Ankle sprains are the most common lower extremity injury in sport. Over 3 million a year occur in the US
alone. Unfortunately, they occur so commonly that we often don’t rehabilitate them fully which can
lead to recurrence. Often, once a fracture is ruled out, the injured person is given crutches and
instructed to begin walking and return to sport once the swelling and pain goes away. Research has
proven that this type of non-treatment leads to a higher rate of recurrent ankle sprains. There are three
things that must be achieved before returning to sport following an ankle sprain.
- Regaining full active range of motion
- Regaining full muscle strength
- Regaining normal and equal proprioception (balance control)
Regain Full Active Range of Motion
The most common range of motion loss following an ankle sprain is the ability to dorsiflex (bring the foot back
towards you). This is demonstrated by having pain with squatting. There are two exercises that will
regain this motion. The first one is a common runners stretch or gastrocnemius stretch. The second
one is a Soleus stretch. Both will be uncomfortable at the start, but will fell better after a week or
two. Once there is no pain with the stretching, full range of motion has been restored.
Regain Full Muscle Strength
Pain and swelling can stop muscles from working normally. Early after injury, simple muscle
pumping exercises will be the first step in returning muscles back to normal. This is achieved by
simply moving the ankle through full range of motion in every direction, repetitively. The next step is
performing resisted tubing exercises for inversion, eversion and plantar flexion. Finally, single leg
toe raises should be performed until you can complete 30-50 without stopping.
Regain Normal Balance and Neuromuscular Control
This is the most important and most often neglected step. When an ankle sprain occurs,
neuroreceptors in the tendons, joint, and ligaments slow the communication between the receptors
and the brain. This prevents the brain from responding to muscular demands and can lead to
another ankle sprain. To regain neuromotor control simple stand on one leg for around 3o seconds.
Once this is easy, stand on an unstable surface. The final step is vertical and horizontal jumping on
one leg. Compare the distance and height to the opposite leg to gauge recovery.
Return to Sport or Other Activities
Return to sport should not be attempted until you can demonstrate the same distance and height of
one leg hop (while not loosing your balance) compared to the uninjured side.
To learn more about Rob Pruden, PT – Director of Physical Therapy, and our rehabilitation department, please click here!