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Ankle Sprain Management

Ankle Sprain Management

Tedd Girouard, MS, ATC
Assistant Outreach Coordinator HealthSouth, Southern Nevada
Brent Mangus, EdD, ATC
Associate Professor University of Nevada Las Vegas

So the doctor has told you that have a sprained ankle. The first thing you want to know is “how bad is my sprain, which grade is it?” Well your doctor should be able to let you know the extent or grade of injury you have experienced. In the sports medicine community, sprains are graded as to the amount of damage done to the ligaments around a specific joint.
A “grade one” sprain is characterized by damage to one ligament in your ankle, the ligament is “stretched” with some damage to the integrity of the ligament itself. The ligament may look close to the original ligament, but it has a different length. A “grade two” sprain is characterized by substantial damage to at least 2 ligaments around the ankle joint. In a grade two ankle sprain there is not a complete tear of any ligament(s). A grade three sprain is the most damaging of all ankle sprains and is characterized as a complete disruption of at least one ligament and substantial damage to some of the other supporting ligaments. Grade 1 ankle sprains may be rehabilitated at home using the following outline. If you have a more substantial injury, please consult a local athletic trainer or physical therapist for more advanced rehabilitation specifics.

Rehabilitation for a Grade 1 Ankle Sprain

Phase 1: Days 1 – 3
– Keep your ankle elevated above your heart and use an elastic wrap to maintain compression on the ankle unless it is being iced or exercised.
– Cool your ankle by submerging the entire foot in a five gallon plastic bucket filled half full with ice and water for twenty minutes.
– After icing your foot, walk as normal as possible in a figure eight pattern for 5 minutes
– Return your ankle to the bucket for 5 minutes
– Next, try to balance on your injured ankle in short time periods for 5 minutes or more. You may want to try to bend your knee during this exercise.

If this is too easy fold a towel in fourths and balance on the towel, this will make it a little more difficult to maintain your balance – Return your ankle to the bucket for 5 minutes
– Next, using your toes, write the alphabet with your ankle from A – Z multiple times
– Re-wrap your ankle with the elastic wrap and repeat the above steps every 2 hours if possible

Phase 2: Days 4 – 6
– While in the elastic wrap try and jog in straight lines for 5 to 10 minutes, if this is too painful then walk for 10 – 15 minutes.
– Spend 5 minutes stretching your calf muscles by standing about one from a wall foot, keep your heels on the floor and lean forward until your chin touches the wall. Keep your heels on the ground and move your feet farther from the wall as you get better at this exercise.
– Perform balance exercises similar to Phase 1 for 5 minutes but try and find a place to throw a ball against a wall to yourself while balancing. This will increase the difficulty of balancing and help to exercise the ankle as needed
– Try to do toe raises for 2 – 3 minutes
– Perform ankle exercises against someone holding your foot. Try to push out, in, up, and down. Do this for 2 minutes, take a short rest, then do again for 2 more minutes
– Have someone throw a ball at your feet and volley the ball back for 3 – 4 minutes
– Following your exercise use the ice bucket for 15 minutes or apply an ice bag directly to your ankle for 30 minutes.
– Repeat the above steps 3 times per day if possible.

Phase 3: Days 7 – 10
Perform these exercises with appropriately applied tape or a commercially available ankle brace.
– Warm up by jogging for 15 – 20 minutes
– Stretch your calf for 2 – 3 minutes
– Find a jump rope and skip for 3 – 5 minutes
– Do some sprinting exercise working from straight sprinting to cutting movements
– Try some jumping exercises like hopping from side to side.
– Ice after your exercise session
– Repeat the above steps 3 times per day.

Once you are able to complete these exercises completely pain free you should be ready to start practice one again. When you return to practice take it slow, try some short runs, and some light passing working up to some longer runs and passing some long balls. The last thing you should work up to is shooting, in particular shooting with the outside of your foot as this will place the most stress on the damaged ligaments. When you are able to do these things without pain, you should be able to return to full speed play.
Use an ankle brace or properly applied tape for the next month, as the ligaments may still not be back to 100% for some time.