Lets Talk Ankle Rehabilitation

With running and soccer season in full swing, one of the more common injuries involved is both sports is the dreaded “rolled ankle” that can limit full participation for the the rest of your season.

At the same time, this isn’t the end of the world. If you rule out complications through guideline testing (Ottawa Ankle Rules), rehab of the condition is fairly straight forward, and can get you back to your sport in a much stronger state.

In many acute injuries, a mild decrease in the inflammatory response is recommended for better ROM and increase in function, especially in getting through your everyday tasks. It also can give a more reliable indicator of the integrity of the ankle, since many ligamentous tests can not be properly done if the ankle is completely swollen on initial testing. In the past I’ve found acupuncture as a successful passive modality, providing a visible reduction in swelling and bruising while also improving function. At the same time, time tested icing and elevation procedures can be used but shouldn’t be heavily relied on.

After a reduction in swelling and acute factors, a multi modal approach to care should be established. A few key points highlighted from the recent evidence based guidelines on ankle rehab are:

  • 1) Bracing: Especially during the early rehab portion of the exercise program, avoiding complete immobilization of the joint in the early stages of the injury.

  • 2) Supervised exercise-based programs: With a gradual increase in difficultly in the following weeks with many resistance methods (isometrics, eccentrics, etc.)

  • 3) Re-gain normal range of motion (ROM): The most important being dorsiflexion (raising your foot up towards the shin) as it is fairly limited following an ankle injury and is a risk factor in re-occurrence if not properly re-established

  • 4) Proprioception. You can’t stress this enough. Training your body ability to sense the position of the joint in space will help it to be reactionary to external forces before it leads to an injury.

While every ankle case is different, the points above are a good ballpark estimate on how to tackle the issue. Below is the guideline study listed for additional information.

Reference: Vuurberg G, Hoorntje A, Wink LM, et al Diagnosis, treatment and prevention of ankle sprains: update of an evidence-based clinical guideline Br J Sports Med Published Online First: 07 March 2018. doi: 10.1136/bjsports-2017-098106