Ankle Injury – A road map of rehab exercise to recovery

Ankle Injury – A road map of rehab exercise to recovery

Ankle sprains are the most common injury in sports, for example accounting for nearly 30% of all running, hiking or mountain trekking.  Understanding ankle sprains, including prevention and rehabilitation strategy, can be incredibly helpful in minimizing the risk of being sidelined by an ankle sprain.

Ligaments on the ankle are either stretched, partially torn or completely torn when an ankle really is sprained, . The most common type of ankle sprain is where the foot is rotated inward. And ankle sprains can range from mild, to moderate, to severe.

Generally  a sprain can happen in the following ways:

  • Stepping on a surface that is unstable or irregular, or such as stepping off rocks on a rugged trail.
  • Awkwardly planting the foot when stepping up or down, running, or during hiking on treacherous trail.
  • Game events when one player steps on another player.

When you do sprain an ankle, the best place to start is to confirm the injury with your Doctor.  As for rehabilitating the ankle, this is where an Physiotherapy and some rehab exercise equipment can really help.

Treatment such as physiotherapy is used to help to decrease pain and swelling and to prevent long term ankle problems. In physiotherapy, ultrasound and electrical stimulation may also be used as needed to help with pain and swelling, some practices may also employ accupuncture or shock wave therapy. However, therapeutic aids can only help you as much time as you visit the physiotherapy clinic, rest of the recovery happen mostly when you are at home, in the office or at school, that involves your diligently putting in time to complete regular rehabilitation exercises that are usually prescribed to you by your physiotherapist.

When you sprain an ankle, you can expect your recovery to go through three phrases:

  • Phase 1 includes resting, protecting the ankle and reducing the swelling (one week).
  • Phase 2 includes restoring range of motion, strength and flexibility (one week to three weeks).
  • Phase 3 includes gradually returning to activities that do not require turning or twisting the ankle and doing maintenance exercises. (4 weeks)
  • Phase 4 Being able to do activities that require sharp, sudden turns such as ball games. (after two months)

Strength – Once inflammation has subsided and mobility is normalizing, emphasis should be on strengthening and proprioceptive retraining. Strengthening muscles across the ankle, particularly the peroneal and tibialis posterior muscles, will help to protect the ligaments from overuse or trauma. Try using a resistance band or mini resistance band for inversion and eversion exercises. Gradually resume hip, and core strengthening  with proper mechanics to protect the ankle from abnormal forces and overuse.

Proprioception – Another critical component of rehabilitation is proprioceptive retraining. Sensory receptors throughout the body send messages to the brain and spinal cord about joint position and motion (especially important if your ankle is beginning to “roll”). The body responds to the messages by coordinating a response to restore an intended position or movement. If proprioception is impaired, which often results from spraining an ankle, then your body may not correct itself as quickly, allowing the ankle to roll too far and become re-injured. Oftentimes, a mini trampoline is used to tackle this problem. When the ankle is injured, the nerve cells in the area become damaged. Balancing on a trampoline allows you to slowly retrain the nerve pathways in your ankle to recognize the joint’s position. Once the damaged nerves learn to sense the body’s position, they can readjust the ankle as necessary for balance and stability.

Stability – As an exercise, try balancing on one foot while standing on an unstable surface such as balance pad. You can make this more challenging by standing and rocking in a yoyo motion on an inverted balance dome  or a lateral balance board. A good physical therapist will advance some dynamic  exercises with a stability slider as appropriate and provide cues for proper technique, such as neutral foot position, hip control, and core stability.

Agility – Slowly progress back to agility training and ball control exercises, as tolerated. Before returning to full training or sport games, the athlete should demonstrate full, pain-free ankle range of motion, nearly full strength compared to the uninjured side, and ability to hop on one foot, run, and cut zigzags without limitations or pain. Bracing or taping may be necessary to stabilize the ankle and decrease the risk of re-injury.

Flexiblity – Sports massage or self-myofascial release with a peanut lacrosse ball around the ankle area and using a smaller-angled foam roller around the ankle and a regular foam roller on calves and shins in general can be effective in treating a sprained ankle in a number of ways. Initially, light massage around the ankle, calf and shin muscles can be used to help reduce swelling from around 3 days after injury. As pain subsides, deeper techniques can be incorporated to help loosen the calf and shin muscles and improve range of motion.

If you have sprained your ankle in the past, you may continue to sprain it if the ligaments did not have time to completely heal. If the sprain happens frequently and pain continues for more than four weeks to six weeks, you may have a chronic ankle sprain. Activities that tend to make an already sprained ankle worse include stepping on uneven surfaces, cutting or twisting actions and sports that require rolling or twisting of the foot, such as trail running, basketball, tennis, football and soccer.

Of course, there are things you can do to help you prevent an ankle sprain:

  • Prevention (Prehab)

Some risk factors that make you susceptible to experiencing ankle sprains are preventable!  Stronger muscles throughout the lower extremity as well as a well-trained proprioceptive system will help provide a more effective (automatic) correction back to neutral when the ankle is moving toward its limit of motion.

Strength and control at the hip and core are massively important for controlling mechanics all the way down to the ankle.  Therefore, it is critical to work on dynamic stability of the gluteals, hip rotators, hamstrings, quadriceps, calf, and ankle inverter/everter muscles to properly maintain neutral mechanics in sport-specific activities.  Performing single leg balance activities on an unstable surface such as a wobble board and practicing quick footwork on an agility ladder are effective strategies to achieve good functional strength and proprioception.

In order to reduce the potential for suffering an ankle sprain, it is important to participate in a comprehensive training program, incorporating total body strengthening, utilizing multiple planes of motion, and practicing in dynamic environments.  Emphasize hip and core stability as well as proprioceptive balance and agility exercises to round out the training program and you will be more equipped to manage awkward and unexpected forces across the ankle.

At the end of the day,  maintaining good strength, muscle balance and flexibility can be a real plus to keeping that ankle from becoming your weakest link of your body. If you need some tools to help with your ankle sprain recovery, you can find the 12 Joinfit’s top selling ankle rehab equipment here.

Patrick Poon  21 March 2018

Advaned Personal Trainer – AASFP

As long distance trail thru-hiker, Patrick experienced his share of injuries and treatment. His desire to help others overcome injuries and resume healthy lifestyles led him to becoming a key member of Joinfit promoting equipment that can aid rehab and recovery in more efficient and effective ways

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