In part
1, we took a look at exactly what a sprained ankle is. We
had a look at the structures that make up the ankle joint; what
happens when an ankle injury occurs; the symptoms associated
with an ankle injury; and the major causes and risk factors
that contribute to ankle injury.
In part
2, we started by going over the risk factors and common
causes of ankle injury, and then looked at a number of prevention
strategies to help reduce those risk factors. We then looked
at the importance of the immediate treatment (the first 48 to
72 hours), and begun to outline the ongoing treatment necessary
for a full recovery.
In this issue, part 3, we're going to outline
a detailed strategy for the complete rehabilitation of an ankle
sprain. We'll look at the rehabilitation and conditioning exercises
needed to get your sprained ankle back to 100%.
By now, you've come over 80% of the way. You
may even feel that your ankle is fully recovered. Your treatment
so far may have stopped the swelling and bleeding, it may have
reduced the amount of scar tissue at the ankle, and it may have
even started to heal the ligaments that were injured. But there
is still one more important thing to do.
The last 20% can be the most crucial to your
complete recovery. If you've ever suffered from a sporting injury
in the past, you'll know how annoying it is to think you're
recovered, and then out-of-the-blue, you're injured again and
back to where you started. It can be one of the most frustrating
and heart-breaking cycles an athlete, or anyone else for that
matter, can go through.
Active Rehabilitation
Most people will refer to this phase of your
recovery as the active rehabilitation phase, because, during
this phase you will be responsible for the rehabilitation process.
You will be doing the exercises and activities required to speed
up your full recovery.
The aim of this phase of your rehabilitation
will be to regain all the fitness components that were lost
because of the injury. Regaining your flexibility, strength,
power, muscular endurance, balance, and co-ordination will be
the primary focus. Without this phase of your rehabilitation,
there is no hope of completely and permanently making a full
recovery.
The first point to make clear is how important
it is to keep active. Often, the advice from doctors and similar
medical personnel will simply be; rest. This can be one of the
worst things you can do. Without some form of activity the injured
area will not receive the blood flow it requires for recovery.
An active circulation will provide both the oxygen and nutrients
needed for the injury to heal.
A Word Of Warning!
Never, never, never do any activity that hurts
your ankle. Of course you may feel some discomfort, but never
push yourself to the point where you're feeling pain. Be very
careful with any activity you do. Pain is the warning sign;
don't ignore it.
1. Range of Motion
Regaining a full range of motion of the ankle
joint is the first priority in this phase of the rehabilitation
process. A full range of motion is extremely important, as it
lays the foundation for more intense and challenging exercises
later in the active rehabilitation process.
For those suffering a first degree sprain, range
of motion may not have been affected, however, second and third
degree sprains will almost always limit range of motion.
As you work through the initial stages of recovery,
and your ankle begins to heal, start to introduce some very
gentle movements. First bending and straightening your ankle,
then as you get more comfortable with this simple movement,
start to incorporate some rotation exercises. Turn your ankle
from side to side, and rotate clockwise and anti-clockwise.
When you feel comfortable with these range of
motion exercise, and can perform them relatively pain free,
it's time to move onto the next phase of the active rehabilitation
process.
2. Stretch and Strengthen
Now it's time to add some intensity to the range
of motion exercises. The aim here is to gradually re-introduce
some strength back into the injured muscles, ligaments and tendons.
When attempting to increase the strength of
your ankle, be sure to approach this in a gradual, systematic
way of lightly over-loading the muscles and tendons. Be careful
not to over-do this type of training. Patience is required.
An effective and relatively safe way to start
is to begin with isometric exercises. These are exercise where
the ankle joint itself does not move, yet force is applied and
the muscles are contracted.
For example: imagine sitting in a chair while
facing a wall, and then placing the ball of your foot against
the wall. In this position you can push against the wall with
your foot and at the same time keep your ankle joint from moving.
The muscles contract but the ankle joint does not move. This
is an isometric exercise.
The above example can be used to strengthen
the ankle in all directions. Pushing your foot to the left or
right against something immoveable, and pushing down (as above)
and pulling up.
It's also important at this stage to introduce
some gentle stretching exercise. These will help to further
increase your range of motion and prepare your ankle for more
strenuous activity to come.
While working on increasing the flexibility
of your ankle, it's also important to increase the flexibility
of the muscle groups around the injured area. These include
the calf muscles, and the anterior muscles of your shin.
3. Balance and Proprioception
Once you feel some strength returning to your
ankle it's time to incorporate some balancing drills and exercises.
This phase of the rehabilitation process is
often overlooked, and is one of the main reasons why old injuries
keep re-occurring.
When ligaments are torn, as with a second or
third degree ankle sprain, nerves are also damaged. These nerves
send vital information to the brain about the specific position
and location of the ankle joint in relation to the rest of your
body.
Without this information the muscles, tendons
and ligaments are constantly second-guessing the position of
the ankle joint. This lack of awareness about the position of
the ankle joint can lead to a re-occurrence of the same injury
long after you thought it had completely healed.
Balancing exercises are important to help re-train
the damaged nerves around your ankle joint. Start with simple
balancing exercises like walking along a straight line, or balancing
on a beam. Progress to one-leg exercises like balancing on one
foot, and then try the same exercises with your eyes closed.
When you're comfortable with the above activities,
try some of the more advanced exercises like wobble or rocker
boards, swiss balls, stability cushions and foam rollers.
4. Plyometrics and Sports Specific Exercises
This last part of the rehabilitation process
will aim to return your ankle to a pre-injury state. By the
end of this process your ankle should be as strong, if not stronger,
than it was before you injured it.
This is the time to incorporate some dynamic,
or explosive exercises to really strengthen up your ankle and
improve your proprioception. Start by working through all the
exercises you did above, but with more intensity.
For example, if you were using light isometric
exercises to help strengthen your ankle, start to apply more
force to your ankle joint, or start to use some weighted exercises.
From here, gradually incorporate some more intense
exercises. Exercises that relate specifically to your chosen
sport are a good place to start. Things like skill drills and
training exercises are a great way to gauge your fitness level
and the strength of your ankle.
To put the finishing touches on your ankle recovery,
I always like to do a few plyometric drills. Plyometric exercises
are explosive exercises that both lengthen and contract a muscle
at the same time. These are called eccentric muscle contractions,
and involve activities like jumping, hoping, skipping and bounding.
These activities are quite intense, so remember
to always start off easy, and gradually apply more and more
force. Don't get too excited and over-do-it, you've come too
far to do something silly and re-injure your ankle.
