Rehabilitating a Sprained Ankle

Ankle sprains aren't just for athletes. You can sprain your ankle doing anything—slipping on the soccer field, stepping off the curb, or falling over someone's outstretched foot.

People who tend to walk on the outside edges of their feet are especially prone to ankle sprains, and someone who has suffered multiple sprains may have permanently loosened the outer ligaments of that ankle, which makes it more susceptible to future sprains.

The most common type of ankle sprain is a grade I, or inversion sprain, and occurs when the foot suddenly turns under you, and your body weight comes down hard on the bone and ligaments of the ankle joint. In a grade II, parts of the ligaments actually may be torn.

In a grade I sprain, there is no rupture, and the ligaments are not injured, but the ankle muscles are overstretched.

This month, I'll focus on exercises to help rehabilitate a grade I ankle sprain. (See illustrations and instructions below, which you can photocopy for your patients.)

Never underestimate an ankle sprain. It is not dangerous, but if you don't take care of it, residual weakness and pain can linger almost indefinitely. Don't be fooled by the absence of pain in the ankle immediately after the sprain. For the first half hour or so, there may not be much pain and swelling, but it will get worse. Patients who are not at home when the sprain occurs should get home as quickly as possible—ideally by having someone drive them. During the first 24 hours, advise patients to keep the ankle elevated and apply an ice bag or cold pack for 20 minutes every hour while they are awake.

One way to assess the sprain is to ask a patient to try to touch his or her toes. If he or she can touch the toes and it does not hurt, it is probably grade I, but if toe touching hurts the ankle, it is probably grade II or III and will need more sophisticated care.

Patients should begin recovery exercises a day or two after the injury, once any swelling has gone down with help from ice and anti-inflammatories. Start without a weight, and then attach a 1-pound weight to the foot to improve strength as needed. Repeat these exercises 2–3 times a day, 6 days a week. Although this sounds like a lot, think about how much we move our ankles when walking normally during the day. While it's important to keep the muscles active, it is also important for patients to use crutches or a cane while the ankle heals, since the stress of bearing weight on the injured ankle can impede full recovery.

Next month: Exercises for a frozen shoulder.

Exercises for a Sprained Ankle

Seated ankle raise. Sit in a straight-backed chair, with a rolled-up towel under the thigh of the injured leg. Flex the injured foot toward your shin, forming a “V” shape between your shin and foot. Hold this flexed position for 5 seconds, then lower your foot and relax for 3 seconds. Start with 8 repetitions, and work up to 12. When this seems easy, attach a 1-pound weight to the foot, and start with 8 repetitions.

Side-lying ankle raise. Lie on your side with the injured leg on top. Flex the foot to the side (away from your bottom leg) without bending the leg. Hold the flexed position for 5 seconds, then lower your foot and relax for 3 seconds. The relax time is important, because it lets the ankle muscles recover. Start with 8 repetitions, and work up to 12. When this seems easy, attach a 1-pound weight to the foot, and start with 8 repetitions again.

Stomach-lying ankle extension. Lie on your stomach with a pillow under your abdomen. Bend the knee of the injured leg, and lift it to a 45-degree angle. Slowly extend your foot; try to point your toes up toward the ceiling. Hold the extended position for 5 seconds, then relax the foot for 3 seconds. Keep the leg raised at a 45-degree angle until you have done 8 repetitions. Work up to 12. When this seems easy, attach a 1-pound weight to the foot, and begin again with 8 repetitions.

Ankle sprains aren't just for athletes. You can sprain your ankle doing anything—slipping on the soccer field, stepping off the curb, or falling over someone's outstretched foot.

People who tend to walk on the outside edges of their feet are especially prone to ankle sprains, and someone who has suffered multiple sprains may have permanently loosened the outer ligaments of that ankle, which makes it more susceptible to future sprains.

The most common type of ankle sprain is a grade I, or inversion sprain, and occurs when the foot suddenly turns under you, and your body weight comes down hard on the bone and ligaments of the ankle joint. In a grade II, parts of the ligaments actually may be torn.

In a grade I sprain, there is no rupture, and the ligaments are not injured, but the ankle muscles are overstretched.

This month, I'll focus on exercises to help rehabilitate a grade I ankle sprain. (See illustrations and instructions below, which you can photocopy for your patients.)

Never underestimate an ankle sprain. It is not dangerous, but if you don't take care of it, residual weakness and pain can linger almost indefinitely. Don't be fooled by the absence of pain in the ankle immediately after the sprain. For the first half hour or so, there may not be much pain and swelling, but it will get worse. Patients who are not at home when the sprain occurs should get home as quickly as possible—ideally by having someone drive them. During the first 24 hours, advise patients to keep the ankle elevated and apply an ice bag or cold pack for 20 minutes every hour while they are awake.

One way to assess the sprain is to ask a patient to try to touch his or her toes. If he or she can touch the toes and it does not hurt, it is probably grade I, but if toe touching hurts the ankle, it is probably grade II or III and will need more sophisticated care.

