Wellness & Lifestyles Australia

ANKLE SPRAIN REHABILITATION E-BOOK

Prepared by: Daniella Kittel

2007,2008,2009

Table of Contents Page No. IMPORTANT NOTICE .................................................................................................................1 INTRODUCTION ......................................................................................................................2 ANKLE ANATOMY AND ANKLE SPRAIN INJURY ...................................................................................3

Anatomy .................................................................................................................... 3 Injury ........................................................................................................................ 3

ACUTE TREATMENT AFTER ANKLE SPRAIN .......................................................................................4 Goals......................................................................................................................... 4

REHABILITATION AFTER ANKLE SPRAIN...........................................................................................5 Stretching................................................................................................................... 5 Strengthening .............................................................................................................. 9 Balance.....................................................................................................................11

ADVANCED REHABILITATION AND RETURNING TO ACTIVITIES ............................Error! Bookmark not defined. SUMMARY ........................................................................................................................... 16 CONTACT US ....................................................................................................................... 17

MANUAL LAST MODIFIED 25/02/2011

http://www.wellnesslifestyles.com.au Ph: +61 8 8331 3000 Fax: +61 8 8331 3002

1

IMPORTANT NOTICE The information provided in this document can only assist you in the most general way. This document does not replace any statutory requirements under relevant State and Territory legislation. Wellness & Lifestyles Australia (W&L) accepts no liability arising from the use of, or reliance on, the material contained in this document, which is provided on the basis that the Office of W&L is not thereby engaged in rendering professional advice. Before relying on the material, users should carefully make their own assessment as to its accuracy, currency, completeness and relevance for their purposes, and should obtain any appropriate professional advice relevant to their particular circumstances. To the extent that the material in this document includes views or recommendations of third parties, such views or recommendations do not necessarily reflect the views of the Office of W&L or indicate its commitment to a particular course of action. © Copyright Australia 2009 This work is copyright. You may download, display, print and reproduce this material in unaltered form only (retaining this notice) for your personal, non-commercial use or use within your organisation. Apart from any use as permitted under the Copyright Act 1968, all other rights are reserved.

http://www.wellnesslifestyles.com.au Ph: +61 8 8331 3000 Fax: +61 8 8331 3002

2

INTRODUCTION Welcome to the W&L series of e-Books. You have chosen the edition on ankle sprain rehabilitation. This resource will be beneficial to: Anyone who is interested in the anatomy of the ankle Anyone who plays sport with a high risk of ankle sprains Anyone who has had an ankle sprain in the past and wants to avoid a reoccurrence Anyone who has sprained their ankle recently and requires rehabilitation This e-Book will cover information about the anatomy of the ankle and what can be injured in an ankle sprain. It will also provide a rehabilitation program for ankle sprains. The information provided is up to date and follows industry standard. W&L recommend that you continue to consult your doctor and physiotherapist so that your progress can be monitored and program tailored to your specific requirements.

http://www.wellnesslifestyles.com.au Ph: +61 8 8331 3000 Fax: +61 8 8331 3002

3

ANKLE ANATOMY AND ANKLE SPRAIN INJURY

Anatomy The ankle is made up by the two bones in the lower leg (tibia and fibula), the heel bone (calcaneus) and a talus which is in the middle. Connecting these bones is a series of ligaments. The ligaments on the inside aspect of the ankle are stronger than the ligaments of the outer aspect which is why the outer aspect of the ankle is easier to injure.

Diagram taken from: LARS Ligaments.com & JK Orthomedic LTD (2004-2007), About Ankle Ligaments, viewed 16th March 2011

http://www.larsligament.com/about_ankle_ligaments.html

Injury By definition, a sprain, is a damage to ligaments. The outer aspect of the ankle can be sprained when the foot rolls so that the heel faces inwards. Although the ligaments are usually the main focus of ankle sprains, the surrounding muscle, bone, capsule and nerves can also be affected. There are three grades of ligament injury:

1. Micro tear where <5% of fibres are torn 2. Partial rupture where 5-95% of the fibres are torn 3. Complete rupture where >95% of the fibres are torn

http://www.wellnesslifestyles.com.au Ph: +61 8 8331 3000 Fax: +61 8 8331 3002

4

ACUTE TREATMENT AFTER ANKLE SPRAIN

Goals The main goals for the first 2-3 days are to be able to reduce the swelling and inflammation. Most effective is the ‘RICER’ technique:

R Rest: Don’t put weight through your injured leg and avoid any activities which cause pain.

