Ultimate Guide for Ankle Sprains – Rehab, Return to Sport, Prevention

Most athletes at some point in their career have sprained their ankle playing sport. Some of us are unlucky and seem to do them multiple times. They can really interrupt a season and sometimes what you do in the first few days can be crucial in how quickly you are able to return. Likewise, once you have returned to sport due to no pain it is important not to forget to actually continue strengthening your ankle as this will likely result in doing the injury again.

Here are some guidelines on the best management for acute ankle sprains as well as some extra tips to get back quicker than most.  This picture below is an ankle I got back in 3 days as the player was injured on the first day of an Australian Netball Nationals competition. Some of these tips were crucial in getting him back that quickly – obviously not without the associated risk and 24hour physio support whilst we were away at Nationals. I wouldn’t recommend a return to sport that quickly without an experts advice but these tips can really make all the difference – which could be the difference in getting you back in 2 weeks instead of 4 for a final for example.

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Acute Stage Best Management:

RICER:

Rest – generally from activity

Ice – 20 mins every 2 hours.

Compression – wear a compression sleeve/tubigrip over your ankle. Taping can also be a form of compression.

Elevate: Keep your foot up above your heart height whenever possible. At night elevate your foot on pillows.

Referral: See a medical professional such as a physiotherapist or sports doctor.

Extra tips on Icing:

Remove the shoe? You will hear debate sometimes over whether to remove the players shoe or keep it on for compression. My belief is that if you want to ice the ankle you cant really access it well enough if the shoe is still on so take the shoe off and ice the areas that are sore and swollen.

No Anti-Inflammatories: Let the icing be the natural management of swelling as there is evidence that using anti-inflammatories can inhibit ligament healing if used in the first 72 hours. Analgesics such as panadol for pain are fine.

Ice Vs Natural Healing = ICE

Some people are beginning to debate whether we should ice at all as swelling is the bodies natural way of healing. However, it is not the normal act of swelling that tends to cause complications with rehabbing an ankle back to sport it is the over-active amount of swelling that increases stiffness and pain. Therefore, I still recommend icing straight away as it will never completely get rid of all the natural inflammatory cells anyway and helps to prevent hiccups in later stages of rehabilitation.

Bucket Icing:

The biggest tip I give people when they have acutely sprained their ankle and it is either really swollen or there is an important match/deadline to be ready by is to ice there foot/ankle in a bucket. Add water and ice into a bucket and dunk the entire foot and ankle in. There are different ways from here as to how you do it depending on the threshold of the injured athlete and their tolerance of the cold.  I generally suggest to keep it in for 5 minutes and to practice moving the foot up and down to keep the mobility and prevent stiffness.If they find it difficult to keep the foot in there due to the cold temperature you can do 30 seconds in and 30 seconds out and do it for longer.  This works a treat as the whole ankle receives the ice including inside the joint and you can keep your foot moving whilst you do it to help prevent stiffness.

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Overnight Icing:

If you are serious about getting back quicker than the norm because you are in the middle of finals for example I would definitely suggest setting your alarm over night on the night that you injured your ankle and getting up perhaps 2-3 x to ice the ankle for 10-20 minutes. Otherwise, expect a fat and stiff ankle the next morning.

Lectric Soda Crystals:

These are another great adjunct to icing to help reduce the swelling. Make sure you follow the instructions as you can get ice burn from overuse.

Signs of an Ankle Fracture:

I would always recommend to see a professional to determine this as missing a fracture can be detrimental to short and long term rehabilitation.

However, my guide as to whether your risk is higher and should seek a professional’s opinion includes:

– Unable to weight bear at all initially or in the next 2 days – This means not even putting a tiny amount of pressure on that foot including to limp off the court.

– Deep ache at night that wakes you up

– Ice is painful

Importance of seeing a Physio/Specialist:

I have given a specific guide for everything that you can do independently to give yourself the best chance but the importance of seeing a sports therapist such as a physio is crucial. This is important to confirm the exact damage that you have done, prognosis, X-ray referral to confirm no fracture and to begin manual therapy. Specific taping techniques can help remove swelling and pain as well as other manual techniques that help to reduce swelling, stiffness and pain.

