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Ankle sprain information and exercise sheet

Hands On exercise sheet front page

Issue 12 (Hands On Series 6) Summer 2012

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This information and exercise sheet should be used as a guide to recovery following a simple ankle sprain. It will not treat all ankle problems. It is ideal for use after you have seen your doctor or physiotherapist and been diagnosed with an ankle sprain. If you have any concerns it is important that you discuss these with your doctor or physiotherapist.

Initially follow the procedure known as PRICED (Protect, Rest, Ice, Compression, Elevation, Drugs). For the first 24–48 hrs the ankle will be painful and swollen. This can be minimised by resting with the foot elevated and applying some compression (e.g. an elasticated bandage) and icing (e.g. a bag of frozen peas wrapped in a towel applied for 15 minutes every 2 hrs).

After 24–48 hrs it is important to get the ankle moving. This includes walking, slowly increasing the amount of time you are on your feet. It is important to maintain a good range of movement, so start stretching the calf of the injured leg (Exercise 1) and ‘alphabet writing’ (Exercise 2). Next you need to strengthen the muscles that turn the ankle outwards (Exercise 3). Then you need to get your ankle balance working well (Exercise 4) before starting some sport-specific exercises as described at the end of this sheet.

Exercises

1. Range of movement: calf stretch

(a) Place a towel around the ball of your injured foot, and pull gently towards you until you feel a stretch in the calf. This should be held for 10–20 seconds (start with shorter times if needed and gradually progress) building up to doing this 10–20 times twice a day.

(b) When you can comfortably bear weight on the injured foot, stand facing a wall. Step back with your injured leg, ensuring your toes are pointing straight towards the wall. Push your hips slowly forwards until you feel a stretch in the calf. Hold the stretch for 20 seconds, and repeat 10 times twice a day. Depending on recovery you may need to build up to this slowly.

2. Range of movement: alphabet writing

While seated ‘write’ the alphabet with your big toe by only moving your ankle. Write the whole alphabet twice a day.

3. Muscle strengthening

It is important to strengthen the muscles that turn the ankle outwards. Make a loop out of a piece of elastic fitness band, and anchor it either with a table leg or with your other foot.

Place your injured foot in the loop. Keeping your heel fixed on the ground, turn your toes outwards against the resistance. Bring your foot back to the original position slowly. Build up to 3 sets of 10 movements twice a day.

4. Balance training

This is the most important part of the rehabilitation in preventing sprains in the future.

Using a stable object such as a kitchen counter top for support start balancing on the injured foot. Build up how long you can do this for, aiming for 3 sets of 1 minute at least twice a day. In addition try to make the most of any opportunities to practise standing on one leg, as by building this into your daily activities you will get better at this faster.

When you feel confident with this, you can make the exercise harder by standing on a cushion. Again build this up slowly. When you can easily balance on this, if you are confident go back to standing on the floor and repeat the initial balance exercise with your eyes closed.

Returning to sport

So far you have worked on generally conditioning your ankle for daily life. The timing of returning to sport will depend on the particular demands of your chosen sport. It is important to look at the specific demands of your sport on your ankle, and ensure your ankle can manage these demands before returning to play. For example the demands on an ankle in a sprinter are very different to those of a footballer, who is constantly changing direction and kicking a ball. When you have worked through the exercises above, and your balance is good, break down your sport into simple blocks, and try doing them in a safe environment. For example a footballer needs to be able to run on an unstable surface and change direction while kicking a ball. Start with running in a straight line, initially jogging, progressing to short sprints. Then move on to zig-zag running through cones. Add a ball and dribble through the cones. Then return to a non-contact training session, and if all goes well introduce short periods of play, building up to a full game. It is best to start each new stage on a hard, flat surface before moving onto an uneven surface such as grass, once you are sure that your balance is good.

The building blocks will be different depending upon what sport you play. A distance runner will need to work more on endurance rather than adding in sudden changes of direction; netball or basketball players will need to add in more stop/ start movements and twisting.

It is important that you follow medical advice, and if you are not progressing or have any concerns that you have a review with your doctor or physiotherapist.

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