Posted on Friday, October 13, 2017

How to Self-Treat an Ankle Sprain (Part III)

As a physical therapist, I find that the most exciting part of a person’s rehabilitation is the full return to function, activity, or sport. Countless variations of exercises and activities are performed while working toward restoring the full functional use of the ankle. Concluding the three part series, the final stage in rehabilitation is centered on improving ankle and foot strength, stability, as well as addressing any balance deficits.

How rehabilitation progresses will vary greatly for each individual. Therefore, no treatment plan will be alike. For discussion purposes, I will address a generic treatment plan, which should be modified for your personal needs and activity level. In this final stage of rehabilitation, you will progress to normal daily activities, including any athletic endeavors. This is also when you work toward limiting any future reoccurrences of the sprain.

At this stage in recovering from a lateral ankle sprain, you should be walking relatively normally and mostly pain-free. Running and more active side-to-side movements likely still cause pain. Although not contra-indicated, these types of activities should be limited (unless you’re wearing a good lace up brace or are being regularly taped by a professional).

The initial portion of the rehabilitation is centered on improving ankle and foot strength, stability, as well as addressing any balance deficits. This process begins with statically based exercises and activities. Ultimately, it progresses into dynamic strength, balance, and mobility activities. How rapidly a person progresses in this phase is wildly variable. The key is to progress at your own pace. If you start experiencing increasing pain, feelings of ankle instability, and sensations that it may “roll” or sprain again, then you need to taper down your activity level. After the pain subsides, continue to focus on the activities that that didn’t cause pain or discomfort previously.

The following treatment plan includes exercises for strength and balance as well as mobility drills and full athletic simulation drills. Each category is listed in an easiest to most challenging format. You shouldn’t progress to the next exercise until the first one is mastered.

Strength

Heel/Toe Raises – A person should be able to perform 25 heel raises in a row with only minimal fingertip assistance on a counter top. A normal amount of calf strength would be considered once you can perform 25 heel raises.

One Leg Squat – Perform a one leg squat without using your hands for balance to increase the difficulty level. The one leg squat on your tip toes is a harder variation which involves more calf muscle activation. Start with two sets of 10 repetitions, then progress to three sets of 10 repetitions.

Clock Exercise – Stand on your affected (injured) foot and attempt to touch your tip toe of the non-affected side as far out as you can reach. Bring your foot back to the center or starting point according to the hands on a clock. For example, 1 o’clock to 6 o’clock (clock-wise) or 12 ‘o clock to 6 o’ clock (counter clock-wise) depending on which foot is affected. Perform the routine between three to five times slowly.

Balance

Stand on one foot – A 30 second hold with eyes open during the first time, then closed during the second time, is considered normal.
Stand on one foot on a pillow – A 30 second hold for two to three repetitions. As you progress, stand on the pillow and perform the Clock Exercise as described above.
Stand on one foot and bounce a ball against a wall.
Stand on a Wobble Board, Bosu Balance Trainer or other unstable surface.

Mobility Drills

Initially, start with forward and backward movements and progress from a walk, to a jog, to a sprint.
Jump Rope
Side Stepping – Progress the speed as pain allows and if you’re not experiencing the feeling of instability.
Karaoke or Grapevine – Walk or run sideways while alternating the placement of the foot either in front or behind the other.
Sprint Ladder – A number of agility drills can be performed with the sprint ladder. Search YouTube and pick your favorite video which closely mimics the footwork desired for your particular sport or activity.
Short side-to-side Wind Sprints – While sprinting, touch your hand to the ground at each change of direction.

Full Athletic Simulation Drills

Depending on your sport of choice, return to your sport specific training drills. You may still require additional support. I recommend wearing a good lace up brace or being taped by a professional for support. Additional support should only be used temporarily and with the intention of progressing from using them as your ankle can tolerate.

If you continue to experience pain and swelling, and/or require an accelerated time table for recovery (or return to competition), then I recommend the services of a sports medicine physical therapist or athletic trainer. Many modalities, such as electrical stimulation, manual techniques and taping methods can assist in recovery when properly utilized. To find a qualified physical therapist in your area, search at American Physical Therapy Association (APTA).

Depending on your time table for recovery and the severity of your injury, the information provided in this three part series on ankle sprains will likely be very helpful in your recovery. Each person and injury is different. If you’re interested in a more complete and comprehensive look at self-rehabilitating an ankle sprain, be sure to check out Treating Ankle Sprains and Strains.

