Rehabilitation of Lateral Ankle Sprains

Recovering from a lateral ankle sprain is a journey that many individuals undertake with the guidance of a physiotherapist. Ankle sprains are a common injury affecting people of all ages and activity levels. They require a comprehensive rehabilitation process to restore strength, mobility, and confidence. In this blog I will explore the stages of the rehabilitation process following a lateral ankle sprain. It is important to note that some stages overlap throughout the process. For example, the focus on strength continues throughout the entire process and balance can begin as early as Stage 2 if tolerable.

Stage 1: Assessment and Acute Management

Following a lateral ankle sprain, a thorough assessment is crucial to determine the extent of the injury and the patient’s baseline function. This assessment helps in creating a personalised rehabilitation plan, whilst address key factors such as pain levels, range of motion, swelling, and muscle strength. The initial focus is on pain control and swelling reduction. Protection, rest, ice, compression, elevation is encouraged during this stage, along with the use of assistive devices like crutches or braces to protect the injured ankle if required and promote early weight-bearing as tolerated.

Examples of exercises that may be prescribed in this stage are drawing the alphabet with the foot and ankle pumps.

Stage 2: Restoring Range of Motion and Strength

Once the acute phase subsides and swelling reduces, the rehabilitation process shifts towards restoring range of motion (ROM) and strengthening the affected ankle. Controlled movements and gentle stretching exercises are introduced to improve flexibility if lacking. This stage aims to regain full, pain-free ROM in the ankle joint. Subsequently, attention is turned to strengthening exercises that target the muscles surrounding the ankle, improving stability, and providing a solid foundation for further rehabilitation.

The key muscles groups that need to be targeted around the ankle are the Peroneals which play a vital role in ankle stability and control. Their role is to assist with eversion and plantarflexion. Tibialis Anterior is responsible for dorsiflexion and plays a crucial role in maintaining balance. The Gastrocnemius and Soleus together form the calf muscles that are responsible for ankle plantar flexion. These muscles are important for propulsion and power during activities such as walking, running, and jumping. It is not only important to target muscles around the ankle but the entire posterior chain, including the glutes and hamstrings. Focusing on the core is also crucial as this contributes to trunk stability, as well as general functional stability.

Here are some examples of exercises that may be prescribed in this phase:

Single leg bent knee calf raise:

Single leg calf raise:

Side plank:

Crab walks:

Stage 3: Proprioception and Balance Training

Proprioception and balance play a crucial role in ankle rehabilitation. Proprioception stems from several structures around the ankle. The joint capsules surrounding the ankle joint contain specialised sensory receptors called mechanoreceptors. These receptors detect changes in joint position and provide feedback to the brain about the ankle’s orientation and movement. Ligaments are strong bands of connective tissue that stabilise the ankle joint. They contain numerous mechanoreceptors that detect changes in tension, joint position, and joint stability. The muscles and tendons surrounding the ankle joint are rich in proprioceptive receptors. They provide information about muscle length, tension, and contraction, which contribute to joint stability and coordination. Lastly, the skin and subcutaneous tissues around the ankle also play a role in proprioception. Sensory receptors in the skin provide information about pressure, touch and temperature, contributing to the body’s overall awareness of the ankle’s position and movement.

By targeting these proprioceptive structures through specific exercises can improve proprioceptive abilities and enhance ankle stability, reducing the risk of future injuries. Exercises that target single leg balance should be a focus here. Incorporating resistance bands or weights can challenge the ankle to have to counteract any external forces. Wobbles boards or foam mats are another great way to challenges the stabilising structures of the ankle.

Here are some examples of exercises that may be prescribed in this phase:

Bosu Ball Balance:

Kettlebell around the worlds:

Cone placers:

Stage 4: Functional Training and Return to Sport

The final stage of rehabilitation focuses on functional training and preparing the patient for a safe return to desired activities. Sport-specific exercises, agility drills, and simulated movements related to daily or athletic activities are introduced to restore full function, agility, and confidence in the injured ankle. It is important to teach the ankle how to tolerate increased loads, such as being able to tolerate hopping, jumping and running. This is vary based off the differing goals that individuals desire to achieve. For example, this phase will

mostly likely differ for a 21 year old keen to return to high level basketball, compared to a 65 year old who is wanting to return to walking and golf.

Here are some examples of exercises that may be prescribed in this phase:

Horizontal hop and stick:

Band assisted pogo jumps:

High knees drill:

Conclusion:

Recovering from a lateral ankle sprain requires patience, dedication and professional guidance. The rehabilitation process encompasses initial assessment, acute management, range of motion restoration, strength training, proprioception/balance exercises and sport specific training. Each individual’s rehabilitation journey will vary based on the severity of the injury and their goals. If you have recently rolled your ankle or have a history of chronic ankle instability book in to see one of our physiotherapists for a consultation.

References:

  1. Braun, B. L. (2017). Effects of ankle sprain in a general clinic population 6 to 18 months after medical evaluation. Archives of Family Medicine, 6(2), 143-148.
  2. Doherty, C., Delahunt, E., Caulfield, B., Hertel, J., Ryan, J., & Bleakley, C. (2016). The incidence and prevalence of ankle sprain injury: a systematic review and meta-analysis of prospective epidemiological studies. Sports Medicine, 46(1), 123-140.
  3. Gribble, P. A., Delahunt, E., Bleakley, C. M., Caulfield, B., Docherty, C. L., Fong, D. T., … & Vicenzino, B. T. (2014). Selection criteria for patients with chronic ankle instability in controlled research: a position statement of the International Ankle Consortium. Journal of Athletic Training, 49(1), 121-127.
  4. Hubbard-Turner, T., & Turner, M. J. (2016). Physical activity levels in college students with chronic ankle instability. Journal of Athletic Training, 51(1), 53-59.
Phoebe McGeoch – BeFit Training Physio Coogee

Phoebe McGeoch – BeFit Training Physio Coogee

Phoebe McGeoch is a physiotherapist based in Coogee in the Eastern Suburbs of Sydney. Phoebe has successfully treated musculoskeletal problems on the basis of a thorough assessment and diagnosis coupled with evidence-based rehabilitation programs tailored to the needs and goals of each individual. To book a consultation, click the link below.

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