Strapping & Taping Guide for Sports Injury Prevention

Guide to the Rehabilitation of the Sprained Ankle Injury

Stage 1: Acute Stage (Days 1 to 3)
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+)

Stage 1: Acute Stage (days 1 to 3)

This ankle rehabilitation programme is an example of the progression followed by a professional footballer with a sprained ankle. The principles of rehabilitation apply to all ankle sprain injuries, regardless of the sport. These principles, together with expert input from a healthcare professional can help you recover safely and quickly following a sprained ankle. The progression of the exercises should be based on pain free completion of the previous exercise. All rehabilitation exercises should be preceded by a warm up.

Follow the PRICE protocol:

Protection

The injured tissues should be protected from further damage. A Removable Plastic Cast is ideal. It provides the same protection as a plaster cast but it is lightweight and can be removed by the patient. All English Premier League football players use removable plastic casts when they suffer a significant ankle injury as it helps protect the joint and limit weight bearing. In the case of Grade 3 ankle sprains crutches should also be used.

Rest

Rest from sports is essential, but even walking on the ankle, if it is painful, may cause further damage and should be avoided. No weight should be put through the injured ankle and crutches should be used. Pain relieving medication prescribed by a doctor may be necessary.

Ice

Ice Packs are applied for periods of twenty minutes every couple of hours (never apply ice directly to the skin). The Ice Packs relieve pain and are thought to reduce bleeding in the damaged tissue. The Aircast Ankle Cryocuff is the most effective method of providing ice therapy and is the professional’s choice. It can provide continuous ice cold water and compression for 6 hours and significantly reduce pain and swelling.

Compression

A swollen ankle is a sign of a significant ankle sprain. The swelling is caused by bleeding in the tissue and a leaking of cellular fluid secondary to tissue damage. If this swelling is allowed to consolidate it can produce excessive scar tissue and structural changes, which seriously lengthens the rehab period. Compression during the early stages helps to reduce swelling and is essential for a good outcome. Compression is provided by the use of a Removable Plastic Cast which has inflatable air cells to massage out swelling, with intermittent use of an Aircast Ankle Cryocuff to provide ice and compression.

Elevation

If the ankle is not elevated the effect of gravity causes the tissue fluid to accumulate at the ankle. This can cause increased tissue pressure which is extremely painful. To relieve pain and prevent excessive swelling, the ankle is elevated above waist height.

If the pain allows, the ankle should be removed from the Removable Plastic Cast and gently pumped forward and back 20 times each hour. This is done by sitting down with the leg elevated and pushing the toes forward and back. This facilitates the dispersal of swelling from the ankle.

Stage 2: Sub-acute stage

The sub-acute stage begins by bearing weight on the ankle to pain tolerance. This is graduated from partial weight-bearing with a Plastic Cast Walker and crutches to full weight-bearing without crutches. A normal walking pattern should be encouraged and there should be no limping.

Ice therapy can be continued so long as there is pain. Compression using the Plastic Cast Walker is continued during walking to encourage the dispersal of swelling. The inflatable air cells of the Plastic Cast Walker have a massaging effect during walking, which helps to resolve swelling. When possible the ankle should be elevated to allow the effect of gravity to help drain swelling away from the injury site. Gentle massage to further encourage the dispersal of swelling towards the back of the knee can also be implemented.

Ankle pumping exercises can be continued and progressed to being done in water. Exercises in water are effective because they involve only partial weight-bearing and because the hydrostatic pressure provided by the water has the effect of encouraging the swelling to disperse.

Exercises in water involve only partial weight-bearing and are effective in helping to disperse swelling.

General fitness is maintained by using a static exercise bike and resistance weight machines in a gym. Exercise bands (Resistance Bands) may also be used to start to encourage range of movement and gentle strengthening exercises. Different levels of resistance can be used so light bands are used at first then as pain, swelling and function all improve the level of resistance can be increased.

Stage 3: Early Rehab (Week 3)

After two weeks most of the rehabilitation is achieved through active exercise, although the physiotherapist may help regain range of movement by carrying out massage and 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 dorsiflexor 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 or a step, 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 Peroneal muscles that evert the foot and enable the foot to turn outwards. These muscles are also vital for proprioception when returning to sporting activities.
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, or anybody returning to sports where landing, twisting and turning are necessary. These exercises should be started as soon as pain allows.
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.
The patient balances on the affected leg for 1 minute, followed by rest periods to avoid muscular fatigue.

Stage 4: Late Rehab (Week 4)

Progressive strengthening of the muscles around the ankle should be continued, as should the proprioception exercises. To prepare for a return to functional activities the intensity of exercise should be increased. The use of an Ankle Brace or Ankle Taping can provide essential support and confidence at this stage.

Taping and Bracing the ankle can help to reduce recurrent ankle injury. A research study has shown the injury incidence in students with taped ankles was 4.9 ankle sprains per 1000 participant games, compared with 2.6 ankle sprains per 1000 participant games in students wearing ankle braces. This compared with 32.8 ankle sprains per 1000 participant games in subjects that had no taping or bracing.

Basic plyometric exercises should be commenced.

Jogging should also commence, and should be progressive as follows:

Day 1: Jog 100 metres, walk 50 metres, with 6 repetitions.
Day 2: Jog 150 metres, walk 50 metres, with 6 repetitions.
Day 3: Jog 200 metres, walk 50 metres, with 8 repetitions.
Day 4: Jog 200 metres, walk 50 metres, with 12 repetitions.
Day 5: Jog 2000 metres.

Stage 5: Functional Rehab (Week 5+)

The progression to functional activities can begin once the patient can jog without pain and is comfortable doing plyometric drills. The idea of this stage is to progress from gentle exercise to the high intensity at which games are played, by breaking down complex movements and strengthening all of the components. All exercises are preceded by a warm up. As each exercise is a progression they should be completed at least one day apart, under the supervision of a chartered physiotherapist.