Knowing how to effectively self-treat and manage ankle sprains and strains is important in order to resume your training and normal activities without the risk of additional damage, injury or re-injury. When you can confidently self-treat, you can limit pain levels, return to activity faster, and prevent reoccurrences.

AVAILABLE NOW ON AMAZON!

In my book, Treating Ankle Sprains and Strains, you will learn how to safely and confidently self-rehabilitate a common ankle sprain. It will guide you through the ins and outs of self-treating your ankle so you can avoid costly rehabilitation bills. Beginning with the acute phase of rehabilitation, I will walk you through the treatment plan on how to rehabilitate your ankle through the intermediate (sub-acute) phase of rehabilitation and return to full activity and sport.

Learn how to safely self-treat and properly rehabilitate your ankle so you can get back to your daily life and exercise goals more quickly without additional costly medical bills!

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Posted on Thursday, October 12, 2017

How to Self-Treat an Ankle Sprain (Part II)

Ankle sprains are one of the most common and prevalent musculoskeletal injuries. Although more likely to occur in children, ankle sprains can happen to anyone anytime. In my last post, How to Self-Treat an Ankle Sprain (Part I), I addressed how to handle the initial acute phase of an ankle sprain. I will continue to guide you through the treatment plan on how to rehabilitate your ankle in this three part series by addressing the progression from the acute phase into the intermediate phase.

Sprains are categorized as Grade I, II, or III. A Grade I sprain is the most common. It’s typically associated with only mild damage to the ligament, and instability doesn’t affect the joint. A Grade II sprain is a partial tear to the ligament and is usually associated with some laxity (hypermobility). If this occurs, it’s best to wear a brace for several weeks. Ideally, scar tissue will form and compensate for the lax ligament, so the joint doesn’t become hypermobile. Good muscle strength and proprioception of the lower foot is important to limit future sprains. In Grade III sprains, a full tear of the ligament occurred. One typically consults with an orthopaedic surgeon for possible repair. After surgery, a guided physical therapy program is recommended.

For discussion purposes, I will only address a Grade I sprain. Initially, one may wear an air splint, ACE wrap, or some other lace-up or slip-on style brace to help with stability, inflammation, and pain control of the ankle. In most cases, a person will want to transition from wearing the brace as soon as the initial pain subsides. (If one had a Grade II sprain, he/she would wear a splint for several weeks so that the ankle would initially stiffen.)

At this point in your recovery, you are likely three to seven days since the initial injury. This phase of rehabilitation can last from seven days to several weeks before progressing into the final phase of rehabilitation (and ultimately, back to full function). Progression out of the intermediate phase is always symptom dependent. You should be able to stand with equal weight on your feet and not experience an increase in ankle pain. The ankle is likely stiff at this time, but it is time to start walking, progress range of motion (ROM), and start gentle resistive exercises.

Walking

If you have been using a crutch to unweight the foot, then start the progression to weight bearing during walking. If you have been walking, then increase the amount of weight you have been putting on the ankle and foot. At this time, the focus will be to normalize your walking pattern. This means having a good heel strike, rolling onto the foot into full weight bearing on the leg, and then propelling forward with a good toe off. You will continue to use the crutch as long as needed until you can walk nearly normal without limping. Until then, utilize the crutch to unweight the leg and foot as much as necessary to perform a nearly normal walk or gait sequence.

Range of Motion (ROM)

Start to increase the range of motion of the ankle. Initially, work to progress the plantarflexion and dorsiflexion movement (the forward and backward movement of the ankle). As pain subsides, progress the side to side motion as well as all other motions.

Recommended Exercises:

Ankle Pumps – A very easy exercise. Just pump your ankle forward and backward into plantarflexion and dorsiflexion movement. Perform 10-15 repetitions several times a day on both feet.

Ankle Alphabet – Move the foot and ankle only by pretending your big toe is a pen, and draw the alphabet using capital letters. Perform 1-2 times a day.

Calf Stretching – Hold each stretch for at least 30 seconds, three times on each leg, 2-3 times a day. This stretch shouldn’t cause more than a mild increase in pain or discomfort.

Gentle Resistive Exercises

Perform plantarflexion and dorsiflexion movement by initially using an exercise band. I recommend using a Thera-Band Exercise Band. As your pain improves, you can progress to standing heel and toe raises as long as you don’t experience more than a mild increase in pain levels.

