Ankle injuries are among the most common musculoskeletal complaints, with inversion sprains leading the way. These occur when the foot twists inward, often due to a misstep or awkward landing, causing damage to the soft tissues of the ankle. Interestingly, studies show that for every fracture caused by an inversion sprain, there are about eight cases of soft-tissue injuries (Boyce & Quigley, 2004). While acute injuries may heal with time, 30% of individuals experience lingering symptoms, including pain, stiffness, and recurring instability (Van Rijin et al., 2008). Without proper rehabilitation, these issues can evolve into chronic ankle dysfunction, which can severely impact mobility and quality of life.
This blog will explore the importance of exercise in ankle pain management, particularly following an inversion sprain, and how a well-rounded rehabilitation plan can help restore function and prevent long-term complications.
In the past, immobilization was a common treatment for ankle sprains. However, research suggests that outcomes are better when functional support and movement are encouraged over prolonged rest (Kerkhoffs et al., 2002). Immobilizing the ankle may initially be necessary for pain management, but once a fracture is ruled out, movement and exercise are crucial to healing. Ankle rehabilitation exercises are proven to reduce swelling, speed recovery, and prevent future injuries (McKeon & Hertel, 2008).
According to Donovan and Hertel’s (2012) review on chronic ankle instability, there are four key areas to focus on during rehabilitation: dorsiflexion, strength, balance, and gait. These pillars form the foundation of an effective recovery plan.
Ankle dorsiflexion is often severely limited following an inversion sprain. Since normal walking requires at least 10 degrees of dorsiflexion, it’s essential to restore this range of motion for functional movement. The dorsiflexion lunge test (or knee-to-wall test) is a simple way to assess progress. If dorsiflexion is restricted, rehabilitation exercises such as posterior glides and banded mobilizations can help improve flexibility and reduce discomfort.
After an ankle sprain, strength deficits are common, especially in the muscles responsible for controlling ankle movement in all directions—dorsiflexion, plantar flexion, eversion, and inversion. It's crucial to address these weaknesses with resistance training, focusing on all four directions of ankle motion. Simple exercises like heel raises or resistance band training can significantly improve strength, speed recovery, and prevent reinjury.
Balance is often impaired after an ankle injury due to changes in proprioception (the body's ability to sense its position in space). Effective balance training can reduce the risk of future sprains by challenging the body's ability to maintain stability under various conditions. Simple balance exercises, such as standing on one leg or using a wobble board, can help restore normal function. Progressing these exercises by adding tasks like catching a ball or performing weight shifts can further enhance stability.
After an inversion sprain, many patients develop altered gait patterns, including limping or difficulty with push-off during walking. These changes are often due to weakness or pain during specific phases of the gait cycle. Assessing gait helps identify which component needs improvement. In cases where toe-off (the phase when the foot leaves the ground) is weak, strengthening exercises like toe walking drills and heel raises can help restore a normal walking pattern.
Ankle inversion sprains, though common, don't have to lead to long-term dysfunction. By focusing on the four pillars of rehabilitation—dorsiflexion, strength, balance, and gait—patients can recover faster and reduce the likelihood of future sprains. Early intervention, proper rehabilitation exercises, and patient education are essential in restoring full function and ensuring a speedy return to daily activities or sports. Always remember that when it comes to ankle pain, movement is not only necessary but essential for recovery.
References
Boyce SH, Quigley MA (2004). Review of sports injuries presenting to an accident and emergency department. Emerg Med J 21:704–706.
Donovan L, Hertel J (2012). A new paradigm for rehabilitation of patients with chronic ankle instability. Phys Sportsmed 40:41–51.
Feger MA, Glaviano NR, Donovan L, et al. (2017). Current trends in the management of lateral ankle sprain in the United States. Clin J Sport Med 27:145–152.
Kerkhoffs GMMJ, Rowe BH, Assendelft WJJ, et al. (2002). Immobilisation and functional treatment for acute lateral ankle ligament injuries in adults. Cochrane Database of Systematic Reviews: CD003762.
McKeon PO, Hertel J (2008). Systematic review of postural control and lateral ankle instability, part II: is balance training clinically effective? J Athl Train 43:305–315.
50% Complete
Lorem ipsum dolor sit amet, consectetur adipiscing elit, sed do eiusmod tempor incididunt ut labore et dolore magna aliqua.