This means that early on, we need to protect the injured areas by not overstressing the tissues, but still apply healthy sub-maximal loads to the tissues that actually stimulate the healing process (more on these exact exercises in a bit!).
Furthermore, recent research has shown that the individual elements of RICE alone are not effective, apart from icing, if given along with exercise. This means that the most important part of ankle sprain rehab is providing protection and optimal loading through exercise, not the rest/icing/compression/elevation that is typically recommended!
Ankle Sprain Rehab Exercises
Protection of the injured area immediately after an ankle sprain means that we should strive to not do any activities or movements that cause an increase in baseline pain levels. This means that the general rule of thumb for these exercises is only to move within your pain-free ranges! Because most ankle sprains involve the ligaments on the outside of the ankle, moving the ankle inwards will typically cause discomfort. This is because you are putting a little stretch on the injured ligament, so be cautious with the inward direction in the first week!
Once you get comfortable exploring your pain-free ranges of motion, you can easily use a theraband to begin to apply some resistance to your exercises. The goal again is to push as much as you can, without increasing your baseline levels of pain.
Once you are able to bear weight and walk comfortably without an increase in baseline levels of pain, your ankle sprain rehab should consist of all standing exercises; ideally on one leg or unstable surfaces to challenge your ankle stability and proprioception. The ankle ligaments help provide feedback to your body which assists in things like balance, for focusing on neuromuscular control exercises are a must! The options are endless for ankle sprain rehab when you reach this stage in your recovery, but some of our favorite exercises are below.
Single Leg Balance
Use Unstable Surfaces
Should I Take Pain Medication?
Ultimately this is a question of preference and your pain tolerance. NSAIDS like motrin, advil, and celebrix are considered over the counter and readily available to most individuals. While they can decrease pain and swelling after an ankle sprain, there is newer ongoing research on the potential negative effects on NSAIDs as they delay and suppress the body’s natural healing process. Our body initially heals through inflammation, so do we want to limit it? In our opinion (not medical advice), take NSAIDS early on if you absolutely need to, but discontinue them as soon as your pain and swelling are under control.
Should I Use An Ankle Brace?
Yes! Early on, a lace-up or semi-rigid ankle brace will allow you to load the injured ligament in a protected manner. These types of braces allow some motion but limit excessive motion that would typically delay the healing process early on. Understand that when in a brace, you are limiting the loads to the healing ligament (which the ligament needs to heal). This is advantageous early on but is not advised in the long term during the day to day activities. Ankle braces can in fact be used for athletes when they are back to playing sports for prevention, so don’t completely discredit the use of an ankle brace!
Ankle Sprain [P]Rehab
Interested in [P]Rehab? We’ve got you covered! HERE’S a completely free Ankle Sprain [P]Rehab Program!