Conquering your Sprained Ankle
Ankle sprains are one of the most common musculoskeletal injuries seen in men and women, young and old. The most common type of sprain being the inversion sprain, most commonly referred to as a “rolled ankle.” You can imagine if your foot was to turn inward so that the outside of your ankle turns to the ground and the bottom of your foot turns upward in the direction of your opposite leg, this is what is called inversion of your ankle, and hence an inversion ankle sprain. The opposite, an eversion ankle sprain would be the exact opposite direction and is much less common. Since this is such a common injury and occurs more during the summer secondary to increased physical activity, I thought I would offer some tips of self-treating this injury and preventing more from following.
IMMEDIATELY FOLLOWING INJURY:
R = Rest
I = Ice
C = Compression
E = Elevation
The day of the injury and the next 2-3 days to follow, RICE is extremely important. These steps will help control swelling and reduce the pain. Without this your ankle may become the size of a balloon and it would take much longer to begin rehabilitation. Ice should stay on no more may 20 minutes at a time, absolutely no heat is to be used. The most effective position to elevate your ankle it to lie on your back with your ankle propped up so it is higher than the level of your heart. You may also want to consider taking an NSAID such as Advil or Motrin at the recommended dose. These OTC medications are useful for decreasing inflammation and pain.
You can start walking on your ankle as soon as the pain allows it however limit the time you spend on your feet to only when it is necessary. If the pain ever goes from bad to worse, stop immediately and rest. If you have any way to reduce the weight you are bearing through your ankle as well this would be a smart option.
Some people may criticize the use of a brace however I find it is very helpful in this situation to reduce the pain in your ankle, provide additional support, and help prevent a future injury. A sprain is an injury where your ligaments have been stretched and damaged and therefore they are not holding your bones together as tightly as they should. Therefore your ankle may feel very unstable (because it is) and a brace in the early stages of the injury will be very helpful in not only providing that support that you are currently missing but prevent you from injuring it again. You can buy one for very cheap (8-10 bucks) at any drug store. Just don’t go to crazy and get the one with the highest support that will immobilize your ankle. The brace will only act as a small support to get you through the next few weeks.
STARTING 2-3 DAYS AFTER INJURY:
Around this time is when you should start having decreased pain and inflammation and you should find it is getting easier to walk. Again, still don’t push the walking and reduce the amount of weight you are putting through your ankle. Now is when the real rehab begins! You should start with what we physical therapists refer to as open chain range of motion therapeutic exercises. That just pretty much means that these exercises are done in a non weight bearing position (you will be sitting, not standing). Here are a few to get you started.
- Ankle pumps: Sit on the floor with your legs extended in front of you. Now slowly bring your foot towards your body, and then push your foot down towards the floor. Just like your pressing an imaginary gas pedal.
- Ankle circles: In the same position just circle your ankle all the way around. Imagine your big toe is a pen and you are trying to draw a circle.
- Ankle alphabet: Now keep imagining your big toe is a pen and draw out every letter of the alphabet.
Within a few days these should start getting easier for you. Make sure if you got a brace you have this off during exercises.
STARTING 5-7 DAYS AFTER INJURY:
Now we start to strengthen your ankle. As I said before, damaging a ligament will make your ankle very unstable and unfortunately a ligament cannot be exercised and strengthened the way a muscle can. So muscle strength is crucial here because it will be your muscles picking up the slack and supporting your ankle until the ligament heals. These exercises are a good place to start with strengthening a sprained ankle. They are done in sitting with your legs extended out in front of you just as the ones above were.
- Theraband exercises: If you have a theraband this is a great time to use it. Position the band around the outside, top or bottom of your foot and move your ankle in the opposite direction against the resistance of the band.
- Wall pushes: Position yourself so the bottom of your foot is against a wall. Now push into that wall with the bottom of your foot and hold that push for 5 seconds each rep. Next sit next to the wall and push your foot out, into the wall, away from your body and also hold for 5 seconds each rep.
STARTING 2-3 WEEKS AFTER INJURY:
You should really be starting to see improvements now in your walking, and should be bearing almost your full weight onto your ankle. If you have a brace you should start taking it off when you are in a safe environment such as your home. Everyday try to leave it off longer and longer without sacrificing pain or increased inflammation if it is in fact still swelling. If everything else has gone good up until now you can start weight bearing exercises. No crazy single leg exercise just yet though, keep both feet on the ground and remember as always, stop if any pain comes on. This phase is to get your ankle used to bearing its full weight in a safe position and build strength of major muscle groups without injury. Also start these with no weights and if possible to do so without pain, add only a small amount of weight at a time. Here is a select few that will work well:
- Squat: I know Marc Halpern must have some great videos of squats on his website! Just do these slow and controlled and only bend as deep and your ankle will allow.
- Lunge: Yeah I bet this site has videos of those too! Same rules as squats, slow, controlled and pain free.
- Heel Raises: Standing up tall simply raise both heels off the floor like you are standing on your tippy toes.
- Planks: Yes, I know planks are for your core but think about what your ankles are doing during this exercise. They are in a great neutral and steady position, bearing weight, yet not the full amount and virtually every muscle is working to keep your steady. These are a great exercise for stability of the whole body.
A MONTH AND ON:
Just as a reminder you should now only be wearing your brace in crowded areas where you feel there is a high probability your ankle may be reinjured. Try to wear it as little as possible, or just remove it from the picture completely.
Now is time for the fun stuff! The name of the game now is balance exercises!!! When a person feels they are going to lose their balance the first thing that we use to compensate is called an ankle strategy. This is when your ankles start to become wobbly and you struggle to stay upright. If you don’t know what I mean go stand on just one foot for a minute and you should get what I am staying fairly quickly. The reason I bring this up is because this is what you should feel during the following exercises. This ankle strategy maneuver you use all the smaller muscles that are in your ankle that really matter the most when it comes to ankle stability. There is a ton of ways to achieve this, here are a few I have found to be most beneficial:
- One legged catch: Simply stand on the injured leg and play catch with someone. If this seems to easy then stand on a pillow instead of the solid ground.
- Pick-ups: Stand up tall, bend forward at your waist with your good leg remaining in full hip extension and your injured leg remaining on the ground and pick a weight off of the floor. This can be a difficult one to understand so feel free to look up videos.
- Got a TRX? One legged squats and lunges would be a great one to pick!
- Steamboats: Put your good leg on a basketball or soccer ball and roll the ball up and down 30 times. Now side to side 30 times. Now clockwise 30 times. Now counterclockwise 30 times.
- Yoga poses: Tree, eagle, warrior 3…
As you are perfecting this last phase you should just gradually start to forget you have an injured ankle and you can start living life normally again. Just never forget what you went through because unfortunately although that ligament may heal it will never be exactly the same and you will from now on be at a much higher risk of reinjuring it. Also, all ankles are not created equal. If your body is not responding to this treatment please go see your physical therapist. Ankle sprains are graded 1-3 and at a grade 3 you may need surgery as the ligament has been completely torn, this advice will not help you! Above all else, listen to your body, it knows best what you need and don’t need. As I stated many times before if anything is causing increase pain, or swelling, please stop immediately. The phrase “no pain no gain” does not apply here.
Samantha Wirth, DPT