Physiotherapy: Ankle Instability and Chronic Ankle Sprains
Ankle sprains are one of the most common injuries, particularly in the sports population. In fact, the ankle joint is the second-most likely body part to be injured in sport.
When you sprain your ankle, your ligaments, which are made up of multiple strands of connective tissue, stretch and sometimes tear. Without proper rehabilitation, sprains can lead to chronic ankle instability.
Undergoing physiotherapy after an initial ankle sprain decreases the chances of this injury recurring.
The main causes of chronic ankle instability following a sprain are a lack of movement and a loss of strength in the ankle. Both of these aspects can be resolved with an effective physio rehabilitation plan. Often, the rehabilitation program determines the success of future function and athletic performance.
Rehabilitation during days 1 through 5 should focus on protection of the injured tissue. After this, supervised and protected stress may be applied from days 6 to 42.
The primary goals of any rehabilitation program will be to decrease pain, inflammation and to protect the joint. Similarly, your rehabilitation program will aim to return your range of motion, muscular strength, power, and endurance.
Although the time required for recovery is different for each patient, healing of the ligaments usually takes about four to six weeks. Swelling, however, may be present for several months.
Reducing Chronic Ankle Sprains Through Exercise
Specific functional exercises are important to stress the healing tissue. In most cases, you can start ankle rehabilitation exercises three days after the ankle injury. That is, if it’s not too severe. Your physiotherapist can deliver you the right treatment plan for your body and the severity of the sprain.
For the first three days, you’ll need to rest and apply an ice pack to the injured ankle for 10 to 15 minutes every few hours. Be careful not to let the ice touch your skin and don’t leave it on longer as complications can occur, such as a skin burn. Check the skin every five minutes.
After that, your physiotherapist will prescribe an exercise regimen. For non-athletes, these exercises can often be performed unsupervised at home. Athletes usually benefit most from hands on care.
The types of exercises for a sprained ankle focus on increasing your range of motion, stretching and strengthening the muscles and ligaments surrounding the ankle joint, and improving your balance.
If you are healing at home, we'll likely ask you to perform a variation of these exercises.
These are all simple motions you can do up to 5 times per day to help improve range of motion and increase flexibility and strength in your ankle. None of these exercises should cause any pain. If you begin experiencing discomfort in your exercise regimen, consult with your physiotherapist before continuing.
#1 - Ankle Alphabet
Seated on the couch or in a comfortable chair, extend your leg out and trace the letters of the alphabet in the air with your big toe. Repeat this 2 or 3 times as tolerated by your ankle. This is a gentle exercise that encourages your ankle to move in all directions. Ensure you guide yourself with your big toe, causing movement at your ankle.
#2 - Knee Motion
Seated in a chair with your foot flat on the floor, slowly move your knee from side to side for 2 to 3 minutes. This stretches and relaxes the ligaments around your ankle.
#3 - Towel and Tissue Scrunches
While seated in a hard back chair, place a small towel or tissue on the floor at your bare feet. Gently grab the towel with your toes, scrunch it up, and count to 5. Release the towel and repeat 8 to 10 times.
#4 - Towel Stretch
Seated on the floor with your leg stretched out in front of you, wrap a towel or strap around the ball of your foot. Gently pull back on the towel so your toes move toward you and hold the stretch for 15 to 30 seconds.
#5 Standing Calf stretch
Facing a wall or countertop in an upright position, place your injured ankle about one step back and your healthy foot forward. Place your hands against the surface to keep balance. With your back heel flat on the floor, slowly bend the knee of your strong leg until you feel a moderate stretch in the calf on the injured side. Repeat this 3 times, holding for 30 seconds.
#6 - Heel Raise
With your hands in front of you and resting against a wall, countertop, or chair back for support, place your feet shoulder width apart. Slowly rise up on your toes and come back down. Try about 10 of these at first and work up to 20 or more as directed by your physiotherapist.
#7 - One Leg Balance
With your hands on a wall, countertop, or chair back, lift your strong leg up behind you so that your weight rests on the leg with the injured ankle. Try to hold this for 20 to 30 seconds. As you get stronger, your physiotherapist may recommend trying this exercise with less support.
#8 - Balance with Eyes Closed
Repeat the basic balance exercise with your eyes closed. This is much harder without visual points of reference to help you balance. Be sure to have something immediately available for support. Again, start with a few seconds and build up to one minute.
Your physiotherapist may also prescribe exercises using equipment such as an elastic band or pillow. We do not recommend attempting these exercises on your own until shown how to perform them properly.
Modalities to Improve Chronic Ankle Instability
In the past, hard casts were often used to treat chronic sprains. However, research has shown that casts slow down recovery in many cases. Now, braces are used most often in conjunction with physiotherapy.
Kinesiology tape and elastic bandages are also effective for treating chronic sprains. One of our kinesiologists can show you the best methods for compression wrapping your injured ankle to support movement throughout the day.
Swelling and pain are treated with modalities such as ice or electrical stimulation. If the swelling is severe, your physiotherapist may apply massage strokes from the ankle toward the knee while your leg is elevated. This helps move excess tissue fluid out of the ankle and back into circulation.
Disc training using a circular platform with a small sphere underneath is also effective under supervision. While sitting or standing, you'll place your feet on the platform and work your ankle by tilting the disc around. This exercise strengthens the muscles around the ankle, improves balance and sharpens your joint position sense.
Don't Let Chronic Sprains Stop You!
Whether you're an athlete or not, we're on your team when it comes to keeping chronic sprains at bay. Give us a call anytime Monday to Friday at 1(833)-U-R-HEARD or book an appointment to work with our team here. We'll have you back on both feet in no time, we promise.
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