As pain and range of motion improve, progress to inversion and eversion with the exercise band. Stop if you experience more than a mild increase in pain levels.

Initial Balance and Proprioception Exercise

Stand on one foot. Initially, you may need to use your hand (or a finger) on a counter top for added support. As the pain subsides and your balance improves, you may need to increase the difficulty level. As you progress, balance will become of greater importance.

Toward the end of the intermediate phase, you should be walking fairly normally. There will likely be some swelling. It’s typical for some amount of swelling to come and go. It will be directly related to how long you are on your feet and your general lower extremity circulation. I highly recommend you continue to wear compression stockings during this time. You may also continue to experience soreness and pain–particularly after a long day or a lot of upright activity. Continue to utilize a regular icing protocol as needed for pain and swelling. Also, continue to supplement with CapraFlex.

It’s time to progress into the final stage of rehabilitation once you have returned to near normal walking, your pain levels are relatively low, and you are able to complete the basic exercises listed above. The final stage of rehabilitation includes a full return to daily activities and eventually, all sport or athletic activities. I will address the specifics of the final stage of rehabilitation in Part III.

AVAILABLE NOW ON AMAZON!

Learn how to safely self-treat and properly rehabilitate your ankle so you can get back to your daily life and exercise goals more quickly without additional costly medical bills!

BUY NOW

Posted on Wednesday, August 13, 2014

Ankle Sprains – Rehabilitation (Part III of III)

As a physical therapist, I find that the most exciting part of a person’s rehabilitation is the full return to function, activity, or sport. Countless variations of exercises and activities are performed while working toward restoring the full functional use of the ankle. Concluding the three part series, the final stage in rehabilitation is centered on improving ankle and foot strength, stability, as well as addressing any balance deficits.

Strength

Continue with the Ankle Resistance Exercises, but progress to a stiffer Thera-Band Exercise Band (http://amzn.to/USkOeo).
Heel/Toe Raises – A person should be able to perform 25 heel raises in a row with only minimal fingertip assistance on a counter top. A normal amount of calf strength would be considered once you can perform 25 heel raises.

One Leg Squat – Perform a one leg squat without using your hands for balance to increase the difficulty level. The one leg squat on your tip toes is a harder variation which involves more calf muscle activation. Start with two sets of 10 repetitions, then progress to three sets of 10 repetitions.

Clock Exercise – Stand on your affected (injured) foot and attempt to touch your tip toe of the non-affected side as far out as you can reach. Bring your foot back to the center or starting point according to the hands on a clock. For example, 1 o’clock to 6 o’clock (clock-wise) or 12 ‘o clock to 6 o’ clock (counter clock-wise) depending on which foot is affected. Perform the routine between three to five times slowly.

Balance

Stand on one foot – A 30 second hold with eyes open during the first time, then closed during the second time, is considered normal.
Stand on one foot on a pillow – A 30 second hold for two to three repetitions. As you progress, stand on the pillow and perform the Clock Exercise as described above.
Stand on one foot on a water noodle – This exercise challenges your balance due to the softer surface and narrow water noodle. It also challenges the side-to-side stability of the ankle, which is the weakest area, yet the most critical, with a lateral ankle sprain. A 30 second hold for two to three repetitions.

Stand on one foot and bounce a ball against a wall.
Stand on a Wobble Board, Bosu Balance Trainer, or other unstable surface.

Mobility Drills

Initially, start with forward and backward movements and progress from a walk, to a jog, to a sprint.
Jump Rope
Side Stepping – Progress the speed as pain allows and if you’re not experiencing the feeling of instability.
Karaoke or Grapevine – Walk or run sideways while alternating the placement of the foot either in front or behind the other.
Sprint Ladder – A number of agility drills can be performed with the sprint ladder. Search YouTube and pick your favorite video which closely mimics the footwork desired for your particular sport or activity.
Short side-to-side Wind Sprints – While sprinting, touch your hand to the ground at each change of direction.

Full Athletic Simulation Drills

Depending on your sport of choice, return to your sport specific training drills. You may still require additional support. I recommend wearing a good lace up brace or being taped by a professional for support. Additional support should only be used temporarily and with the intention of progressing from using them as your ankle can tolerate.

Depending on your time table for recovery and the severity of your injury, the information provided in this three part series on ankle sprains will likely be very helpful in your recovery. For some, it won’t fully meet your needs for a full and speedy recovery. Each person and injury is different. If you continue to experience pain and swelling, and/or require an accelerated time table for recovery (or return to competition), then I recommend the services of a sports medicine physical therapist or athletic trainer. Many modalities, such as electrical stimulation, manual techniques and taping methods can assist in recovery when properly utilized. To find a qualified physical therapist in your area, search at American Physical Therapy Association (APTA).