I Ice: Use ice packs or ice wrapped in moistened cloth on your injured ankle for 20 minutes every 2

hours. Continue for 2 – 3 days.

C Compression: Wrap a tubigrip bandage around your ankle firmly (but do not cut off circulation) to

reduce swelling. It is best to apply ice in conjunction with compression also.

E Elevation: Keep the ankle resting above the level of the heart (best achieved laying down with a

pillow under the ankle) to reduce blood pooling in the area.

R Referral: See a doctor or therapist as soon as practically possible to commence treatment and to

determine the extent of your injury.

http://www.wellnesslifestyles.com.au Ph: +61 8 8331 3000 Fax: +61 8 8331 3002

5

REHABILITATION AFTER ANKLE SPRAIN

You should see a physiotherapist so that they can commence you on a rehabilitation program and structure one specific to your needs. There are different stages of rehabilitation and the amount of exercise needs to be moderated as you improve. The basic elements of an ankle rehabilitation program include: stretching, strengthening and balance and proprioception. Your physiotherapist can advise which exercises are suitable for you at each point of your rehabilitation program.

Stretching The following set of exercises is designed to stretch your ankle in different directions and ensure that you retain your range of movement in your ankle as it is healing. This is important to limit the amount of scar tissue formed. Ankle dorsiflexion – draw your toes towards the ceiling and use an exercise band to help pull them up further. Hold for 30 seconds and repeat 3 times a day.

http://www.wellnesslifestyles.com.au Ph: +61 8 8331 3000 Fax: +61 8 8331 3002

6

Ankle plantar flexion – point your toes downward only to the point where you begin to feel an increase in pain. As you improve, you can use your hand to help push your foot down further. Hold for 30 seconds and repeat 3 times a day

Ankle inversion – use your hand to point your toes downward and turn your foot so that the sole is facing inwards only to the point where you begin to feel an increase in pain. Hold for 30 seconds and repeat 3 times a day

http://www.wellnesslifestyles.com.au Ph: +61 8 8331 3000 Fax: +61 8 8331 3002

7

Calf muscle stretch I – stand in a lunge with your injured leg leading (with only a small amount of weight going through your injured leg). Do a small squat so that your knee goes over your toes. Make sure your heel stays planted. You can use a chair or wall to hold yourself steady and take some weight if desired. Do this exercise only to the point where you begin to feel an increase in pain. Hold for 30 seconds and repeat 3 times a day

Calf muscle stretch II – stand with the foot of your injured leg slightly angled inward but your knee pointing straight ahead. Take a step forward with your good leg and keep your injured leg straight with your heel planted. You should feel a slight stretch in your calf with this exercise. Hold for 30 seconds and repeat 3 times a day

http://www.wellnesslifestyles.com.au Ph: +61 8 8331 3000 Fax: +61 8 8331 3002

8

Sitting on haunches – kneel on a bed or sofa with your injured leg against the floor. Gently sit back onto your bad leg until you feel a slight stretch at the front of your ankle. If desired, use one or more pillows between your bottom and leg until you are able to reach lower. When comfortable, you can perform this exercise with both legs against the floor. Hold for 30 seconds and repeat 3 times a day

http://www.wellnesslifestyles.com.au Ph: +61 8 8331 3000 Fax: +61 8 8331 3002

9

Strengthening The following exercises are designed to strengthen the muscles surrounding your ankle to provide your ankle with more support. Raising onto toes – in standing, raise both feet onto your toes with a focus on control. A chair or bench surface can be used for balance. Repeat 10 times. This exercise can be varied by changing the amount of weight in your injured leg or doing it on your injured leg only. A further challenge is gained if your heel starts below the level of the step before you rise onto your toes. Progressions include adding weights.

http://www.wellnesslifestyles.com.au Ph: +61 8 8331 3000 Fax: +61 8 8331 3002

10

Ankle twists – in sitting with the heel of your injured leg planted, turn your toes inwards and hold then turn them outwards and hold. Make sure that the movement is coming from your ankle and that you knee is stationary. Hold each position for 10 seconds and repeat 10 times each side.

