Throughout my years of working with athletes, I have come to realize that most runners experience a lateral ankle sprain at some point. Unfortunately, when I ask athletes what they have done to rehab, most say “I ice” or even worse, “nothing”. A lateral ankle sprain occurs when the outside portion of the ankle rolls towards the ground.
While performing my assessments, I have found that an untreated or ill treated ankle sprain is the underlying culprit for most other insidious onset of injuries in the lower extremity. It doesn’t seem to make a difference if the ankle sprain happened one month ago or 10 years ago. They all have lasting impact on the mechanics of the body.
If you have an injury, ask yourself, ” have I EVER had an ankle sprain?” “Do I have an injury on the same side as the ankle sprain?”
The moment you feel your ankle roll, an inflammatory response occurs. This inflammatory response induces chemical reactions which allow an increase of fluid into the injured region. Micro tears occur in the muscles and ligaments of the lateral ankle. When proprioceptors are stretched, the body has an increased difficulty communicating the joint position to the brain. This leads to an increased susceptibility to future ankle sprains.
Change in Biomechanics
Swelling takes up joint space, making it difficult to move, and limiting range of motion (ROM). Over time the impaired motion limits joint mobility resulting increased stiffness of the capsule (tissue around joint). The limited ankle dorsiflexion ROM also contributes to instability since the plantar flexed position is unstable due to bony anatomy. Our body, in its attempt to find the path of least resistance, moves through another joint. This leads to injuries in other regions not meant to take the stress.
How do we rehab from an acute ankle sprain?
Immediately after injury, the first priority is to manage swelling. Minimizing swelling will help decrease pain, maintain good ROM and mechanics. Next, recover proprioception through balance exercises to regain sense of joint position. If joint motion is lost, it must be restored as quickly as possible.
There are several ways to improve ROM of the ankle joint. Here’s how to use the swing leg to drive an ankle stretch in all 3 planes of motion. The movements help to engage more muscle fibers then the typical forward stance. There are 2 muscles which make up the calf, gastrocnemus and soleus. The gastrocnemus is stretched when the knee is straight and soleus when the knee is bent.
Tri-plane gastrocnemus stretch: swing leg driver (video below) – Stand with one leg forward with the front knee bent. Shift your body forward until you feel a stretch in the calf of the back leg. Use the forward leg the drive in the sagittal plane, frontal plane and transverse plane.
To stretch the soleus, bend back leg and perform the swing leg driver in 3 planes.
*** Most shoes have more cushion at the heel which makes it difficult to stretch your calf. If you don’t feel a stretch, go barefoot, or use a towel, tree root or rock under your forefoot to get a better angle.
The proprioceptors need to be retrained after being over stretched after an ankle sprain. Single leg balance activities are the best way to improve function.
Single Leg Balance – Standing on one leg is the best exercise to improve balance. Since vision contributes to balance, closing your eyes will increase the difficulty. Another way to increase the challenge is to look left and right or up and down. Mimic running by standing on one leg while swinging your arms.
Balance Reaches (video below) – A balance matrix exercise uses your leg to create instability in different planes on the standing leg. You reach forward (sagittal plane), to the side (frontal plane) and rotate to the back (transverse plane). Initially, you can gently tap the ground to provide stability, then progress to reaching without touching the ground. To make this more challenging reach to toward the stance leg. This encourages lateral motion of the ankle which is the position of an ankle sprain. Balance reaches performed in these positions train the ankle to recover prior to reaching the critical point of a sprain.
One way to strengthen the muscles around the ankles is to perform a tri-plane heel raise.
Heel raises (3D style) – Most people know how to perform a heel raise. Performing the exercise with different foot positions changes the emphasis of the muscles being used. There are seven basic foot positions: normal, narrow, wide, toe out, toe in, right forward and left forward. The exercise can be changed to fit the needs of each individual. An example is instead of raising straight up, perform a twist in all the foot positions. This promotes the transverse plane.
*** Perform these exercises to your comfort level and in a pain-free range. These are general exercises demonstrating the use of 3 planes of motion to get your body moving after an ankle sprain. Visit a movement specialist for exercises specific to your biomechanics presentation.
When the ankle hits the ground a simultaneous chain of events begins. As the foot strikes the ground a reaction occurs up the lower extremity, while at the same time being driven by top down motion of the arms swinging.
Limited Hip Motion
As body weight is transferred to the lead leg, a frontal plane motion is generated. If hip adduction is limited, the ankle will try to compensate for the lack of side to side motion. This will cause the ankle to roll to the side, resulting in increased susceptibility to injury.
As the arm swings, a rotational motion in transmitted to the spine. However, if thoracic spine motion is limited, the rotatory force is transferred through the hip and to the ankle causing an lateral sprain. The force can be magnified if the hip is also tight.
Stay Tuned for Ankle Sprains Part 2
Janet Yiu is a Doctor of Physical Therapy who earned her degree from University of Southern California in 2010. Janet competed in cross country at the high school, NCAA Division I college and post college level. Her treatment philosophy is to treat the whole body using the kinetic chain model instead of just the injury itself. A fellow of Applied Functional Science (FAFS) from the Gary Gray Institute, Orthopedic Certified Specialist by the American Board of Physical Therapy Specialties, and Certified Strength and Conditioning Specialist, Dr. Yiu has worked with numerous clients of all skill and age levels including runners, triathletes, high school athletes and individual who want to enhance their fitness. Read more from Dr. Yiu at her website, 3-D Runner.