Rehab of Ankle Sprains

Ankle
Sprains are one of the most common sporting injuries, and often are relatively
quick solve and recover from - a little bit of patience and discipline can do
the trick. However, this isn’t always the case. I regularly see patients who
complain of having sprained their ankle (to various degrees of severity)
several months previous to seeing me. They have usually rested and iced
initially, then done some basic rehab exercises and slowly begun to re
introduce their normal exercise routine, but not without problems. They often
complain of chronic stiffness, the ankle aching after exercise, pain around the
contours of the foot, and sometimes pain within the joint itself. In some cases
I have experienced, this may be 12 months after the original injury.

For me, the
main thing that often seems to be missed in these cases is Range of Motion
(ROM) throughout the rehab. In any musculoskeletal injury, ROM is key to
regaining a joints original function. For some reason though, in ankles, it
seems to be missed out regularly. People often rest until pain subsides, and
most of the movement returns, then they may do some strengthening exercises (in
some cases, ALOT of strengthening exercises), and gradually start to build up
their activity again. However, this misses out a key stage, which is re-gaining
FULL ROM as quickly as possible. During the initial resting period (which may
be up to 3-4 weeks for a grade II, or post-cast in a grade III),

After this
point, strengthening should be done regularly and gradually. This is something
I will discuss in another blog, but in this one, I want to focus on the thing
people forget.

At first,
regaining ROM can be as simple as sitting on a chair with your feet off the
ground and simply pointing your toes, then bringing them up towards your knee.
Compare this to the other ankle, if similar, move onto rolling your ankle on
and over a football or similar. Roll it left and right, forwards and backwards,
and in a big circular pattern.

If this
becomes as easy to do as the other side. Then move to ROM exercise using a
resistance band. Wrap the band around a fixed location and around your foot.
Pointing and bending the foot as far as you can against the resistance band.
This can be with eversion and inversion as well (keep heel on the ground and
point the foot left and then right.)

You would
then move onto weight bearing ROM exercises. Such as a knee-wall stretch. Stand in front of a wall and set your foot on
the ground with toes touching the wall. Keeping your heel on the floor, try to
get your knee to touch the wall. If this is easy, bring the toes back a few mm
and repeat. When you find a distance that is challenging, stay at that distance
and repeat the bend 20 times. This is again easily comparable to the other
ankle.

All the
above exercises are extremely simple and straight forward. However, these are
the things that often aren’t done following ankle sprains and even breaks.
Regaining early ROM will always increase your chances of making a quick and
effective recovery. So don’t ignore them. Wolfe et al (2001), is a literature
review study that well demonstrates this.

Getting
early treatment from a trained professional is also another great way to ensure
early ROM is increased. This study shows how use of mobilisation can improve
ankle ROM in sub-acute sprains (Collins et al, 2004).

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References:

Collins, N., Teys, P. and Vicenzino, B., 2004. The initial
effects of a Mulligan’s mobilization with movement technique on dorsiflexion
and pain in subacute ankle sprains. Manual
therapy, 9(2),
pp.77-82.

Wolfe, M.W., Uhl, T.L., Mattacola, C.G. and McCluskey, L.C.,
2001. Management of ankle sprains. American
family physician, 63(1),
pp.93-104.

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