Health Library Rehabilitation Exercises for an Ankle SprainFrom Healthwise

Ankle sprains are common injuries that can result in lifelong problems. Some people with repeated or severe sprains can develop long-term joint pain and weakness. Treating a sprained ankle can help prevent ongoing ankle problems.

Key points

Rehabilitation exercises are critical to ensure that the ankle heals completely and reinjury does not occur.

• You can begin healing by walking or bearing some weight while using crutches if you can do so without too much pain.
• Start rehabilitation with range-of-motion exercises in the first 72 hours after your injury. Continue with further rehabilitation, including stretching, strength training, and balance exercises, over the next several weeks to months.
• You can do rehabilitation exercises at home or even at the office to strengthen your ankle.

 What is an ankle sprain?
 Why is rehabilitation important for an ankle sprain?
 How to do rehabilitation exercises for an ankle sprain
 Where can I learn more about rehabilitation exercises for my sprained ankle?

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An ankle sprain occurs when ligaments that connect the bones in the foot, ankle, and lower leg are stretched or torn.

An ankle sprain often happens when you make a rapid shifting movement with your foot planted, for example, when playing soccer or getting tackled in football. Most commonly, the ankle rolls outward and the foot turns inward in what is called an inversion injury. It results in stretching and tearing of the ligaments on the outside of the ankle.

Less commonly, the ankle rolls inward and the foot turns outward in an eversion injury, damaging the ligaments at the inside of the ankle.

See your doctor immediately if you notice any of the following:

• Your foot or leg bends at an abnormal angle.
• You feel severe pain.
• Your foot is cool or pale or changes color.
• You feel numbness or tingling in your foot or toes that lasts after the initial injury.
• You can't move your ankle.

You should see your doctor after an ankle sprain if you notice any of the following:

• You heard a "popping" sound at the time you sprained your ankle.
• You have moderate or severe pain or severe swelling or bruising around your ankle.
• You can't walk or put weight on your affected foot, or your ankle feels unstable.
• You have redness, swelling, or pain in your leg or groin. These can be signs of a blood clot.
• You have no improvement in your ankle after 1 week.
• Your swelling and bruising last more than 2 weeks.

Also be sure to contact your doctor if you have a cast or splint around your ankle that feels too tight.

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If ligaments do not heal properly after an ankle sprain, the ankle can become weak and unstable and give out with only minor trauma, such as stepping off a curb. Rehabilitation exercises help repair and strengthen injured ligaments.

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Start each exercise slowly and use your pain level to guide you in performing these exercises. Ease off the exercise if you have more than mild pain. Following are some examples of typical rehabilitation exercises.

Keep in mind that the timing and type of rehabilitation exercises recommended for you may vary according to your doctor's or physical therapist's preferences.

Range-of-motion exercises

Range-of-motion exercises begin right after your injury while you have ice on your ankle. Perform a set of exercises by repeating them 10 to 30 times. Do each set 3 to 5 times a day.

Try the following simple range-of-motion exercises:

• Trace the alphabet with your toe, which encourages ankle movement in all directions.
• Sit in a chair with your foot flat on the floor. Slowly move your knee side to side while keeping your foot pressed flat.

Towel curls. While sitting, place a hand towel on a smooth floor, such as wood or tile. While keeping your heel on the ground, curl your toes and grab the towel with your toes to scrunch the towel. Let go, and continue scrunching up the entire length of the towel. When you reach the end of the towel, reverse the action by grabbing the towel with your toes, scrunching it, and pushing it away from you. Repeat, until you have pushed the entire length of the towel away from you.

Stretching exercises

Start exercises to stretch your Achilles tendon as soon as you can do so without pain. The Achilles tendon connects the calf muscles on the back of the lower leg to the bone at the base of the heel.

• Towel stretch. If you cannot stand, sit with your knee straight and a towel looped around the ball of your foot. Gently slowly pull back on the towel for about 15 seconds until you feel your calf stretch. In moderate to severe ankle sprains, it may be too painful at first to pull your toes far enough to feel a stretch in your calf. Use caution and let pain be your guide. A little pain is normal, but you should not feel moderate to severe pain. Do 15 to 20 repetitions of this exercise, 3 to 6 times a day.
• Calf stretch. If you are able to stand, you can do this exercise by facing a wall with hands at shoulder level on the wall. Place your injured foot behind the other foot with the toes pointing forward. Keep your heels down and your back leg straight. Slowly bend your front knee until you feel the calf stretch in the back leg. Hold this position for at least 20 seconds and repeat. Try to do this stretch 3 to 6 times a day.

Muscle-strengthening exercises

Talk to your doctor or physical therapist about the timing of strengthening exercises for the ankle. Generally, you can start them once you are able to stand without increased pain or swelling.

These exercises should be held for 3 to 5 seconds. Do 15 to 20 repetitions once or twice daily for 2 to 4 weeks, depending on the severity of your injury.

• Start by sitting with your foot flat on the floor and pushing it outward against an immovable object such as the wall or heavy furniture. After you feel comfortable with this, try using rubber tubing looped around the outside of your feet for resistance.
• While still sitting, put your feet together flat on the floor. Press your injured foot inward against your other foot.
• Next, place the heel of your other foot on top of the injured one. Push down with the top heel while trying to push up with your injured foot.

Balance and control exercises

You can usually start balance and control exercises when you are able to stand without pain. But talk to your doctor or physical therapist about the exact timing. Also, don't try these exercises if you could not have done them easily before your injury. If you think you would have felt unsteady doing these exercises when your ankle was healthy, you are at risk of falling when you try them with an injured ankle.

Do these exercises 6 times for 60 seconds at least once a day.

• Stand on just your injured foot while holding your arms out to your sides with your eyes open. When you can do this for 60 seconds, try adding the advanced moves in the next level.
• Stand on your injured foot only and:
  • Hold your arms across your chest with your eyes open.
  • Hold your arms out to the sides and close your eyes.
  • Hold your arms across your chest and close your eyes.

Stretching exercises should be continued on a daily basis and especially before and after physical activities to prevent reinjury. Even after your ankle feels better, continue with muscle-strengthening exercises and balance and control exercises several times a week to keep your ankles strong.

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For more information about rehabilitation exercises, talk to:

• Your doctor.
• A physical therapist.
• A sports medicine specialist.

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• Leg Injuries

Author:	Shannon Erstad, MBA/MPH	Last Updated: January 11, 2008
Medical Review:	William M. Green, MD - Emergency Medicine H. Michael O'Connor, MD - Emergency Medicine
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