Exercise as a part of rehabilitation of ankle sprains

For many years the medical world has worked on the principle that “Rest is Best” when it comes to injuries. This philosophy does hold merit for some conditions (e.g. broken bones); however there is a new way of thinking when it comes to rehabilitation of soft tissue injuries.

The idea of exercising to get over an injury may be foreign to many people but it is gaining more credit as studies have shown it to be the most effective method in returning an athlete to training. The term exercise when linked with rehabilitation includes strength training, stretching, proprioceptive and balance training, power training and sport specific exercises.

Ankle sprains are among the most common sporting injuries estimated as accounting for up to 30% of all sporting injuries. They also have an extremely high occurrence rate with some experts estimating around 70%. Historically, the treatment for ankle sprains has been to rest, ice, compress and elevate (RICE) with no weight being taken through the foot for days if not weeks, until the ankle has become relatively pain free. The RICE principle is still extremely important, especially during the initial stages post-injury. The immediate aim must be to minimise swelling. Several recent articles have suggested however that physical therapy applied during the first few days post-injury improves return-to-sport time in athletes significantly. Physical therapy involves putting the ankle through its range of motion under the guidance of a health professional. Not only did the athletes who received physical therapy return to sport quicker, they also reported decreased levels of pain at set intervals post-injury when compared with those athletes who simply rested.

So what forms of exercise should be taken into consideration when rehabilitating a sprained ankle? Firstly, the ankles natural range of motion (ROM) must be restored. This is done by either actively (the patient does it themselves) or passively (someone does it for them) putting the injured ankle through that ROM. This is what physiotherapists are for. Once ROM has begun to be restored, the ankle must redevelop strength and proprioception (awareness of where the body is in space). Ligaments in the ankle are used as sensors to tell the body about its position in relation to the ground surface. When the ligaments are stretched or injured this is often lost or becomes incorrect. Therefore exercises like wobble-boards and even simply single leg balance become crucial in the rehabilitation process. Before the athlete returns to sport it is essential that sport specific exercises have been performed to ensure the athlete is fit and able to compete/train at their full potential. Sport specific activities include agility sessions where the athlete must shift their weight from side to side at pace.

So next time you sprain you ankle follow the RICE principle initially to try and minimise the inflammation however as soon as possible try and start moving your ankle to maintain its range of motion. Even something as simple as writing the alphabet in the air with your foot will go a long way to minimising your rehabilitation time.

Eiff MP, Smith AT, Smith GE. Early mobilization versus immobilization in the treatment of lateral ankle sprains. Am J Sports Med. 1994;22;83-88