Sprained Ankle Rehabilitation Stage 3
AKA: Ankle Sprain

Common Signs & Symptoms
Pain	Swelling	Stiffness	Weakness	Instability	Locking

Injury in Brief

Injury in Depth

Rehabilitation

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Stage 1: Acute Stage

Stage 2: Sub-Acute stage (days 3 to 14)

Stage 3: Early Rehab (week 3)

Stage 4: Late Rehab (week 4)

Stage 5: Functional Rehab (week 5+)

After two weeks most of the rehabilitation is achieved through active exercise, although the physiotherapist may help regain range of movement by carrying out passive mobilising techniques. This involves the physio gently moving the bones of the ankle to help restore range of movement and relieve stiffness.

Exercise 1	The first exercise is to help restore the ankle's range of movement. Sitting on the floor, the ankle is pumped forward and back. 20 repetitions, 5 times daily. The patient progresses to doing the same exercise while sitting on a high bench or chair, letting the feet hang down.
Exercise 2	This exercise uses a Resistance Band to strengthen the dorsi flexor muscles that pull the toes back towards the knee. Sitting on the floor, a resistance band is tied around the foot, with the other end attached to a fixed object in front of the foot. Slowly the foot is pulled back towards the knee. 20 repetitions, 5 times daily. As this becomes easier, the Resistance Band is changed to one that provides more resistance. Tip: Doubling up the resistance band is an easy way to achieve more resistance.
Exercise 3	This exercise is designed to strengthen the plantar flexor muscles that push the foot down, such as when pushing the peddles of a car. Sitting on the floor, with the legs out straight, a Resistance Band is tied around the foot, and the other end held in the hand. Slowly, the foot is pushed forward and then relaxed. 20 repetitions, 5 times daily. Again, as this becomes easier, the resistance level of the resistance band is increased.
Exercise 4	This exercise is a progression of the previous plantar flexor strengthening exercises. The patient stands with their hands resting against a wall so that it is taking some of their body weight. With both feet, the patient pushes up on the toes so the heels rise up off the floor. This position is held for 2 seconds and then the heels are slowly lowered. 20 repetitions, 5 times daily. Once this becomes easier, the same exercise is done but without any hands against the wall. Once this has been mastered, the patient progresses to doing the exercise with the toes positioned on a block, so that the heels have to come down lower before pushing up. The final progression to this exercise is to do it on the affected ankle alone.
Exercise 5	This exercise is designed to strengthen the evertor muscles that enable the foot to turn outwards. Standing up, the base of the foot is turned outwards, held for 2 seconds and then relaxed. 20 repetitions, 5 times daily.

Apart from mobilising and strengthening exercises, the rehabilitation for a sprained ankle can be greatly enhanced by practicing what are called proprioception exercises. These enhance neuromuscular control around a joint and are very important to the professional sportsperson. These exercises should be started as soon as pain allows.

Proprioceptive exercise

The patient balances on the affected leg while partial weight-bearing. This should be done for 1 minute, followed by rest periods to avoid muscular fatigue.

Proprioception exercises can be done while partial weight-bearing first, then progressed to full weight-bearing, such as using a Wobble Board (below). The Wobble Board together with Ankle Brace are commonly used in the rehabilitation of ankle instability. Wobble boards are designed to assist the re-education of the proprioceptive system by improving sensory nerve function. Research has shown that wobble board training improves single leg stance ability and balance, while other studies have suggested that patients with ankle instability who underwent wobble board training experienced significantly fewer recurrent sprains during a follow-up period than those who did not follow the training programme.

Proprioceptive exercise