Ankle Sprain Rehab Protocol for Athletes
Ankle sprains are one of the most common injuries that I see among my athletes.
No matter the sport, almost all athletes are susceptible to ankle sprains. Rolled ankles, sprained ankles, twisted ankles, turned ankles - whatever you call them, they happen all the time. And after you’ve done it once, it’s more than likely that it’ll happen again.
But that doesn’t mean you have to just deal with it, get used to the pain, or let it sideline you for an entire season. There are so many things that you can do to get the ball rolling with your healing - you just need the right guidance (hello, sports PT!). Seeking physical therapy care right away can help you get back in the game sooner, decrease your chances of re-injuring that ankle, and prevent an even worse injury from happening (save the ACL!). And PS: I wrote a blog all about physical therapy for athletes if you want to learn more.
And keep in mind, your ankle sprain recovery should include a customized treatment plan. Your recovery should be completely customized to you and your injury. A cookie-cutter approach or one-size-fits-all routine doesn’t get the best results. In fact, you’ll progress through each aspect of your recovery differently because your injury is unique (and it should be approached that way).
So let’s dive into my ankle sprain protocol for athletes.
Deal with your ankle sprain now to avoid bigger problems later
Ankle sprains result in swelling - that’s inevitable. But if we can manage how much swelling is in the area we can speed up recovery. The inflammatory process begins immediately after your ankle sprain. Blood vessels dilate as blood carrying inflammatory proteins rushes into the area. Fluid builds up in the area as a result and your lymphatic system struggles to pump it out efficiently. When swelling is present, it inhibits the muscles from working properly and delays muscle activation. At the ankle, especially after a sprain, muscle activation and reactivity is crucial to preventing another injury because the ankle relies so heavily on muscular and ligamentous stability to function. If the muscles don’t fire when they should and how they should, it puts other areas at risk for injury, like your knees and hips.
How does physical therapy help with an ankle sprain?
Physical therapists are movement experts and recovery experts. Our job is simple, get you back to living life and playing your sport without pain. We use a combination of exercise, hands-on manual techniques, and activity modification as needed (to keep you moving forward without sabotaging your progress), and teach you all the tips and tricks that reduce your risk of getting injured again. A sports physical therapist can help you get back on the field safely and guide you through the entire recovery process.
Proper physical therapy treatment of an ankle sprain should include:
Examination and evaluation of the ankle
Hands-on assessment of your mobility, strength, swelling, and movement limitations
Swelling management
Learn all the tips and tricks (scroll down for my best ones!) to keep swelling under control to prevent muscle weakness and inhibition
Regaining range of motion
Combination of hands-on manual therapy techniques to mobilize the joints, tendons, ligaments, and soft tissues AND mobility exercises that you can do on your own
Strengthening
Progressive exercises and movements to target areas of weakness in order to help you get back to normal.
Return to sport timeline
Gradually return with a full game plan to get you back into your sport safely. We want you to feel completely confident in your return to the game (and reviewing this plan with your PT is a crucial part of your recovery).
If your report includes running, jumping, or cutting/agility movements, your first time doing these things shouldn’t be when you’re out on the field.
Home exercise program
Outlined and detailed routine that ensures you’re on task at home with your strength and mobility program to achieve your goals as quickly as possible
Top-notch support
Make sure your team of doctors, therapists, and coaches are all on the same page, take the time to listen, communicate effectively, and support your vision of recovery.
How to Manage Swelling After an Ankle Sprain
Elevate
Compress
Ice
Movement
Physical therapy
Now for the details!
Elevate
Raise your leg ABOVE the level of your heart. Try laying on your back down on the floor and elevating your ankles/legs up the side or front of the couch. Stay in this position for at least 20 minutes to help decrease further swelling. Combine with compression and ice for maximal benefit.
Compress
Use an ACE bandage or compression sock on your foot, ankle, and lower leg. This will help to prevent pooling of blood and fluid around your ankle.
Ice It!
Applying ice over the area of pain can help decrease swelling by inducing vasoconstriction of the blood vessels in the area. This reduces the amount of blood pooling and staying stagnant in the foot and ankle. Swelling will still occur, this just keeps it at a manageable level. Pro tip: You can also try alternating heat and ice at 20 mins each several times per day for contrast and swelling management.
Move and Mobilize
One of the worst things you could do is keep the ankle completely still. Now I don’t want you running around and completely ignoring the injury either. We want gentle movement of the ankle joint within a tolerable range of motion. Start by writing the ABCs in the air with your foot - keeping your knee and lower leg still, moving only the ankle and foot. Even if you’re only able to move inches at first, that’s a start. We’re preventing tissue adhesions, maintaining mobility in the tendons and joints, and improving circulation to the area. Don’t overdo it though! Slow and steady is key. A sports physical therapist can guide you through a appropriate progression for you with a customized treatment plan
Start Treatment ASAP
Schedule an appointment with your physical therapist ASAP to get your recovery started! PTs are movement and injury recovery experts and many states (like Washington) don’t require a referral to start care. PTs can evaluate your ankle and determine if you’ll need to see a physician for imaging or further evaluation. In a lot of cases, seeing a physical therapist first can reduce the amount of time you spend on the sidelines, speed up healing, and decrease your risk of further or repeated injury.
Types of Ankle Sprains
An ankle sprain is basically a stretching of the ankle ligaments, which connect one bone to another, usually under increased force or load. These injuries are commonly seen in athletes playing soccer, basketball, softball, baseball, pickleball, and tennis, as well as in runners and cheerleaders. And here we go! Let’s dive into the three main types of ankle sprains.
