All About Ankle Sprains - Taping video at the bottom!
Updated: Mar 5
About Ankle Sprains
Ankle sprains are one of the most common injuries to the lower body. The most common way to sprain an ankle is by stepping onto an uneven surface and rolling the outside of the foot inward. Ankle sprains can be as minimal as including mild swelling and pain for a few days, or as severe as to completely tear apart one or more ligaments into two pieces. Ankle sprains can involve any number of the four ligaments supporting the joint. Dr. Campbell has a great deal of experience with helping people rehabilitate themselves following an ankle sprain. If you sprain your ankle, come on in and Dr. Campbell will do her best to help you!
What Is A Sprain?
A “sprain” is a term used to describe the tearing of a ligament. A ligament is a tough fibrous connective tissue that attaches two bones together on either side of a joint. Ligaments serve to stabilize the body and hold joints together during movement in all directions. Healthy ligaments have elasticity which protect them from tearing during normal joint ranges of motion. If a ligament is stretched beyond the elastic fibers’ capacity, the ligament becomes torn. Once a ligament is torn, it heals mostly with scar tissue, replacing elastic tissue. Scar tissue is rigid like an elastic band that has gone stale, and tears easier than normal healthy tissue when the same forces are applied. Therefore, the joint loses it’s normal range of motion and undergoes an inflammatory process, making the joint more susceptible to movement restriction and future injury.
The Phases of Healing – A Brief Overview
It’s important to remember that the healing process has different phases. The initial phase of healing involves inflammatory products cleaning up the area and swelling to splint the joint, protecting it from further damage. In the second phase, the ligament starts to regenerate it’s tissue into a less-elastic scar tissue. The final phase involves scar tissue remodelling, depending on the degrees of movement you take your ankle through.
In this remodelling phase, you will benefit the most from the ankle stabilization exercises listed below. At this point, inflammation and swelling are decreased enough to move the joint through full ranges of motion. Therefore, the natural healing process will not be hindered, nor should further swelling occur.
How Does Exercise Fit Into The Healing Process?
In the remodelling phase, scar-tissue develops to only allow the ranges of motion that you move the joint through. When you blow up a balloon, the elastic tissue of the balloon will only stretch as far as you take it. If you don’t blow up a balloon for a long time, it becomes tougher and will not blow up to the same degree as originally possible. Likewise, if you don’t rehabilitate a sprained ankle and stress the scar tissue’s capacity through normal ranges of motion, the scar-tissue will not allow full motion once healing is complete. Therefore, it is important to move the joint through full normal ranges of motion and perform rehabilitative exercises while the scar-tissue is remodelling. This will allow the joint to have as close to normal function and motion as before the injury, and future injuries will be less likely.
Why Should I Do Rehabilitative Exercises After A Sprain?
Once the ligament is torn and the elasticity is diminished, it is important to rehabilitate the ankle joint as soon as possible in order to minimize inflammation, remodel the scar-tissue to allow full range of motion, and to maximize the function of the muscles controlling ankle movement. The main goals of ankle rehabilitation is to ensure that all of the structures surrounding the joint (muscles, healthy ligaments, proprioceptors) are in the best shape possible to prevent future ankle injuries.
You can consult with Dr. Campbell as to what phase of healing your ankle is in, in order to determine whether or not your ankle joint is ready for you to initiate these exercises following an ankle injury.
The Ankle Stabilization Exercises
Here are the ankle stabilization exercises! Remember to only perform them as long as you do not have pain while performing them. It is always a good idea to put a towel-covered ice pack on your ankle for 10 minutes following these exercises. The ice will help to minimize inflammation from the scar-tissue remodelling process that the exercises will initiate.
1. Range of Motion: The first thing to do when rehabilitating a sprained ankle is taking it through it’s full range of motion. The goal of the range of motion exercises is to ensure the ligaments have enough elasticity, regardless of the scar tissue formation, to allow for normal movements. Here’s how:
extend your ankle and bring your toes up and back toward your knee. You can deepen this motion by using your hand to pull back on your toes. Flex your ankle by bringing your toes down so that the top of your foot is being stretched and arched downward. You can deepen this motion by using your leg muscles to point your toes downward. Turn your foot inward, carefully. This is the action that you likely did while your sprained your ankle so do this motion slowly and gently. Turn your foot outward.
2. Proprioception: Proprioceptors send nerve signals to your muscles about the position of your joints when stationary and moving. They have information about what normal motions to allow and what motions to not allow. When unnatural motions occur, the proprioceptors send signals through nerves to your muscles to trigger them to stop this unnatural motion. Stopping the motion is your body’s way of protecting your joints from injury.
The goal of the proprioceptive exercises is to re-train your muscular reflexes to protect your ankle joint when any unnatural movement occurs in the future. To do this, you will need to stand on an unstable object. It’s just like riding a bike; the more you practice on with an unstable object (i.e. bike), the more your natural reflexes will take over and the action will feel natural. It is a good idea to stand beside a chair or counter top that you can hold onto to prevent a fall. Here’s how to do the exercises:
stand on the injured-side-foot on a Bosu ball for 30 seconds. Once you can stand for 30 seconds without stepping off, try adding small squats (still standing on the injured-side-foot).
3. Resistance training for the surrounding muscles: Last but not least, it is important to strengthen all of the lower leg muscles that surround the ankle joint. For the following exercises, you will need some surgical tubing. You can get this at most medical health stores or pharmacies.
Tie the ends of the tubing together to form a circle. Encircle your injured-side foot with the tubing and placing the other end of the tubin around the bottom of a chair leg. Move away from the chair until you feel some non-painful resistance on the end of the tube around your foot.
Now you are going to only use your leg muscles to move your ankle through the ranges of motions listed above. Hold your ankle at the end of each motion, the maximum flexion/extension/internal/external your foot can go, without using your hand to assist, for 30 seconds. Perform this in each direction 1-3 times per day.
As always, I hope you found this article useful. I look forward to reading your comments, questions, and any experiences you would like to share!
Author: Casey Campbell BSc., D.C.