Advanced ankle dorsiflexion – in sitting on the floor with straight legs, draw your toes towards your body and hold for 15 seconds. Repeat 10 times. Make this exercise harder by pulling your toes against an exercise band.

http://www.wellnesslifestyles.com.au Ph: +61 8 8331 3000 Fax: +61 8 8331 3002

11

Balance The following exercises are designed to improve your balance and coordination. This part of rehabilitation is crucial for preventing further ankle sprains as it retrains you brain to control your ankle. Alphabet tracing – in sitting with legs crossed, draw each letter in the alphabet with your big toe. Focus on controlling your ankle movement, this can be made harder by making the letters smaller or closing eyes.

Controlled rolling – in standing, have a small amount of weight going through your injured ankle. Roll your injured foot onto the outside border so that the inside part of your foot is lifting up. Only roll until you reach about ¼ of your range and then replace your foot flat on the ground. Repeat this exercise 10 times with your eyes closed, focussing on moving your ankle the same amount. Make the exercise harder by putting more weight in your injured leg, rolling your ankle more, doing it barefoot, doing the movements faster (with the same control) or doing it on an incline.

http://www.wellnesslifestyles.com.au Ph: +61 8 8331 3000 Fax: +61 8 8331 3002

12

Balancing – with support at hand, start standing on the injured ankle (i.e. on one foot) with your knee bent slightly. Aim for 10 seconds. When you can achieve this, make it harder by standing on a pillow/wobble board, closing your eyes, tilting your head back, standing on tip-toes or catching a ball. Combinations of these options, will progress your ability.

http://www.wellnesslifestyles.com.au Ph: +61 8 8331 3000 Fax: +61 8 8331 3002

13

Trampette – position this besides a wall or steady surface (but be sure not to fall onto them). Practice balancing on your injured leg and progress as above. Try doing gentle jogging. Do some small jumps and then progress to hopping (try hopping and turning).

http://www.wellnesslifestyles.com.au Ph: +61 8 8331 3000 Fax: +61 8 8331 3002

14

Body twisting – balance on your injured leg and twist your upper body, relying on your ankle to control your balance. Make this exercise harder by closing your eyes, swinging your body faster, holding arm weights or standing on an incline. Repeat 30 times each side.

http://www.wellnesslifestyles.com.au Ph: +61 8 8331 3000 Fax: +61 8 8331 3002

15

Hopping – before hopping, practice jumping and when you feel confident, you can commence hopping on your injured leg. Try to do 15 in a row or as pain tolerates. Make this exercise harder by hopping higher, using a skipping rope, hopping on a slight incline, hopping in different directions or hopping on/off steps.

Running – run in different directions and practice agility by stopping suddenly or changing directions.

http://www.wellnesslifestyles.com.au Ph: +61 8 8331 3000 Fax: +61 8 8331 3002

16

SUMMARY In summary, ankle sprains are fairly common and can range in the severity and involvement of different ankle structures. Early treatment aims to reduce inflammation, swelling and pain. Rehabilitation exercises will work to increase the range, strength and coordination in your ankle. Rehabilitation progresses to become more challenging by involving actions that are required to return to sporting activities by the end of the program. Please use this resource as a guide to your rehabilitation in consultation with your therapist. All the best for a speedy recovery, The W&L Team

http://www.wellnesslifestyles.com.au Ph: +61 8 8331 3000 Fax: +61 8 8331 3002

17

CONTACT US Wellness & Lifestyles Australia 2/59 Fullarton Road, Kent Town SA 5067 P: +61 08 8331 3000 F: +61 08 8331 3002 E: contact@wellnesslifestyles.com.au W: www.wellnesslifestyles.com.au www.wleducation.com.au W&L services include: Physiotherapy Aged Care Funding Instrument (ACFI) Consultancy Podiatry Speech Pathology Dietetics Diabetes Education Occupational Therapy Psychology Physiotherapy Aide Diversional Therapy Aromatherapy Natural Therapies Massage Exercise Physiology Educational Training Staff Wellness Program Locum Services Medicare Billing Aged Care Funding Instrument Documentation Online Training W&L products include: Posters E-books E-learning modules