Inversion ankle sprain
The most common type of ankle sprain
Roll the ankle to the outside with the foot turning inward
Typically injures the anterior talofibular ligament or calcaneofibular ligament
Pain, swelling, and bruising on the outside (lateral) of the ankle and foot
Can strain everter muscles due to quick stretch and contraction of the muscles to help protect the ankle during the injury
Eversion ankle sprain
Less common ankle sprain
Roll the ankle to the inside with the foot turning outward
Usually injures the deltoid ligament (sometimes results in an avulsion fracture)
Pain, swelling, and bruising on the inside (medial) of the ankle and foot
Can strain inverter muscles due to quick stretch and contraction of the muscles to protect the ankle during the injury
High ankle sprain
Similar mechanism to the inversion ankle sprain, foot goes inward as the ankle rolls outward
Results in injury to the anterior tibiofibular ligament and syndesmosis (tissue between the lower leg bones - tibia and fibula), sometimes with injury to the ligaments on the lateral ankle as well
Easily misdiagnosed as a regular inversion ankle sprain, which can delay healing and safety with return to sport
Important because treatment is different based on structures involved
Typically has a little longer recovery associated with it
Does severity actually matter?
Well, kinda. The severity of the ankle sprain basically tells you what structures are involved and how heavily those structures were damaged during the injury. In ankle sprains it ranges from Grade I to III, but the label isn’t that important. Knowing the severity of the sprain will make a difference in the things you do for recovery, how fast you progress through rehab, and setting expectations for recovery timeline but it’s up to your therapist and doctor to guide you through rehab appropriately based on the structures involved.
But most importantly, it doesn’t mean that you skip out on doing rehab for a Grade I sprain just because it’s considered “mild.” It’s a great idea to go through even a short course of physical therapy to make sure that you’re recovering as expected and reduce your risk of re-injury.
Are you at risk for an ankle sprain?
What kinds of things put you at risk for an ankle sprain? There are a few factors that increase your chances of experiencing an ankle sprain.
Previous ankle sprain: seems obvious, but if you’ve had one before then you’re more likely to do it again (and it could be worse)
Weakness in the hips or knees on either leg
Poor single-leg standing balance: indication of instability and impaired balance. The general adult population should be able to stand for at least 30 seconds on each leg, but most athletes should be able to do 60+ seconds on each leg.
Sports that involve a lot of changing direction, running at various speeds, or stopping and starting rapidly
Prevent a Sprain, Save Your Ankle
So what does this mean? It’s time to train for it! This doesn’t mean that you should avoid these sports or be worried that playing soccer means you’ll almost certainly sprain your ankle. Instead, I suggest that you incorporate some single-leg strengthening, balance exercises, and agility movements into your training routine to protect those ankles.
Throw in some speed ladder, sprints with changing direction, and moving through cones or agility courses at various speeds and with quick starts and stops. These things simulate game-like movements to make you faster and stronger while simultaneously reducing your risk of injury.
Common Misconceptions and Myths About Ankle Sprains
Let’s chat for a moment about some of the most popular misconceptions that athletes think and hear from others regarding what they should do after experiencing an ankle sprain.
1. Just rest it for two weeks and then go back
Rarely does propping your foot up on the couch for two weeks, resting the ankle completely, or preventing all movement ever truly solve the problem. It’s all about gradual, progressive movement, and loading through the ankle as tolerated. A sports physical therapist can help with this.
2. You just need to do some ankle ABCs and Theraband inversion/eversion for recovery.
If only rehab were that simple. Those are great places to start, but if you want to get back in your sport without being at high risk for another injury, there’s many more exercises to progress through in your recovery journey.
3. You can just do the same thing you did in rehab for the last ankle sprain.
You might end up with some of the same exercises in rehab, but each ankle sprain is different. Most plans incorporate elements of balance/stability exercises and unilateral strengthening, but that doesn’t mean everything is the same. Your ligaments, tendons, and joints respond differently to each trauma. So doing what you did last time might not hurt you but it likely won’t get you the best results
4. You don’t need therapy or sports rehab if it’s just a mild ankle sprain.
I repeat, there’s nothing wrong with doing just a few sessions or a short stint with your physical therapist after a mild ankle sprain. Ensure that your ankle is on its way to a full recovery with your home program and get feedback on how your ankle and foot joints are moving. However, there’s the hands-on manual therapy treatments that you can’t really do to yourself. A physical therapist can assess the joints in your ankle and foot, as well as damage to surrounding musculature and ligaments in the injury. Physical therapists also provide the manual therapy treatments needed to support your recovery and mobility,
5. There’s nothing you can do to prevent another ankle sprain - you’ll do it again, and again, and again.
There’s actually SO much you can do to prevent it from happening again! Strengthening, balance training, agility movements, ankle mobility, motor control (ability to control how accurate and the speed at which your muscles respond to movement), and safe, gradual progression into your sport. A physical therapist can help guide you through an appropriate rehab designed to reduce risk of re-injury.
6. “It’s just an ankle sprain. It’ll heal.”
While that’s true, it will heal, not doing the right things from the start and just ignoring the ankle sprain usually results in delayed recovery, increased likelihood of re-injury, and frustration. There’s a lot that physical therapy can help with - regaining you strength, improving single leg balance, improving mobility, and keeping your recovery on track.
7. Why waste my time going to rehab for my ankle sprain if it doesn’t hurt?
Having an ankle sprain previously doesn’t just put you at risk for another ankle sprain, it puts you at an increased risk for knee and hip injury. You know that ACL injury you work so hard to prevent? Your ankle sprain could be sabotaging all of your hard work.
Get treatment for your ankle sprain
If you’re local to the Kennewick, WA area and looking for top-notch ankle sprain treatment and physical therapy, Game Changer can help you. Schedule a free discovery call or learn more about our physical therapy services for athletes. We’d love to get you back in the game and stronger than ever.
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