Ankle sprains are common injuries among spring athletes, particularly as they ramp up their training and competition schedules. These injuries often involve the soft tissues around the ankle, including ligaments, tendons, and sometimes muscles. Treatment varies depending on the severity of the injury, but for physical therapists, there are established tools, techniques, and rehabilitation strategies to promote recovery.
Structures Involved in Ankle Sprains
The structures involved in these injuries include ligaments, tendons, and muscles. The lateral ligaments, including the anterior talofibular ligament (ATFL), calcaneofibular ligament (CFL), and posterior talofibular ligament (PTFL), are commonly involved in lateral ankle sprains. The deltoid ligament on the medial side may be injured in eversion sprains.
Tendons such as the peroneal tendons stabilize the ankle laterally and can become strained or injured, especially in more severe sprains. The Achilles tendon may also be affected if the sprain results in a loss of ankle mobility or places excessive load on the tendon during recovery. Additionally, muscles like the peroneus longus and brevis, tibialis anterior, and gastrocnemius play a role in ankle stability and can be strained during the injury.
Phased Rehabilitation for Ankle Sprains
Acute Phase (0–72 Hours)
The treatment approach for physical therapists typically follows a phased rehabilitation process. In the acute phase (0–72 hours), the focus is reducing pain, swelling, and inflammation while protecting the injured structures. This is typically achieved through the R.I.C.E. protocol (Rest, Ice, Compression, Elevation).
Ice is applied for 15–20 minutes every 2–3 hours to reduce swelling, compression with an elastic bandage to control swelling, and elevation to reduce edema. Protective bracing or orthotics, such as a lace-up ankle brace or air cast, may support the ankle and prevent further injury.
Subacute Phase (3–7 Days to 2–3 Weeks)
During the subacute phase (3–7 days to 2–3 weeks), the focus shifts to restoring range of motion (ROM), reducing stiffness, and beginning strengthening exercises. Range of motion exercises like ankle circles and towel stretches can help improve flexibility in the ankle. In contrast, isometric strengthening exercises, such as isometric dorsiflexion and plantarflexion, are introduced to engage the muscles around the ankle without overstressing the joint. Manual therapy, such as joint mobilizations to improve dorsiflexion and soft tissue techniques like trigger point release, can help address any tightness in the surrounding muscles.
Early Strengthening Phase (3–6 Weeks)
The early strengthening phase (3–6 weeks) aims to build strength and stability while introducing weight-bearing exercises. Strengthening exercises, such as resisted ankle dorsiflexion, plantarflexion, inversion, and eversion with resistance bands, step-ups, lunges, and single-leg balance exercises, help improve lower leg strength and proprioception. Proprioception training with balance boards or wobble boards is essential for restoring coordination, and agility drills like lateral shuffles or mini-hurdle jumps further enhance stability.
Advanced Strengthening & Return-to-Activity Phase (6 Weeks to 3 Months)
In the advanced strengthening and return-to-activity phase (6 weeks to 3 months), athletes focus on functional strength and sports-specific training. Plyometric exercises like box jumps, bounding, and hopping drills help improve explosive power and agility. Sport-specific drills, including cutting, sprinting, and jumping, are gradually reintroduced to prepare athletes for their sport. Eccentric strengthening, such as eccentric heel drops, helps strengthen the Achilles tendon and calf muscles. At the same time, a return-to-running program begins with light jogging and progresses to more intense running and uneven terrain.
Maintenance & Prevention
Maintenance and prevention are crucial aspects of the rehabilitation process. Once the athlete has returned to play, regular ankle strengthening exercises and proprioceptive training should be incorporated into their routine to prevent reinjury. Dynamic warm-ups and post-activity stretching will help maintain muscle flexibility, and continuing balance and coordination exercises will improve overall stability.
Effective rehabilitation involves restoring the full range of motion, strength, and proprioception while ensuring the athlete can safely return to their sport. Physical therapists must tailor rehabilitation programs to the athlete’s specific needs, considering both the severity of the injury and the demands of the sport.
Conclusion
If you’ve recently sprained your ankle, CSC+M’s team of NYC physical therapists can help. Contact CSC+M today to schedule an appointment and begin a personalized rehabilitation plan.
