What to Do?
A comprehensive and complete rehab is important following an ankle sprain. We’ll break the rehab into two phases.
The focus of this phase is on protecting the injury as to not make it worse, controlling swelling, and gradually returning to a normal gait pattern. Traditionally we focused on “RICE”- which involved Rest, Ice, Compression, and Elevation as a way to promote healing. We know this to strategy to be successful for helping to control pain, and minimizing swelling and limiting secondary injury on a cellular level. However, more recently there’s been a push to clarify that the “rest” should really be explained as “Optimal Loads”- meaning we should encourage use and motion of the injury as much as we can- but careful not add too much stress to soon. We’re shooting for the “sweet spot” that facilitate healing, while encouraging early mobility. As such, there’s a push for a new acronym, POLICE– Protect, Optimal Loads, Ice, Compression, Elevation. The “Optimal Load” will vary based on the severity of the injury. For some this may involve bracing or use of crutches initially with a gradual return to full weight bearing. Regardless of what your beginning “optimal load” is- the research is unanimous that early mobilization and weightbearing is the key to the initial phase of rehab- and those who began rehab while still in the acute phase had a decrease in ankle sprain recurrences measured at 1 year after the original injury!
One of the benefits of having your ankle sprain evaluated by a sports physical therapist is their understanding of what your optimal load should be. Given that current research on the rehabilitation of ankle sprains strongly supports the POLICE strategy- this will put you on the right path to a full recovery as quickly as possible.
Other components of the acute phase will focus on restoring normal range of motion at the ankle, helping to minimize swelling through different manual therapy and massage techniques as well as taping, and a beginning to strengthen the ankle with specific exercises. Research has shown that a significant decrease in recurrence rate was observed for those who initiated rehab while still in the acute phase. There is no reason to wait!
Progressive Loading and Sensorimotor Training Phase
The next stage of rehab is the progressive loading and sensorimotor training phase. While continuing to restore full ROM with manual therapy techniques including joint mobilizations- there is a shift to more weight bearing exercises especially with a focus on single leg balancing activities. So much of our sports involve being able to be strong on one leg (think being able to plant and change direction on a court, jump and land off of one leg going up for a lay up or rebound, or even just planting a foot when running and being able to go through a normal gait sequence) that is important to regain this functional stability and normal proprioception of the ankle.
|*Proprioception is defined as “the ability to take sensory information from the environment and integrate that information to create a motor response”. In the case of a sprained ankle- it is your body’s ability to detect information about the position of your ankle joint and instantaneously relay information to your pain so that the muscles of your lower leg can react and contract to help stabilize the joint. Proprioception training has been shown to not only help restore normal ankle function – but have also shown to be effective in decreasing the risk of future ankle sprains- regardless of ankle sprain history! If you are someone with a history of ankle sprains- get going on an appropriate balance/proprioception program as this can help reduce the risk for future injuries!