Wellness & Lifestyles Australia

ANKLE SPRAIN REHABILITATION

E-BOOK
Prepared by: Daniella Kittel

2007,2008,2009

Table of Contents

Page No.

IMPORTANT NOTICE ................................................................................................................. 1

INTRODUCTION ...................................................................................................................... 2
ANKLE ANATOMY AND ANKLE SPRAIN INJURY ................................................................................... 3
Anatomy .................................................................................................................... 3
Injury ........................................................................................................................ 3
ACUTE TREATMENT AFTER ANKLE SPRAIN ....................................................................................... 4
Goals......................................................................................................................... 4
REHABILITATION AFTER ANKLE SPRAIN........................................................................................... 5
Stretching................................................................................................................... 5
Strengthening .............................................................................................................. 9
Balance.....................................................................................................................11
ADVANCED REHABILITATION AND RETURNING TO ACTIVITIES ............................Error! Bookmark not defined.
SUMMARY ........................................................................................................................... 16
CONTACT US ....................................................................................................................... 17

MANUAL LAST MODIFIED 25/02/2011

IMPORTANT NOTICE
The information provided in this document can only assist you in the most general way. This document
does not replace any statutory requirements under relevant State and Territory legislation.
Wellness & Lifestyles Australia (W&L) accepts no liability arising from the use of, or reliance on, the
material contained in this document, which is provided on the basis that the Office of W&L is not thereby
engaged in rendering professional advice. Before relying on the material, users should carefully make
their own assessment as to its accuracy, currency, completeness and relevance for their purposes, and
should obtain any appropriate professional advice relevant to their particular circumstances.
To the extent that the material in this document includes views or recommendations of third parties, such
views or recommendations do not necessarily reflect the views of the Office of W&L or indicate its
commitment to a particular course of action.
Copyright Australia 2009
This work is copyright. You may download, display, print and reproduce this material in unaltered form
only (retaining this notice) for your personal, non-commercial use or use within your organisation. Apart
from any use as permitted under the Copyright Act 1968, all other rights are reserved.

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INTRODUCTION
Welcome to the W&L series of e-Books. You have chosen the edition on ankle sprain rehabilitation.
This resource will be beneficial to:

Anyone who is interested in the anatomy of the ankle

Anyone who plays sport with a high risk of ankle sprains
Anyone who has had an ankle sprain in the past and wants to avoid a reoccurrence
Anyone who has sprained their ankle recently and requires rehabilitation

This e-Book will cover information about the anatomy of the ankle and what can be injured in an ankle
sprain. It will also provide a rehabilitation program for ankle sprains.
The information provided is up to date and follows industry standard. W&L recommend that you continue
to consult your doctor and physiotherapist so that your progress can be monitored and program tailored to
your specific requirements.

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ANKLE ANATOMY AND ANKLE SPRAIN INJURY

Anatomy
The ankle is made up by the two bones in the lower leg (tibia and fibula), the heel bone (calcaneus) and a
talus which is in the middle. Connecting these bones is a series of ligaments. The ligaments on the inside
aspect of the ankle are stronger than the ligaments of the outer aspect which is why the outer aspect of
the ankle is easier to injure.

Diagram taken from:

LARS Ligaments.com & JK Orthomedic LTD (2004-2007), About Ankle Ligaments, viewed 16th March 2011
http://www.larsligament.com/about_ankle_ligaments.html

Injury
By definition, a sprain, is a damage to ligaments.
The outer aspect of the ankle can be sprained when the foot rolls so that the heel faces inwards. Although
the ligaments are usually the main focus of ankle sprains, the surrounding muscle, bone, capsule and
nerves can also be affected.
There are three grades of ligament injury:
1. Micro tear where <5% of fibres are torn
2. Partial rupture where 5-95% of the fibres are torn
3. Complete rupture where >95% of the fibres are torn

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ACUTE TREATMENT AFTER ANKLE SPRAIN

Goals
The main goals for the first 2-3 days are to be able to reduce the swelling and inflammation.
Most effective is the RICER technique:

Rest: Dont put weight through your injured leg and avoid any activities which cause pain.

Ice: Use ice packs or ice wrapped in moistened cloth on your injured ankle for 20 minutes every 2
hours. Continue for 2 3 days.

Compression: Wrap a tubigrip bandage around your ankle firmly (but do not cut off circulation) to
reduce swelling. It is best to apply ice in conjunction with compression also.

Elevation: Keep the ankle resting above the level of the heart (best achieved laying down with a
pillow under the ankle) to reduce blood pooling in the area.

Referral: See a doctor or therapist as soon as practically possible to commence treatment and to
determine the extent of your injury.

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REHABILITATION AFTER ANKLE SPRAIN

You should see a physiotherapist so that they can commence you on a rehabilitation program and structure
one specific to your needs. There are different stages of rehabilitation and the amount of exercise needs
to be moderated as you improve.
The basic elements of an ankle rehabilitation program include: stretching, strengthening and balance and
proprioception. Your physiotherapist can advise which exercises are suitable for you at each point of your
rehabilitation program.