Patients should begin recovery exercises a day or two after the injury, once any swelling has gone down with help from ice and anti-inflammatories. Start without a weight, and then attach a 1-pound weight to the foot to improve strength as needed. Repeat these exercises 2–3 times a day, 6 days a week. Although this sounds like a lot, think about how much we move our ankles when walking normally during the day. While it's important to keep the muscles active, it is also important for patients to use crutches or a cane while the ankle heals, since the stress of bearing weight on the injured ankle can impede full recovery.

Next month: Exercises for a frozen shoulder.

Exercises for a Sprained Ankle

Seated ankle raise. Sit in a straight-backed chair, with a rolled-up towel under the thigh of the injured leg. Flex the injured foot toward your shin, forming a “V” shape between your shin and foot. Hold this flexed position for 5 seconds, then lower your foot and relax for 3 seconds. Start with 8 repetitions, and work up to 12. When this seems easy, attach a 1-pound weight to the foot, and start with 8 repetitions.

Side-lying ankle raise. Lie on your side with the injured leg on top. Flex the foot to the side (away from your bottom leg) without bending the leg. Hold the flexed position for 5 seconds, then lower your foot and relax for 3 seconds. The relax time is important, because it lets the ankle muscles recover. Start with 8 repetitions, and work up to 12. When this seems easy, attach a 1-pound weight to the foot, and start with 8 repetitions again.

Stomach-lying ankle extension. Lie on your stomach with a pillow under your abdomen. Bend the knee of the injured leg, and lift it to a 45-degree angle. Slowly extend your foot; try to point your toes up toward the ceiling. Hold the extended position for 5 seconds, then relax the foot for 3 seconds. Keep the leg raised at a 45-degree angle until you have done 8 repetitions. Work up to 12. When this seems easy, attach a 1-pound weight to the foot, and begin again with 8 repetitions.

Ankle sprains aren't just for athletes. You can sprain your ankle doing anything—slipping on the soccer field, stepping off the curb, or falling over someone's outstretched foot.

People who tend to walk on the outside edges of their feet are especially prone to ankle sprains, and someone who has suffered multiple sprains may have permanently loosened the outer ligaments of that ankle, which makes it more susceptible to future sprains.

The most common type of ankle sprain is a grade I, or inversion sprain, and occurs when the foot suddenly turns under you, and your body weight comes down hard on the bone and ligaments of the ankle joint. In a grade II, parts of the ligaments actually may be torn.

In a grade I sprain, there is no rupture, and the ligaments are not injured, but the ankle muscles are overstretched.

This month, I'll focus on exercises to help rehabilitate a grade I ankle sprain. (See illustrations and instructions below, which you can photocopy for your patients.)

Never underestimate an ankle sprain. It is not dangerous, but if you don't take care of it, residual weakness and pain can linger almost indefinitely. Don't be fooled by the absence of pain in the ankle immediately after the sprain. For the first half hour or so, there may not be much pain and swelling, but it will get worse. Patients who are not at home when the sprain occurs should get home as quickly as possible—ideally by having someone drive them. During the first 24 hours, advise patients to keep the ankle elevated and apply an ice bag or cold pack for 20 minutes every hour while they are awake.

One way to assess the sprain is to ask a patient to try to touch his or her toes. If he or she can touch the toes and it does not hurt, it is probably grade I, but if toe touching hurts the ankle, it is probably grade II or III and will need more sophisticated care.

Patients should begin recovery exercises a day or two after the injury, once any swelling has gone down with help from ice and anti-inflammatories. Start without a weight, and then attach a 1-pound weight to the foot to improve strength as needed. Repeat these exercises 2–3 times a day, 6 days a week. Although this sounds like a lot, think about how much we move our ankles when walking normally during the day. While it's important to keep the muscles active, it is also important for patients to use crutches or a cane while the ankle heals, since the stress of bearing weight on the injured ankle can impede full recovery.

Next month: Exercises for a frozen shoulder.

Exercises for a Sprained Ankle

Seated ankle raise. Sit in a straight-backed chair, with a rolled-up towel under the thigh of the injured leg. Flex the injured foot toward your shin, forming a “V” shape between your shin and foot. Hold this flexed position for 5 seconds, then lower your foot and relax for 3 seconds. Start with 8 repetitions, and work up to 12. When this seems easy, attach a 1-pound weight to the foot, and start with 8 repetitions.

Side-lying ankle raise. Lie on your side with the injured leg on top. Flex the foot to the side (away from your bottom leg) without bending the leg. Hold the flexed position for 5 seconds, then lower your foot and relax for 3 seconds. The relax time is important, because it lets the ankle muscles recover. Start with 8 repetitions, and work up to 12. When this seems easy, attach a 1-pound weight to the foot, and start with 8 repetitions again.

Stomach-lying ankle extension. Lie on your stomach with a pillow under your abdomen. Bend the knee of the injured leg, and lift it to a 45-degree angle. Slowly extend your foot; try to point your toes up toward the ceiling. Hold the extended position for 5 seconds, then relax the foot for 3 seconds. Keep the leg raised at a 45-degree angle until you have done 8 repetitions. Work up to 12. When this seems easy, attach a 1-pound weight to the foot, and begin again with 8 repetitions.