3 Steps to Recover from an Ankle Sprain by Robin Gerber MS, ATC and Michael Volkmar, MS, CSCS, PES, CPT
One of the most common ‘weekend warrior’ injuries seen by medical doctors is the ankle sprain. Most frequently the ankle is injured during running or jumping activities in which the foot rolls or twists after stepping on an uneven surface. These injuries happen because of a plantar flexion (ankle / toes are pointing down) & inversion (ankle rolls outward) motion of the foot and ankle causing injury to the lateral ligaments or tendons. After your ankle sprain has been diagnosed by a physician and they prescribe rehabilitation, there are 3 things that will benefit you on your return to your athletic pursuits.
Range of Motion and Flexibility
Range of motion should begin as soon as your physician deems it is ok. At first, you want to start with dorsi-flexion (up) and plantar flexion (down) at the ankle joint. Essentially move your foot up and down at the ankle joint. Next, you want to move your foot through inversion (in) and eversion (out). Circumduction (circle) would be the next progression. These motions should be done 30 times each at least 3 times a day while seated in a chair with the injured ankle supported
Another key part to ankle/foot range of motion is the gastrocnemius/soleus complex (calf) muscle. This complex attaches to the posterior heel and plays a huge role in ankle mobility. Typically, this complex is tight causing decreased ankle range of motion leaving the foot in a plantar flexed position (toes pointing down). Having the foot in this position creates a predisposition to lateral ankle sprains. Stretching and foam rolling of the gastrocnemius/soleus complex is vital. Stretching and foam rolling should be done at least 3 times a day. The foam rolling is supportive in releasing the tight myofascial tissue within the complex.
Wall Calf Stretch
Targets: gastrocnemius/soleus complex
Stand facing a wall from several feet away. Stagger your stance, placing one foot forward. Lean forward and rest your hands on the wall, keeping your heel, hip and head in a straight line. Keep your heel on the ground while pushing your hips towards the wall. Hold the stretch for 30-45 seconds. Relax and repeat for the other side. Next, repeat with a slightly bent back knee to focus on the soleus.
Foam Roll Calf
Targets: gastrocnemius/soleus complex
Seated on the floor, place a foam roller under the calf muscle and push yourself up to apply pressure to the calf muscle. Slowly roll back and forth on the muscle until you find a tender spot. These are “trigger points” of pain. These are knots and adhesions built up over years of training and post injury that limit your mobility. By applying pressure with your foam roller you goal is to break up those knots and increase your mobility.
Once you have regained full range of motion in your ankle, we need to begin strengthening the structures around the injured site.
First, we begin with a thera-band (which can be purchased at Walmart) moving through ankle range of motion (dorsi-flexion, plantar flexion, inversion, eversion). Hold the thera-band in both hands while wrapping the band under your foot. Different color bands will have different strengths and you should progress as you tolerate. Those exercises should be completed in 3 sets of 10 reps.
Next up is strengthening the muscles anterior (front) and posterior (back) of the injury site. o strengthen the gastrocnemius/soleus complex and the anterior tibialis musculature perform heel and toe raises. Complete 3 sets of 10 reps for each exercise.
Neuromuscular control is a combination of sensory information coming in and going out of the body that allows you to return to your activity with an awareness of your body. It allows you to make coordinated movements and is based off previous athletic experiences as well as new athletic experiences. Part of neuromuscular control is proprioception. Proprioception is the awareness of joint position in space (your ability to balance). To help re-educate and reinforce correct pathways; performing this type of rehab exercise is the concluding steps to your rehab program.
These rehab exercises begin with single leg balancing on the injured ankle. Once you are able to hold a single leg balance position for 45 seconds on the injured leg follow the following progression for increased proprioception.
Single Leg balance – Eyes closed – flat surface: 5 sets of 45 seconds
Single Leg balance – Eyes open – uneven surface (pillow): 5 sets of 45 seconds
Single Leg balance – Eyes closed – uneven surface (pillow): 5 sets of 45 seconds
Single Leg hops – Dot Drill: 5 scattered dots hopping to each dot twice
Following each of these 3 steps will help you improve your ability to get back to your sport/activity in a quick and healthy way. Continuing these steps even after returning to your sport/activity will also help prevent future injury. Ankle sprains are injuries that tend to have a higher rate of reoccurrence than others so it is always important to do everything you can to prevent future injury and stay in the game. So be sure to add in 2 or 3 of these exercises to your daily routine to prevent further injury.
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ROBIN GERBER, MS, ATC received her Master’s of Science degree in Athletic Training from Seton Hall University in 2010. Prior to attending Seton Hall University, she received her Bachelors of Science at Bloomsburg University of Pennsylvania in 2008. While attending Bloomsburg University, she was a member of the women’s soccer team. During her time at Seton Hall University she worked with local high school athletic teams as well as covering NCAA Division III college football. Currently, she is a faculty member at the Peddie School in Hightstown, NJ. In collaboration with her colleague, she covers 51 athletic teams throughout the school year. In a state of the art athletic training room, she provides injury prevention, evaluation, and treatment along with a host of other tasks. While living at a boarding school she is also substantially involved within the school community.
MICHAEL VOLKMAR, MS, CSCS, PES, CPT, received his master’s degree in Exercise Science with a specialization in Exercise, Nutrition, and Eating Behavior from George Washington University (GWU). In 2001, Mike started his well-traveled path in Sports Performance Training at the Junior College level (OCC, Onondaga, NY) working with the baseball team. He worked for three years as the Strength and Conditioning Coach at GWU, first with the Single A affiliate (High Desert Mavericks) of the Milwaukee Brewers, and later season with the Double A affiliate (Harrisburg Senators) of the Washington Nationals, before moving on to spend one year at the International Performance Institute of IMG Academies, FL. Mike continued his professional development by becoming the Director of Strength and Conditioning at the APEX Academies. Currently, Mike is the strength and conditioning coach at the Peddie School. A Division I baseball player during his undergraduate career, Mike is an amateur powerlifter with a passion for all things fitness. Mike has advanced specialty certifications in strength and conditioning, post-rehab exercise, athletic development, and sports medicine. He is the co-author of Mobility Workout Handbook.