Stretching
The following set of exercises is designed to stretch your ankle in different directions and ensure that you
retain your range of movement in your ankle as it is healing. This is important to limit the amount of scar
tissue formed.
Ankle dorsiflexion draw your toes towards the ceiling and use an exercise band to help pull them up
further. Hold for 30 seconds and repeat 3 times a day.

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Ankle plantar flexion point your toes downward only to the point where you begin to feel an increase in
pain. As you improve, you can use your hand to help push your foot down further. Hold for 30 seconds and
repeat 3 times a day

Ankle inversion use your hand to point your toes downward and turn your foot so that the sole is facing
inwards only to the point where you begin to feel an increase in pain. Hold for 30 seconds and repeat 3
times a day

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Calf muscle stretch I stand in a lunge with your injured leg leading (with only a small amount of weight
going through your injured leg). Do a small squat so that your knee goes over your toes. Make sure your
heel stays planted. You can use a chair or wall to hold yourself steady and take some weight if desired. Do
this exercise only to the point where you begin to feel an increase in pain. Hold for 30 seconds and repeat
3 times a day

Calf muscle stretch II stand with the foot of your injured leg slightly angled inward but your knee
pointing straight ahead. Take a step forward with your good leg and keep your injured leg straight with
your heel planted. You should feel a slight stretch in your calf with this exercise. Hold for 30 seconds and
repeat 3 times a day

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Sitting on haunches kneel on a bed or sofa with your injured leg against the floor. Gently sit back onto
your bad leg until you feel a slight stretch at the front of your ankle. If desired, use one or more pillows
between your bottom and leg until you are able to reach lower. When comfortable, you can perform this
exercise with both legs against the floor. Hold for 30 seconds and repeat 3 times a day

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Strengthening
The following exercises are designed to strengthen the muscles surrounding your ankle to provide your
ankle with more support.
Raising onto toes in standing, raise both feet onto your toes with a focus on control. A chair or bench
surface can be used for balance. Repeat 10 times. This exercise can be varied by changing the amount of
weight in your injured leg or doing it on your injured leg only. A further challenge is gained if your heel
starts below the level of the step before you rise onto your toes. Progressions include adding weights.

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Ankle twists in sitting with the heel of your injured leg planted, turn your toes inwards and hold then
turn them outwards and hold. Make sure that the movement is coming from your ankle and that you knee
is stationary. Hold each position for 10 seconds and repeat 10 times each side.

Advanced ankle dorsiflexion in sitting on the floor with straight legs, draw your toes towards your body
and hold for 15 seconds. Repeat 10 times. Make this exercise harder by pulling your toes against an
exercise band.

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Balance
The following exercises are designed to improve your balance and coordination. This part of rehabilitation
is crucial for preventing further ankle sprains as it retrains you brain to control your ankle.
Alphabet tracing in sitting with legs crossed, draw each letter in the alphabet with your big toe. Focus
on controlling your ankle movement, this can be made harder by making the letters smaller or closing
eyes.

Controlled rolling in standing, have a small amount of weight going through your injured ankle. Roll your
injured foot onto the outside border so that the inside part of your foot is lifting up. Only roll until you
reach about of your range and then replace your foot flat on the ground. Repeat this exercise 10 times
with your eyes closed, focussing on moving your ankle the same amount. Make the exercise harder by
putting more weight in your injured leg, rolling your ankle more, doing it barefoot, doing the movements
faster (with the same control) or doing it on an incline.

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Balancing with support at hand, start standing on the injured ankle (i.e. on one foot) with your knee
bent slightly. Aim for 10 seconds. When you can achieve this, make it harder by standing on a
pillow/wobble board, closing your eyes, tilting your head back, standing on tip-toes or catching a ball.
Combinations of these options, will progress your ability.

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Trampette position this besides a wall or steady surface (but be sure not to fall onto them). Practice
balancing on your injured leg and progress as above. Try doing gentle jogging. Do some small jumps and
then progress to hopping (try hopping and turning).

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Body twisting balance on your injured leg and twist your upper body, relying on your ankle to control
your balance. Make this exercise harder by closing your eyes, swinging your body faster, holding arm
weights or standing on an incline. Repeat 30 times each side.

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Hopping before hopping, practice jumping and when you feel confident, you can commence hopping on
your injured leg. Try to do 15 in a row or as pain tolerates. Make this exercise harder by hopping higher,
using a skipping rope, hopping on a slight incline, hopping in different directions or hopping on/off steps.

Running run in different directions and practice agility by stopping suddenly or changing directions.

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SUMMARY
In summary, ankle sprains are fairly common and can range in the severity and involvement of different
ankle structures.
Early treatment aims to reduce inflammation, swelling and pain. Rehabilitation exercises will work to
increase the range, strength and coordination in your ankle. Rehabilitation progresses to become more
challenging by involving actions that are required to return to sporting activities by the end of the
program.
Please use this resource as a guide to your rehabilitation in consultation with your therapist.
All the best for a speedy recovery,
The W&L Team

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CONTACT US
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P: +61 08 8331 3000
F: +61 08 8331 3002
E: contact@wellnesslifestyles.com.au
W: www.wellnesslifestyles.com.au www.wleducation.com.au
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