Ankle Sprain Rehabilitation

TODD SABOL, MS, AT

If you have been around athletics really for any period of time you know that muscle strains and ligament sprains are among the most common injuries that we see. At the ankle joint this number is magnified. Ankle sprains, regardless of type, account for 40% of all athletic injuries that we see in the clinical setting. This is not surprising when we think about the responsibility of the joint itself. It is a relatively stable joint complex that has four major joints and dozens of ligaments that provide static support, as we talked about in the last article. It also is supported dynamically by a number of muscles and tendons.

The plantar fascia and four layers of intrinsic foot musculature provide dynamic support to plantar surface of the foot and form lateral, medial and transverse arches that are vital in gait, weight distribution, balance and force absorption. The antagonist muscles on the dorsal, or top surface of the foot provide much of the dorsiflexion for the ankle and metatarsals to allow us proper heel strike and weight transfer throughout the gait cycle. The second to last group of dynamic stabilizers come from the posterior compartment of the leg, the gastrocnemius, soleus, tibialis posterior, flexor digitorum longus and flexor hallicus longus (Tom, Dick and Harry). These are mainly plantarflexors, but as I have talked about extensively on social media, the deep compartment muscles (Tom, Dick and Harry) span the posterior leg and wrap around the medial malleolus (through the tarsal tunnel) into the bottom of the foot and account for some of the muscle bellies in the plantar surface of the foot. The final group of dynamic stabilizers of the foot and ankle are the lateral compartment muscles of the leg. These muscles include the peroneal or fibular muscles; the peroneus longus, peroneus brevis and peroneus tertius, which span the lateral leg and wrap around the lateral malleolus and attach on dorsal and plantar aspects of the foot.

When we talk about injury rehabilitation, we first need to have an accurate idea of what injury has occurred and address the proper channels of rehab. When we talk about injury prevention, we like to have an idea of what deficiencies or asymmetries an athlete has through a comprehensive functional assessment, and address those in an individualized program. Unfortunately, diagnosis over the internet is extremely tough, due to the lack of palpation and examination of the ankle. But my goal for this rehabilitation or prehab program is to give a general guideline for strengthening the dynamic stabilizers of the ankle and foot using a combination of eccentric, concentric and isometric work. This will allow for increased tensile strength, the increase ability to attenuate force and activate the muscles that are often inhibited from lack of use. The other portion of the program will focus on tissue flexibility and joint mobility to allow your ankle and foot to be moving properly and efficiently. The reason I couple these together and put emphasis on them is when you take away stabilization from an area, whether that is from joint mobilizations, soft tissue mobilizations, stretching or mobility work, you have to add stabilization somewhere else. The goal is to provide both to you and give you a general guide if you have sustained an ankle injury and are looking to rehabilitate back to your sport/activity or strive to prevent an injury like this from occurring. I look forward to hearing your feedback and as someone who has had chronic ankle instability and dozens of sprains in both ankles spanning back to middle school, I have found a special passion for this area of the body, because I know how aggravating it can be when you are suffering through it. Give these a shot and let me know if you have any questions.

 

#HealByMoving

 

Repeat 2-3x Per Week for Rehabilitation Purposes

*If in the acute stage of healing, these ROM exercises should be completed in an elevated position, and if tolerable a compression wrap as well.

*Full ROM should be attained before progressing to strengthening and balance exercises

 

ROM Warmup

Ankle Circles Counterclockwise: 3x15

Ankle Circles Clockwise: 3x15

Ankle Pumps Up/Down: 3x15 (Up and down is 1 rep)

Ankle Pumps Side-to-side: 3x15 (Side to side is 1 rep)

 

Mobility (As tolerated by pain and amount of time since injury)

Kneeling Forward Lunge (Pushing Knee Over Foot): 4x30sec

Straight Leg Calf Stretch: 4x30sec

Bent Knee Calf Stretch: 4x30sec

Iso-Goblet Squat: 1 min in hole, rest, repeat

 

Strengthening

Banded Ankle Dorsiflexion: 3x15 (Slow eccentric portion)

Banded Ankle Eversion: 3x15 (Slow eccentric portion)

Banded Ankle Inversion: 3x15 (Slow eccentric portion)

Banded Ankle Plantarflexion: 3x15 (Slow eccentric portion)

Calf Raises on Slanted Surface: 3x15 (Slow eccentric portion)

Toe Walks: 3x20 Steps

Heel Walks: 3x20 Steps

 

Balance/Proprioception

Single-Leg Balance (Eyes Open): 3x20sec

Single-Leg Balance (Eyes Closed): 3x20sec

Single-Leg Balance – Standing on Towel (Eyes Open): 3x20sec

Single-Leg Balance – Standing on Towel (Eyes Closed): 3x20sec

Lateral Single-Leg Jump and Land (hold landing for 1 second) – 10 Jumps Each Leg

 

If you liked this article check out:

Anatomy Of The Ankle

 

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