Physiotherapy Treatment for Ankle Sprains
A sprained ankle is one of the most common ankle injuries that we help treat at Rebalance Sports Medicine. If you have rolled your ankle you understand just how debilitating an injury like this can be, making walking and everyday activities much more difficult. It is important to know that once you have sprained an ankle your likelihood of re-injury is exponentially higher. If you think you have sprained your ankle, taking some immediate steps to rehabilitate your ankle will help you recover faster and prevent a future sprain.
What is an Ankle Sprain?
An ankle becomes sprained when the ligaments (supportive joint tissues) becomes stretched beyond their natural range and the forces then become absorbed by the secondary restraining structures such as the muscles, joint capsule and joint surfaces. This can occur by rolling your ankle inwards, outwards, or jamming it with an upward pressure. This results in damage to the ligamentous tissues and symptoms of pain, swelling, bruising and walking with a limp can present. Once these symptoms resolve they can be followed with the feeling of instability, stiffness in certain movements and decreased balance and agility.
In more significant forceful events there can be fractures of the bones, and this would be indicated if the pain is so intense after injury you are unable to weight bear for at least three steps on the injured foot/ankle. If you cannot weight bear without an intense pain after an ankle injury it is important that you get X-ray imaging immediately to determine if the bone has been fractured.
In a typical ankle sprain, meaning no fracture, the damage that occurs to the ligament and supportive tissue to the ankle causes the ankle tissues to become inflamed and the joint less stable. Once the initial inflammation process is under control it will be important to strengthen and retrain the muscles around the ankle to improve the stability of the joint and prevent future re-injury.
How can a Physiotherapist or Chiropractor help with an Ankle Sprain?
Your trusted health care professional will perform a thorough assessment to determine the extent of the tissue damage and the possible cause. More often than not you may have rolled your ankle from weakness or imbalance up the kinetic chain, meaning your knees, hips or core.
They will work with you to set goals that include management of the acute swelling and pain, resolve the proper range of motion with hands on manual therapy treatment, increasing strength and proprioception with exercises and getting you back to your activity.
They may recommend a brace for the initial recovery period, apply therapeutic modalities such as ultrasound or acupuncture, perform hands on treatment and use specialized equipment such as a wobble board to retrain your ankle’s ability to respond to unstable surfaces. Most of all they will provide you with guidance and re assurance of how best to proceed and help you achieve a speedy recovery.
If your injury is not healing in the expected timeline our physiotherapist or chiropractor will refer you to our sports medicine doctors for further assessment and investigation.
What are the Best Exercises to Help you Recover from an Ankle Sprain?
In the first few days following an ankle sprain you will want to do range of motion and gentle strengthening exercises in all directions and in a pain free range.
Range of motion exercises
Perform circles with your ankle, spell the Alphabet in an exaggerated way with your big toe making sure to move your ankle at the same time. Repeat 4-5x a day.
Use a resistance band and loop it on the foot in a direction that will add resistance in the direction you want to strengthen. Then move your foot/ankle in the four directions: lift the foot upwards, point the foot downwards, move the foot/toes inwards and then outwards in a slow and controlled manner. Repeat 10x in all directions 2x/day.
Stretches of the calf will also be important, start with using a belt to pull the ball of your foot towards you and progress to this:
In later stages of an ankle sprain you will want to progress the strengthening and improve balance.
Calf raises and foot strengthening
This exercise strengthens your core, legs and improves balance and proprioception
Standing on the injured ankle hinge forward at your hips so your trunk leans forward and other leg goes back in equal amounts. Be sure to keep your pelvis squared forward and you can place your arms out to the side to help you balance. Hold this position for up to a minute. Take note of all the little adjustments occurring at your foot and ankle and how responsive your body is to keep you balanced.
What Should be Avoided when you have Sprained your Ankle?
If you have recently sprained your ankle, it is important in the first few days to try to walk as normally as possible but in short durations/intervals. You might by limping and that is normal but for the most part try to keep your stride with your heel contacting first and rolling off your big toe as normal as possible. Do not immediately jump to crutches or a walking boot unless a doctor or other health care professional has recommended it to you. If after the injury you feel this is necessary you will want to consult with a doctor for imaging.
Prevent the swelling from continuing and getting worse. To do this make sure you elevate your foot at rest. Avoid or decrease activities that cause the pain or swelling to increase. Try ice to see if this can help.
Make sure your wear supportive shoes, do not wear flip flops, high heels or unsupported flat sole shoes.
How can you Treat your Ankle Sprain at Home?
Rest, ice, Compress, Elevate your ankle up to 4xday with ice ON/OFF for 10min intervals. When you are at work or rest continue to elevate your ankle, for as long as the swelling is around.
Use a brace and supportive shoes, such as running shoes.
Start rehabilitative exercises early
See above and progress them as you improve.
If you heel quickly on your own but return to sport and notice pain, stiffness and or swelling from the activity it is indication that your tissue is not ready for that stress. In this case an assessment with a trusted physiotherapist or chiropractor is indicated. It most likely needs some hands on manual therapy to improve the mechanics and may only take a few treatments to resolve.
Don’t forget to work on your ability to balance. It may seem unnecessary but improved balance is a huge factor in re-injury prevention. Practice standing on one leg and even try this challenge on an unstable surface such as the subway, a bosu ball or a couch cushion.
How Long Does it Take to Recover from an Ankle Injury?
The timeline for recovery will vary depending on your injury severity and the tissues involved. In some cases, in a low-grade sprain you can heel in a few weeks and may not even feel the need to seek treatment, however you have to remember you are more pre-disposed to a re-occurrence. In most cases, seeking the care of a trusted health professional will help you understand your injury severity and help guide you on the quickest road to recovery. On average with a commitment to exercises and treatment, it should take 2-3 months to get back to the activities you enjoy.
In some more severe cases, the injury can take as long as 6 months to fully recover. This is typical in cases where the boney surfaces of the ankle get bruised or injured. In very rare cases a surgery may be elected to repair the tissue and regain stability. In these very severe cases, our sports medicine doctors will be following you closely and will make appropriate referrals for care.
If you have sprained your ankle, see a registered physiotherapist or chiropractor today who is trained in manual therapy and who will teach you specific exercises to restore your mobility, strength and balance. A study that was recently published supports this recommendation (Ankle Sprains – Combination of Manual Therapy and Supervised Exercise Leads to Better Recovery). It concluded that patients who did physiotherapy had much better outcomes than those who just did a home exercise program.
To book an appointment with one of our physiotherapists or chiropractors in downtown Toronto please contact us or request an appointment online.
Heather Imrie, FCAMPT Physiotherapist
Heather Imrie is a FCAMPT physiotherapist practicing at Rebalance Sports Medicine in downtown Toronto.