Ankle sprains are a common injury for a majority of sports but the highest incidence rates are found with basketball, volleyball, soccer, baseball and gymnastics. Depending on the severity, you could be out of the game for as little as 1 week to 8 weeks or more.
In order to ensure proper recovery from an ankle sprain, let me take you through an 8-step return to play overview for an ankle sprain to help you avoid continuously turning your ankle and suffering from chronically a ‘weak’ ankle.
A laterally sprained ankle occurs when one or more of the ligaments on the outer side of your ankle are
torn. If a sprain is not treated properly, you can have long-term problems. This is the most common
type of ankle sprain (typically known as an inversion sprain).
Step 1 Immediate Treatment
Pressure – reduces the swelling in the area and gives support.
Ice- slows down the inflammatory process. (Dr. Keith would disagree with me on this here…)
Elevation – helps reduce swelling and gets blood flowing to the heart (increase venous return).
Rest or Restricted Activity – prevents unwanted movement at the ankle.
Next step is to go for therapy /clinical rehab.
Step 2 Clinical Assessment
At the clinic the initial assessment entails a case history, postural assessment, gait assessment and
functional testing of the ankle joint. The case history includes a variety of questions related to how and when the sprain occurred, where it hurts, what makes it worse/better and past history of ankle injuries.
Next if possible, the therapist will have walk or have you stand. Following this the therapist will test your
range of motion. He /she will see if you can move the foot up or down and side to side. They will then
test your strength and possibly do a few more tests.
Step 3 Protection Phase
Initial treatment may include modalities like ultrasound, laser and PIER to help with swelling, muscle
setting exercises and pain free active range of motion exercises like moving the ankle up (dorsiflexion)
and to the outside (eversion). These need to be done in a clinic setting with a home program to do away
from the clinic when not being treated. In this phase the focus is to decrease, remove swelling and maintain the current range of motion at the ankle.
Step 4 Controlled Motion Phase
In this phase the goal is to regain normal range of motion, flexibility and the introduction to weight bearing and balance exercises. Stretching the calf muscle and actively moving the ankle in all directions.
At this point if the ankle is supported the athlete may get on stationary bike and do 30-45 minutes of
work to maintain a basic level of fitness.
Step 5 Return to Function Phase
In this phase the goal is to integrate total body strength and power exercises such as lunges, squats, single and double hops / jumps in different directions and agility exercises that mimic the movements on the sports field such as stop starts and change of direction.
This phase also includes appropriate aerobic training to reach pre-sport fitness levels. Ideally this should
be ground based; however this may be done a bike.
At this point the athlete may be braced or taped depending on the severity of the injury.
It is in this phase that the athlete may return to the field / ice to do isolated agility drills, stop starts and
change of direction.
Step 6 Field / Ice / Court Training 1 – (This may happen at the same time as Step 5 in the clinic.)
Dynamic Warm up, individual game skills, specific aerobic fitness training. For example if you are a hockey player most shifts are 30 to 45 seconds with about minute and half to three minute rest. You want mimic your work to rest timing as though you are in game.
Step 7 Non – Contact Practice
Work with your team for plays, drills; however there is no contact
Step 8 Full Contact Practice
In this step you are fully engaged as though you were in game.
If you have been successful in the previous steps you are now ready to participate in a game.
Your friendly neighbourhood Athletic Therapist!
Michael Wolfe Grafstein
B.Ph.Ed, RMT, R.Kin, SMT(C), CAT(C)