Ankle Sprains, Part III

Prevention of ankle sprains
It is estimated that 30 to 40% of all ankle inversion sprains end in re-injury. To avoid being one of the 30 to 40% it is important not to stop the rehabilitation process but continue with it until full fitness is regained. It is a common complaint that once an athlete goes over on the ankle they become prone to doing the same thing again. If the original sprain is a bad one and joint laxity has resulted, then it may be for certain sports where fast changes of direction are required that strapping of the ankle or wearing a brace is necessary to prevent re-injury.

If the sprain does not result in joint laxity then a recurrence may be avoided by the following:
1. Re-establish proprioception. This involves lots of balancing exercises on one leg which is essential to avoid re-injury. If you start to turn the ankle over then you will find you automatically right it without even thinking about it. If the proprioception is damaged then you lose this ability.
2. You need to strengthen the ankle in order to provide a far more stable joint. Then, if the ankle does start to turn and the proprioceptors work as they should, the ankle muscles should contract quickly to hold the joint stable
3. For a severe sprain (one you can not put weight on), you may need a visit a physician to make sure you don’t have a fracture, ligament tendon damage or another serious ankle injury.

In general, you should avoid putting weight on the joint as long as you have swelling. When possible, you should keep your foot elevated. Within a couple of days, your pain should decrease enough to allow moderate weight bearing without pain. As you are able to tolerate more weight, you can begin a walking and gentle stretching program to increase your flexibility.

Proprioception exercises or balance exercise can help you recover more quickly and should actually be preformed as part of a prevention program. Poor balance is a good predictor of future ankle sprains. After an ankle injury, balance training is essential to recovery. In addition to our eyes and inner ears, there are special receptors in our joints (proprioceptors) that provide information about our position in space.

By balancing on one leg, you can reinforce and strengthen those receptors in the ankle. Balance on the affected leg and hold steady for 15 seconds. Continue to challenge your ankle by balancing with your eyes closed, or with your head turning from side to side. If you play soccer, balance on your sprained ankle and kick a soccer ball against a wall. If you play basketball, balance and shoot or practice bounce passes. Get creative with your exercise to match your sport.

Ankle sprains can be prevented by using appropriate equipment for your sport. However, sport-specific shoes and protective gear are just the start. To avoid ankle sprains, you need to strengthen your ankle joint and develop a highly refined balance system. Don’t forget to keep your first aid kit nearby.
Range of Motion Exercises
Some simple exercises can help maintain ankle motion, and stretch the injured ligaments in the ankle joint.
Achilles stretches
Achilles tendon stretching can easily be started soon after sustaining an ankle sprain. While seated or lying down, take a towel and loop it around your toes. Pull the ends of the towel, pulling your toes upwards, and feel the stretch in the back of the ankle. Perform this 3-4 times a day for several minutes.
Alphabet writing
While seated or lying down, write the alphabet in the air with your toes. Make the letters as big as possible. Get creative by trying all uppercase, then lower case, then cursive, etc…
Strength Exercises
The next step in recovery from ankle sprains is strengthening the muscles that surround the ankle joint. By strengthening these muscles, you can help support the ankle joint and help prevent further injury. Some exercises to perform after an ankle sprain include:
Toe raises
Stand on a stair or ledge with your heel over the edge. Stand up on your tip toes, then in a controlled manner, let the heel rest down. Repeat 10-20 times (each foot), 4 times a day.
Heel and Toe Walking
Walk on your toes for one minute, then on your heels for one minute. Alternate walking on your heel and toes, and work up in time to a total of 10 minutes, repeating 4 times each day.
Activity-Specific Training
Activity specific exercises may include simply walking or jogging, or may be more intense for athletes who participate in basketball, soccer, or other sports. The key, no matter what level (recreational or competitive) athlete you may be, is to progress slowly. Begin at very low intensity, and very low duration of activity, and slowly work up–never suddenly increase either the intensity or duration of your activity.
Here is a sample progression for a soccer player
• Jogging
Begin at 50% intensity. Jog 100 yards, walk 100 yards. Repeat 4 times. Increase intensity and duration over 2-3 weeks
• Figure of Eights
Jog in a figure-of-8 pattern around cones. Begin with the cones near each other. Each day, spread out the cones and increase the speed.
• Box Runs
Make a box of cones. Jog forward the first side, side shuffle to the right, run backwards, then side shuffle to the left. Again, increase the size of the box and the speed of the running each day.

Once these activities can be done at full speed with no pain, patients can resume their sport. More sport specific exercises can be given to you by a coach or trainer if needed.

What if the pain continues?
The most common cause of persistent pain following an ankle sprain is known as incomplete rehabilitation. This means that patients either don’t complete the right type of rehabilitation, or they don’t progress properly (i.e. too fast or too slow). If you feel that your progress is not going along properly, make sure you seek advice such as speaking to your doctor or working with a physical therapist or athletic trainer. Most causes of chronic ankle pain are due to a lack of full rehabilitation and returning to play before all healing has occurred.