If you have additional questions or comments regarding this series, please comment below or submit your question to contact@thePhysicalTherapyAdvisor.com. Be sure to join our growing community on Facebook by liking The Physical Therapy Advisor!

Disclaimer: The Physical Therapy Advisor blog is for general informational purposes only and does not constitute the practice of medicine or other professional health care services, including the giving of medical advice. No health care provider/patient relationship is formed. The use of information on this blog or materials linked from this blog is at your own risk. The content of this blog is not intended to be a substitute for professional medical advice, diagnosis, or treatment. Do not disregard, or delay in obtaining, medical advice for any medical condition you may have. Please seek the assistance of your health care professionals for any such conditions.

Posted on Wednesday, August 6, 2014

Ankle Sprains – Intermediate Phase (Part II of III)

Ankle sprains are one of the most common and prevalent musculoskeletal injuries. Although more likely to occur in children, ankle sprains can happen to anyone anytime. In my last post, Ankle Sprains – Acute Phase (Part I of III), I addressed how to handle the initial acute phase of an ankle sprain. I will continue to guide you through the treatment plan on how to rehabilitate your ankle in this three part series by addressing the progression from the acute phase into the intermediate phase.

Walking – If you have been using a crutch to unweight the foot, then start the progression to weight bearing during walking. If you have been walking, then increase the amount of weight you have been putting on the ankle and foot. At this time, the focus will be to normalize your walking pattern. This means having a good heel strike, rolling onto the foot into full weight bearing on the leg, and then propelling forward with a good toe off. You will continue to use the crutch as long as needed until you can walk nearly normal without limping. Until then, utilize the crutch to unweight the leg and foot as much as necessary to perform a nearly normal walk or gait sequence.
Range of Motion (ROM) – Start to increase the range of motion of the ankle. Initially, work to progress the plantarflexion and dorsiflexion movement (the forward and backward movement of the ankle). As pain subsides, progress the side to side motion as well as all other motions.
Recommended Exercises:
- Ankle Pumps – A very easy exercise. Just pump your ankle forward and backward into plantarflexion and dorsiflexion movement. Perform 10-15 repetitions several times a day on both feet

Ankle Alphabet – Move the foot and ankle only by pretending your big toe is a pen, and draw the alphabet using capital letters. Perform 1-2 times a day.
Calf Stretching – Hold each stretch for at least 30 seconds, three times on each leg, 2-3 times a day. This stretch shouldn’t cause more than a mild increase in pain or discomfort.

Gentle Resistive Exercises:
- Perform plantarflexion and dorsiflexion movement by initially using an exercise band. I recommend using a Thera-Band Exercise Band (http://amzn.to/USkOeo). As your pain improves, you can progress to standing heel and toe raises as long as you don’t experience more than a mild increase in pain levels.
- As pain and range of motion improve, progress to inversion and eversion with the exercise band. Stop if you experience more than a mild increase in pain levels.
- For further instruction and photos, please refer to Ankle Resistance Exercises.
Initial Balance and Proprioception Exercises. For a complete discussion on the specifics of balance, please refer to How Do I Improve Balance? (Part I) and How Do I Improve Balance? Part II.
- Standing on one foot. Initially, you may need to use your hand (or a finger) on a counter top for added support. As the pain subsides and your balance improves, you may need to increase the difficulty level. As you progress, balance will become of greater importance (to be addressed in Part III).

Toward the end of the intermediate phase, you should be walking fairly normally. There will likely be some swelling. It is typical for some amount of swelling to come and go. It will be directly related to how long you are on your feet and your general lower extremity circulation. I highly recommend you continue to wear compression stockings during this time. You may also continue to experience soreness and pain–particularly after a long day or a lot of upright activity. Continue to utilize a regular icing protocol as needed for pain and swelling. Also, continue to supplement with Capra Flex by Mt. Capra (http://amzn.to/1pF936I).

It’s time to progress into the final stage of rehabilitation once you have returned to near normal walking, your pain levels are relatively low, and you are able to complete the basic exercises listed above. The final stage of rehabilitation includes a full return to daily activities and eventually, all sport or athletic activities. I will address the specifics of the final stage of rehabilitation in Part III.

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