Sprained Ankle: Rehabilitation Exercises

An ankle sprain occurs when ligaments that connect the bones in the foot, ankle, and lower leg are stretched or torn.

An ankle sprain often happens when you make a rapid shifting movement with your foot planted, for example, when playing soccer or getting tackled in football. Most commonly, the ankle rolls outward and the foot turns inward in what is called an inversion injury. It results in stretching and tearing of the ligaments on the outside of the ankle.

Less commonly, the ankle rolls inward and the foot turns outward in an eversion injury, damaging the ligaments at the inside of the ankle.

See your doctor immediately if you notice any of the following:

• Your foot or leg bends at an abnormal angle.
• You feel severe pain.
• Your foot is cool or pale or changes color.
• You feel numbness or tingling in your foot or toes that lasts after the initial injury.
• You can't move your ankle.

You should see your doctor after an ankle sprain if you notice any of the following:

• You heard a "popping" sound at the time you sprained your ankle.
• You have moderate or severe pain or severe swelling or bruising around your ankle.
• You can't walk or put weight on your affected foot, or your ankle feels unstable.
• You have redness, swelling, or pain in your leg or groin. These can be signs of a blood clot.
• You have no improvement in your ankle after 1 week.
• Your swelling and bruising last more than 2 weeks.

Also be sure to contact your doctor if you have a cast or splint around your ankle that feels too tight.

Continue to Why?

If ligaments do not heal properly after an ankle sprain, the ankle can become weak and unstable and give out with only minor trauma, such as stepping off a curb. Rehabilitation exercises help repair and strengthen injured ligaments.

Continue to How?

Start each exercise slowly and use your pain level to guide you in doing these exercises. Ease off the exercise if you have more than mild pain. Following are some examples of typical rehabilitation (rehab) exercises.

Keep in mind that the timing and type of rehab exercises recommended for you may vary according to your doctor's or physical therapist's preferences.

Range-of-motion exercises

Range-of-motion exercises begin right after your injury. Try doing these exercises then putting ice on your ankle, up to 5 times a day. These are easy to do while you are at a desk or watching TV.

Try the following simple range-of-motion exercises:

• Trace the alphabet with your toe, which encourages ankle movement in all directions. Trace the alphabet 1 to 3 times.
• Sit in a chair with your foot flat on the floor. Slowly move your knee side to side while keeping your foot pressed flat. Continue for 2 to 3 minutes.

Towel curls. While sitting, place a hand towel on a smooth floor, such as wood or tile. Keeping your heel on the ground, curl your toes and grab the towel with your toes to scrunch the towel. Let go, and continue scrunching up the entire length of the towel. When you reach the end of the towel, reverse the action by grabbing the towel with your toes, scrunching it, and pushing it away from you. Repeat, until you have pushed the entire length of the towel away from you.

Stretching exercises

Start exercises to stretch your Achilles tendon as soon as you can do so without pain. The Achilles tendon connects the calf muscles on the back of the lower leg to the bone at the base of the heel. Try the towel stretch if you need to sit down, or try the calf stretch if you can stand.

• Towel stretch. Sit with your leg straight in front of you. Place a rolled towel under the ball of your foot, holding the towel at both ends. Gently pull the towel toward you while keeping your knee straight. Hold this position for 15 to 30 seconds, and repeat 2 to 4 times. In moderate to severe ankle sprains, it may be too painful at first to pull your toes far enough to feel a stretch in your calf. Use caution, and let pain be your guide.
• Calf stretch. Stand facing a wall with your hands on the wall at about eye level. Put the leg you want to stretch about a step behind your other leg. Keeping your back heel on the floor, bend your front knee until you feel a stretch in the back leg. Hold the stretch for 15 to 30 seconds. Repeat 2 to 4 times. Repeat the exercise with the back knee bent a little, still keeping your back heel on the floor. This will stretch a different part of the calf muscles.

Strengthening exercises

Talk to your doctor or physical therapist about the timing of strengthening exercises for the ankle. Typically you can start them when you are able to stand without increased pain or swelling.

Do 8 to 12 repetitions of these exercises once or twice daily for 2 to 4 weeks, depending on the severity of your injury.

• Start by sitting with your foot flat on the floor and pushing it outward against an immovable object such as the wall or heavy furniture. Hold for about 6 seconds, then relax. After you feel comfortable with this, try using rubber tubing looped around the outside of your feet for resistance. Push your foot out to the side against the tubing, then count to 10 as you slowly bring your foot back to the middle.
• While still sitting, put your feet together flat on the floor. Press your injured foot inward against your other foot. Hold for about 6 seconds, then relax.
• Next, place the heel of your other foot on top of the injured one. Push down with the top heel while trying to push up with your injured foot. Hold for about 6 seconds, then relax.

Balance and control exercises

You can usually start balance and control exercises when you are able to stand without pain. But talk to your doctor or physical therapist about the exact timing. Also, don't try these exercises if you could not have done them easily before your injury. If you think you would have felt unsteady doing these exercises when your ankle was healthy, you are at risk of falling when you try them with an injured ankle.

Practice your balance exercise at least once a day, repeating it about 6 times in each session.

1. Stand on just your injured foot while holding your arms out to your sides with your eyes open. If you feel unsteady, stand in a doorway so you can put your hands on the door frame to help you. Balance for a long as you can, working up to 60 seconds. When you can do this for 60 seconds, try exercise number 2.
2. Stand on your injured foot only and hold your arms across your chest with your eyes open. When you can do this for 60 seconds, try exercise number 3.
3. Stand on your injured foot only, hold your arms out to the sides, and close your eyes. If you feel unsteady, stand in a doorway so you can put your hands on the door frame to help you. When you can do this for 60 seconds, try exercise number 4.
4. Stand on your injured foot only, hold your arms across your chest, and close your eyes. Balance for a long as you can, working up to 60 seconds.

Stretching exercises should be continued on a daily basis and especially before and after physical activities to prevent reinjury. Even after your ankle feels better, continue with strengthening exercises and balance and control exercises several times a week to keep your ankles strong.

Continue to Where?

For more information about rehabilitation exercises, talk to:

• Your doctor.
• A physical therapist.
• A sports medicine specialist.