How To Rehab An Ankle Injury

By: | Tags: | Comments: 0 | March 11th, 2022

How To Rehab An Ankle Injury Even If You Have Had Pain For Over 6 Months 

Ankle injuries can be extremely debilitating and leave us feeling like we’ll never get back to the sport that we love. Whether your main symptom is pain or perhaps you are more affected by instability and are unable to trust it over uneven surfaces, we can help.

This article aims to help you understand your ankle injury and get you on the right track to resolve your pain and disability.

 

Let’s start with the basics : What Is An Ankle Sprain?
An ankle sprain is a common injury and there are 3 main mechanisms of injury which affect different parts of the ankle. It’s important to know which is affected because it may change your management and help us to identify tissues that are affected.

Poor rehabilitation after initial sprain increases the chances of injury reoccurrence. 

Lateral Ankle Sprains

Lateral ankle sprains typically occur during a rapid shift in body centre of mass over the landing or weight bearing foot. 

The ankle rolls outwards whilst the foot turns inwards. This causes the ligament on the outside of your ankle to stretch and sometimes tear. 

Pain is often located on the outside on the ankle.

Medial Ankle Sprains

With this mechanism the weight is overloaded on the inside of the ankle. Pain is usually located on the inside of the ankle.

High Ankle Sprains

This is common in football and basketball injuries. Thee is a specific test ( squeeze test) that can be done to identify this.

 

How Can You Sprain Your Ankle?
Ankle sprains are often caused by losing your footing, uneven ground, sporting injuries ( Contact and non contact), unsuitable foot wear and drunken injuries!

The first step is identifying that you have a problem. If you are reading this article then I imagine you have already worked out you need help. 

A simple single leg stand test comparing left to right is an easy way to spot the deficit. 

If you are considering doing this at home make sure someone is with you and there is something close to hold on to. This is for information purposes only. Our recommendation would be to seek help from an expert to assess this safely.

 

Ankle Sprain Recovery Time
Mild ankle sprains can take a couple of weeks to heal, however it may take two-three months to return to normal, including playing sports. If you have suffered with a very bad ankle sprain it can take several months to heal and recover. 

Recovery time is dependent on a few things… 

Age – Younger people tend to heal better so you may need to allow additional healing time if you are 30+

Smoking – Smoking delays healing in ankle sprains. Try to reduce your cigarette consumption or quit all together if possible to reduce your recovery time

Co-morbidities – Other illness can play an influence in healing. For example diabetes may delay recovery. 

Too much too soon – It’s a careful balance to understand tissue healing times and follow relative rest advice to protect the specific ligament affected until it has healed. It is important to do the right exercises to improve scar tissue quality, proprioception and reduce atrophy.

Unfortunately 50% + ankle sprains remain painful after 6 months. This is likely due to the person feeling ‘it will just get better’ and not doing adequate rehab. The ankle may feel good whilst walking around but as soon as you put to through greater load such as change of direction or sport it continues to give way or produce pain.

 

 

 

badminton rachet hitting shuttle cock

 

What Treatment Is There For Ankle Sprains?
How to help yourself when you have sprained your ankle– if you have sprained your ankle, theres a lot you can do yourself to ease your symptoms in the first few days. There is the POLICE principles which are steps that you can do to reduce your pain and aid you to recovery.

P– protect, resting your ankle straight after injury and protect from further damage
OL– Optimal loading, you should start moving your ankle and gradually put weight on it as soon as you can.
I– Ice, will help with pain you are experiencing. Place ice on your ankle for 10-20 minutes every couple of hours for the first two to three days.
C– Compression, use a bandage to compress the injury to reduce swelling
E– Elevate, keep your foot elevated by raising it above your heart on either a chair or cushion. 

Things to avoid in the first couple of days of injury are procedures from the HARM principle which are
H– Heat, avoid hot baths, showers saunas and heat pack/ rubs
A– Alcohol, can slow your recovery time down and could put you at risk of further damage as it can mask symptoms
R– Running, don’t run or do any other form of moderate exercise as this can cause further damage
M– Massage, avoid massage for the first day or two as this can cause more swelling and damage to your ankle. 

 

Important Exercises For Ankle Pain
Gentle exercise is very effective after an ankle sprain and it’s best to start moving your ankle as soon as you can. This will help your ankle get better/ back to normal more quickly than just keeping it still and immobile. Gentle movements such as range of motion acts as a muscle pump and helps to decrease pain and swelling. Isometric contraction exercises to the muscles around the ankle will not only strengthen your ankle but will decrease pain as well. There are different restrictions depending on the ligaments that are affected so please ask your physiotherapist or sports therapist which are best for you. 

 

Recovery Of An Ankle Sprain
Depending on what you have done depends on recovery time. 

Ligament damage can take anything between 8-12 weeks to fully recovery from an ankle sprain and sometimes even longer.

Bruising tends to come out immediately and can get worse over the next few days. For broken/ fractured ankle you’ll usually have an x-ray to determine the break and how bad it is. If you’ve had a very minor break you may not need to be in a cast or have surgery, but for a more serious break you may need:
. A special boot to support ankle
. A plaster cast to hold ankle in place whilst it heals
. The bones to be moved back into place by a doctor
. Surgery to fix the broken bones.

