Ankle Sprain Injury
Date issued: November 2019
For review: November 2021
Ref: C-386/TSH/Physiotherapy/Ankle Sprain Injury
PDF: Ankle Sprain Injury [pdf] 1MB
What is an Ankle Sprain?
Ankle sprains are common injuries that occur in all age groups and account for 5% of all attendances to emergency departments.
Ankle sprains tend to occur when your toes are grounded with your heel raised. This puts the ligaments around the ankle under tension and vulnerable to injuries. Ankle injuries are often caused by a sudden force that twists the ankle inwards (inversion or outwards (eversion).
What are Ligaments?
Ligaments are strong fibrous tissues that connect bone to bones, providing stability and keep the joints in the correct position.
Most sprains happen in the lateral ligaments (on the outer part of the foot) and range from tiny tears in the fibres to complete ligament tears.
Why Can it Take So Long to Heal?
Soft tissue and ligaments can take longer to heal. This is because of the structure of the tissue and time it takes to repair them. The table below outlines the time frame and symptoms to expect during your rehabilitation. It also gives you goals to achieve during your recovery.
|
Average Time Scale |
Common Symptoms |
Rehabilitation Goals
|
|
0-3 days |
Swelling, bruising, unable to fully weight-bear due to pain |
Reduce pain, swelling, promote weight-bearing |
|
4-10 days |
Swelling reduces, range of moment slowly increases, able to weight-bear more but not able to produce heel to toe movements |
Restore function, increase weight-bearing and gentle daily activities |
|
11-21 days |
Increase weight bearing with normal heel to toes movement. Pain and fear of daily task movements i.e. climbing stairs, returning to work |
Increase strength, stability, daily activities and skills by increasing load bearing capacity i.e. climbing stairs, returning to work |
|
3-6 weeks |
Pain and fear of movement in sport |
Return to agility and light sport i.e. jogging |
|
6-12 weeks |
|
Return to sport at previous level |
What Can I do to Manage my Symptoms?
This leaflet is designed to help you self manage and rehabilitate your acute ankle sprain. If after completing this programme your ankle remains symptomatic seek advice from your GP or self refer to Physiotherapy
Exercise Programme
Ankle sprains have three phases of recovery and need to be rehabilitated to prevent reoccurrence of injury. Follow each phase as guided below.
Phase 1 (0-3 days)
Protect: the injured area from further damage, a support bandage or simple ankle support maybe useful. Use of crutches is recommended if weight bearing is very painful and problematic. After a few days, gentle motion can be started while you still maintain a level of protection for the injured area.
Optimum Loading: While you are protecting your ankle, gentle motion can, and should, be started after a few days. This progressive loading of your injury can help promote optimal healing of the injury, and it can prevent delays in returning to normal due to joint and muscle tightness or muscle atrophy.
Ice: to reduce swelling and help manage your pain. Do not apply directly to the skin (use a thin piece of cloth between the ice bag and skin). Apply between 15-20 minutes at a time.
Compression: during the early stages this can help to resolve swelling. An elasticated bandage may be helpful. Large amounts of swelling and bruising are common in early stages of ankle sprains are necessary in early healing. Your aim is to try and reduce this over the coming days with this advice.
Elevate: the foot by reclining and propping it up above the waist or heart level when at rest. Swelling often subsides within a few days, but sometimes can take much longer.
Phase 2 (4-21 days)
The aim during this phase is to restore normal ankle range of motion, flexibility, and strength.
Dorsiflexion & Plantar flexion
In sitting or lying slowly pull your toes up towards your head and slowly back down to the floor. Repeat ……….. times……..a day.
Inversion and Eversions
In sitting or lying keeping the knee still, gentle rock the foot from side to side, raising the outer part of the foot off the ground (see figure A), and then rolling the foot so the inner part of the foot rises to (see figure B). Start slowly and gently and slowly progress as far as you can. Repeat…………. times……..a day.
Circumduction
In sitting or lying, keeping the knee still, gentle move the foot in a circular motion. Repeat …………. times…………a day.
Resisted Plantar Flexion
Sitting on the floor or a chair, put a towel or resistant band around your foot. Point your toes towards the floor, whilst resisting the band/towel, and slowly return to the starting position. Repeat ……. times…………. a day.
Resisted Inversion and Eversion
Sitting on a chair, with a resistance band around the chair leg and affected foot. Turn the foot in (inversion) resisting against the band. Repeat …………….times …………a day.
Again sitting with both feet now in the band, turn the affected foot out (eversion) resisting against the band.
Repeat ……………times ………a day.
Gastrocnemius Stretch
Stand facing a wall. With your unaffected leg forward with a slight bend at the knee. Your effected leg is straight and behind you, with your heel flat on the floor and toes pointing in slightly. Keep both heels flat on the floor and press your hips forward towards the wall. You should feel a stretch down the back of the calf. Hold for a count of 30 seconds…….. repeat………….times a day.
Soleus Stretch
Stand facing the wall with your unaffected leg forward with a slight bend at the knee. Your affected leg is behind you with a slightly bent knee, and toes pointing forward. Keep both heels flat to the floor and and press hips forward towards the wall. You should feel a stretch in the calf. Hold for a count of 30 seconds, repeat …………..times………….a day.
Toe Crunching
Sit with both feet flat on a piece of tissue. Grab the tissue with your toes, curling the tissue towards you. Relax and repeat ………...times…………. a day.
Phase 3 (3-12 weeks)
This phase aims to gradually restore dynamic movement, balance, and increase the load you ankle joint takes during exercise.
Heel Raises
Stand with your weight evenly distributed holding onto the back of a chair. Slowly raise both heels of the floor, raising yourself up onto your tiptoes. Slowly lower and repeat………….times……………a day.
Knee to Wall Stretch
Stand with your affected foot at the base of the wall, not allowing the hips to rotate during the exercise. Slowly bend the knee to wall to feel a stretch, hold for 30 seconds and repeat ……...times………a day.
Heel to Toe Walking
Single Leg Balance
Standing somewhere where you can hold onto if needed. Stand on your affected leg. Try to stand on the leg keeping your balance for 30 seconds. Repeat………..times.
A progression of this exercise would be to stand on a cushion or pillow.
Star
Stand on the affected foot. Slowly extend the lifted leg out into 8 different directions aiming for a point marked onto the floor (as in above image), whilst keeping your balance. Each time you extend the leg try to reach further along the line than you did before. Repeat this …………..times…………..a day.
Hopping in a Straight Line/Across a Line
Stand on the affected leg, hop along a line whilst maintaining your balance as you land. A progression of this exercise would be to hop further along the line each time, or hop either side of the line. Repeat this………….times……………a day.
