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Rehabilitation Considerations for Ankle Sprains

Ankle sprains are one of the most common injuries among athletes.  In fact, the ankle joint accounts for about 1/3rd of all sport-related injuries.  1 in 5 individuals who are physically active will sustain a lateral ankle sprain, which is when the foot turns in and the ligaments on the outside of the ankle are either sprained or torn.  Incidence of these ankle sprains is highest in young athletes between 15-19 years old.  While the incidence of these injuries is well known, proper rehabilitation of the injury and knowing when to get back to sports participation can be difficult to determine. 


What should I do if my young athlete sprains their ankle? 

After your athlete sustains an ankle injury, observe for common signs and symptoms: localized pain, swelling that builds up and may lead to discoloration, a popping sound during the injury, and difficulty moving the ankle or foot.  Be especially aware of difficulty bearing weight on the leg or even difficulty walking, as this may be a sign of a more severe ankle sprain or fracture.  If you suspect a severe injury, seek professional care from a physician, urgent care, or emergency health provider for further evaluation. 

Once an ankle sprain is determined, the old method of rest, ice, compression, and elevation (often referred to as “R.I.C.E.”) still stands tried and true.  The athlete should rest from activity, ice the area of pain for up to 15-20 minutes, maintain compression with a wrap, and elevate the ankle above the level of the heart.  All these initial treatments will help with overall circulation, reduce pain and decrease excessive swelling.  More severe sprains may require use of a boot or air-cast that can be acquired from and applied by a physician. 

If your young athlete experiences an ankle sprain, visit one of two Orthopedic Injury Clinic locations for a same-day visit. You’ll receive immediate care from orthopedic specialists, including on-site X-ray, splinting, and casting. Services are available for patients ages five and up. 


When Can Your Athlete Move Their Ankle? 

After initially protecting the injured ankle ligaments and restricting ankle movement to allow time for healing, light range of motion exercises can help prevent stiffness and improve circulation. This improved circulation can allow proper blood flow for healing and reduction of swelling.  Some simple exercises are completing the “ankle alphabet”. The athlete will “draw” letters of the alphabet with their big toe, moving their ankle through pain-free range of motion.  This can be accomplished by starting with small letters and gradually making bigger letters once pain improves. The athlete can also perform ankle circles with drawing smaller to bigger circles in clockwise and counterclockwise directions. 


When Can Your Athlete Walk? 

Early weight bearing has been linked to improved outcomes in rehabilitation of ankle sprains.  It is important for the athlete to “normalize” their walking pattern and to have their heel touch the ground first with their toes forward, then roll through their step and gently push off from their toes.  If use of a larger boot or brace limits ankle mobility, have the athlete “roll” through their step from heel to toe with their toes facing forward as much as possible.  If the athlete is having difficulty pushing off from their toes during walking, they may benefit from completing a heel raise exercise.  The athlete can complete the exercise on both legs at the same time and then progress to single leg heel raises as their strength improves. 

In addition to the athlete having a normalized walking pattern, they should also work on balance exercises to assist with relearning how to stabilize the ankle.  Several studies have been done on specific types of exercises, use of equipment and special supplies, but the primary message these studies have is that any type of exercise that challenges an athlete’s single leg balance, such as balancing on one leg on uneven surfaces, help promote improvement in overall stability of the ankle joint.  This can be accomplished by having the athlete balance on 1 leg on a flat surface while pain free for up to 30 seconds.  When the athlete reports no pain or instability with these exercises, they can start single leg balancing on uneven surfaces, such as thick carpeting or a couch cushion. After they are looking more stable and feeling more confident balancing on uneven surfaces, the athlete can practice sport specific drills, such as throwing, catching, or kicking a ball.  These types of balances programs are even recommended as a pre-season work-out and have been correlated to decreased incidence of injuries among athletes. 


When Can Your Athlete Play Sports Again? 

While waiting is hard, clinicians will clear the athlete to return to physical activity and sports as soon as they are healthy, and it is safe to do so. 

Some tests clinicians will complete with the athlete are single leg balancing tasks, pain-free walking and running without favoring their injured leg, progressing to sport specific skills without any form of contact from other players or teammates, and equal performance of jumping and hopping on each leg.  The rehabilitation practitioner should be able to help the athlete in finding exercises and activities for them to complete to properly train their injured ankle and get them fully prepared to return to their sport. 


How to Prevent Future Injuries? 

In a perfect world, everyone would be able to participate in their own sport or activity free from aches, pains, and injuries.  However, injuries are very much a part of the sports world and unfortunately will continue to occur despite best efforts.   

There are still many things one can do to avoid a higher incidence of future injury.  This includes sport specific and cross training, including continued training in balance exercises throughout sports participation, completion of a thorough return to sports test with your medical provider, and continued use of ankle support with use of a functional lace-up ankle brace or athletic taping.  These have been found to reduce the incidence of ankle sprains when returning to sports following injury.  Consult a physician, physical therapist, or athletic trainer for recommendations on functional bracing and for assistance with application of ankle taping, as well as ways to assist with injury reduction strategies to enhance participation and enjoyment in sports.