A broken ankle usually takes 6 to 8 weeks to heal but can take longer. You need to see a physiotherapist to help with exercises to get foot moving and functioning again. 

Woman playing volley ball in grey shirt

 

How Can Ankle Injuries Be Prevented?
To reduce your chances of spraining or re-injuring your ankle follow this advice.

Keep the muscles around your ankle strong and flexible. 

Here are some tips to help you…

Wear suitable shoes – make sure your shoes are as comfortable as possible and suitable for the activity you are doing. Having incorrect footwear can increase your risk of re injury if the footwear is not stable enough. This is not the time to test those new high heels!

Exercise – try to incorporate strength and flexibility exercises into your training and have days off from intense exercise so your ankle will have time to recover and become stronger.

Many ankles are reinsured when someone tries to increase the load and go back to harder activities. Exercise programs should include proprioceptive, balance. Strength, plyometric and sport specific applied in a graded way and progressed based on clear milestones. Ask you physio to help you know where you are and what your next step is.

Bracing/ taping – sometimes a brace or tape is needed as you return to sport. Our aim should always be to rehab the ankle to a standard that you no longer require tape. 

Warm up – warm up and stretch before you take part in any exercise as this gives your muscles time to adjust to what you are doing.

How Long Can Ankle Sprains Last?

As mentioned above most ankle sprains will resolve between 8-12 weeks to fully heal however people may still experience niggly or severe pain if they have not adequately rehab the injury. It’s not just about the tissue healing. Physio/sports therapy helps you regain the moment, strength and proprioception needed for a fully functional ankle.

 

How Can A Sprained Ankle Get Worse?
If you leave an ankle sprain untreated or ignored pain this can lead to ankle instability and increase your chances of reoccurrence. 

Progressing too quickly through your ankle rehab without hitting basic milestones may put it at risk of overriding it too much before it’s ready.

Examples of milestones are..

  • pain and swelling well controlled 
  • strength testing 4+/5 on a manual muscle test 
  • adequate balance on a clock test 
  • This helps guide us to when it’s safe to return to harder activities. 

man playing golf

 

 

How Can I Reduce Swelling?
You can reduce swelling by doing gentle range of movement exercises as this acts as a muscle pump and disperse any swelling. 

 

How Can You Strengthen Ankles?
Strengthen the muscles that support the ankle joint such as your calfs and foot intrinsic muscles especially. Simple exercises such as heel raises, balance and isometric exercises are good place to start once ligament ruptures/ severe tears have been rule out. 

 

How Do I Rule Out That My Ankle Pain Isn’t Caused By Infection?

A doctor can rule out infection as a cause of your ankle pain.
Factors which can increase chance of infection are:

  • An existing bacterial infection elsewhere which can spread to the joint through the bloodstream
  • Prosthetic joint implants, ankle joints are particularly susceptible. The infection rate for this is 9%. If this does occur implant will need to be removed.
  • Certain chronic illnesses such as diabetes or any disease which weakens the immune system.
  • Existing problems with the ankle joint such s rheumatoid arthritis or osteoarthritis.
  • Recent ankle injury
  • Insect bite
  • Recent arthroscopic surgery. 

 

When Can I Walk After An Ankle Sprain?
If you’ve suffered from an ankle sprain, you may be confused when your doctor or physiotherapist recommends walking on it. Resting an injured ankle is wise immediately after, however the latest data suggest that you will hugely benefit from walking on a properly supported ankle as soon as possible.

 

When Can I Run After An Ankle Sprain?
Since running is an activity which requires a lot of work from the ankle ligaments it’s not ideal to try to run immediately after a sprain or before healing has run its course. 

There is no set timeline for when you can start running again but if you can say yes to the following questions, you may consider taking it slow and seeing how your ankle responds to a short run:

  • Are you pain free when walking on the ankle?
  • Are your pain free when taking the first few steps when attempting to run?
  • Have you pursued physio therapy on your ankle at least once a week?
  • Have you gained confidence in the stability of your ankle?
  • Has bruising, swelling or discolouration significantly reduced or totally disappeared?

So if you can answer yes to those questions above then you can see how your ankle copes with a short run. Your guided return to run should be guided by a physio/sports therapist and will often involve a run/ walk program. Be sensible, as you don’t want to overdo it, especially if you haven’t run for a long period of time. Stop if something doesn’t feel right even if you don’t experience pain in the area. 

woman running

 

When Can I Return To Sport After An Ankle Sprain?

Return to sport after an ankle sprain is determined by the type of injury and whether you have 

As a general rule we like strength to be at least 85% compared to the non affected side. 

We strive for range of movement (ROM) to be at least 90% of the opposite side.

Balance on eyes closed single leg stand to compare left and right. 

You probably started this article looking for answers to try and do this alone. If you have made it this far you have managed to consume over 2000 words! 

The truth is this article has barely scratched the surface.

There’s many components that influence recovery and these are always tailored to you as an individual.

If you want to save valuable time, avoid pain and set backs then it might be best to access 1-1 expert help to ensure achieve the best long term results then why not book a discovery call?

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