Under the Knife?

Typically most ankle sprains do not require surgery. However, if you are having recurrent problems and recurrent sprains you need to try at least 3 months of an ankle stability and strength program. If this did not work then you could get an opinion from a surgeon. If you had full tears of all 3 lateral ligaments it may be suggested earlier but generally if you have tried rehab with no luck then it may be warranted.

Why do ankle rehab?      image_3

Once you have sprained a ligament they typically don’t heal well due to the poor blood supply. However, to prevent recurrent injuries and get you back to sport where you need to run, jump and change direction just resting is not enough. First of all your calf will decrease in bulk and your calf strength is important to be able to shock absorb to decrease the force going through the ankle joint.

Secondly, even though your ligaments don’t heal well your body can learn to use the muscles and tendons around the ankle instead if you strengthen them.

Thirdly, after an acute injury where there is a lot of pain and swelling your brain tends to forget where your joints are in space and tends to be a little slower to react – for example loss of balance. This is called proprioception. This is also really important to retrain as it can help correct your ankle quickly just before rolling outwards next time your playing sport or hit a curb unexpectedly walking and ultimately prevent another sprain.

These same exercises can be very effective in preventing ankle injuries as your muscles and ligaments will react a lot faster and be generally stronger to resist your ankle rolling outwards. I would recommend incorporating some balance exercises as a warm up in your trainings and game days to help with prevention.

 

When can I return to sport?

Typically ankle sprains take 4-6 weeks to return to sport depending on what sport. For milder grade one sprains sometimes return can happen quicker but use the judgement of you therapist.

General Checkpoints:

  • Good ankle range of motion – equal to the other side or atleast roughly 8cm in the knee to wall test. If good ankle flexibility is not achieved you will have poor shock absorption through your ankle.
  • Good proprioception/balance – ankle strength.
  • Good calf strength – also an important shock absorber for the ankle. Specific calf exercises are important for this. Not resting and not running to gain strength.
  • Painfree movements – hopping, running, change of direction etc.

Brace or Tape?

The evidence doesn’t really show a big difference between taping or bracing with ankles. So, I would recommend if it is the first time you have injured your ankle then maybe tape for the first month of return to sport to help provide extra feedback and support to your ankle whilst you are continueing with your rehab exercises. This may help to prevent another sprain which would ultimately weaken your ankle further.

If you have already sprained your ankle multiple times or play multiple times in a week then it may be worth buying a brace for ease and cost.

At the end of the day you still need to strengthen either way to help prevent future injury as relying on a brace or tape is not the answer either.

 

Examples of Ankle strengthening useful for post injury or preventative prehab:

Example of a good calf raise rising up through the big toe and not rolling out. Using both sides of calf muscle. These should be pain free, full range before returning to running.

Example of a good calf raise rising up through the big toe and not rolling out. Using both sides of calf muscle. These should be pain free, full range before returning to running.

What not to do with your calf raises. This is how you injured your ankle so you need to keep really good alignment when rising up so that your brain remembers the normal movement.

What not to do with your calf raises. This is how you injured your ankle so you need to keep really good alignment when rising up so that your brain remembers the normal movement.

Balancing on wobble board single leg - Gold Standard for rehab and ankle sprain prevention!

Balancing on wobble board single leg – Gold Standard for rehab and ankle sprain prevention!

Bosu ball Lunges

Bosu ball Lunges

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Arabesque on upturned bosu ball. High level balance rehab!

Another example of high level rehab on a wobble board.

Another example of high level rehab on a wobble board.

Leap and Land onto a bosu ball. Also High level rehab!

Leap and Land onto a bosu ball. Also High level rehab!

 

 

 

 

About the author

Julia Allan
Julia Allan

I'm a physiotherapist working majority in the sports field. I'm based in Melbourne working with a variety of different athletes which is currently predominantly with the Victorian Under 19 netball side and the Victorian Fury netball side through Eltham Physio Centre. I also play high level netball myself in the State League competition (VNL) here in Melbourne and I want to share my knowledge to help all athletes prevent injury and improve performance.

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