Program for treatment of the No. 1 injury in competitive sports: Sprained ankles

By Dr. John Aronen

 

With the ankle being the No. 1 injury in sports, here is a treatment program for sprained ankles.

 

Goals

>>Eliminate the soft-tissue swelling of your injured ankle so it looks like your other ankle. Do this with compression (Ace wrap), elevation and pain-free motion exercises.

>>Eliminate the soft-tissue swelling of your injured ankle so it looks like your other ankle. Do this with compression (Ace wrap), elevation and pain-free motion exercises.

>>Regain full pain-free motion of your ankle equal to that of your other ankle. Do this with pain-free motion exercises.

>>Restrengthen the muscles responsible for preventing recurrent ankle sprains. Do this with the strengthening exercises to prevent recurrent ankle sprains.

 

How does elevating my ankle help, and how frequently do I elevate it?

 

Elevation of your ankle expedites elimination of the swelling. Although the maximum benefits result from the ankle being elevated higher than your heart, any elevation during the day is better than none. At night, the most effective way to maintain your injured ankle elevated higher than your heart is to place a large pillow or other object at the end of your bed between your mattress and spring so you “permanently” elevate the end of your bed. You can greatly enhance the benefits you gain from elevating your sprained ankle by performing the motion exercises whenever you have your ankle elevated. Start the strengthening exercises to prevent recurrent ankle sprains as soon as you have enough motion to do them.

 

Why do I need to perform the motion exercises, and when do I start doing them?

The motion exercises contribute to the treatment of your ankle sprain in two ways:

The motion exercises contribute to the treatment of your ankle sprain in two ways:

>>The motion of the ankle helps “pump” the swelling from the ankle, especially when the ankle is elevated.

>>The motion exercises enable you to regain the amount of ankle motion you had before spraining your ankle. The sooner you start the exercises, the sooner you will regain full pain-free motion of your ankle. Each time you perform the exercises, use pain as your guideline–perform only the amount of motion that you can do pain-free. The more times you perform the exercises, with or without elevation, the sooner you will regain full pain-free motion.

Figures 1A and 1B show the first of the three motion exercises. The first exercise is the same as repeatedly pushing your foot down on a gas pedal of a car as far as you can and pulling it back up as far as you can.

Figures 1C and 1D show the second motion exercise. With this exercise, you keep your heel still and move your forefoot with the motion as that of a windshield wiper of a car. Keep your heel still and repeatedly move your forefoot in and up as far as you can and then out and up as far as you can.

 

Figure 1A	Figure 1B
Figure 1C	Figure 1D

Once you have achieved an increase in your pain-free motion, you can add a third motion exercise. The third exercise combines the actions of the first two exercises and thus enhances your gains. To perform this exercise, keep your heel still and, using your big toe as a pen, write the letters of the alphabet in capital letters with your big toe while you keep your heel still. Continue to perform the motion exercises until you are capable of writing the alphabet in capital letters as large in size as you can with your other ankle—”proof” you have regained full motion.

Figure 2A	Figure 2B

 Strengthening exercise to prevent recurrent sprains

The typical ankle sprain occurs when you come down on the outside of your foot and your ankle rolls under. When you land on the outside of your foot, the muscles that turn your foot up and out are trying to stop your ankle from rolling under. Sometimes these muscles have sufficient strength to stop your ankle from rolling under, but if they don’t, your ankle rolls under and you end up with a sprained ankle.

Along with spraining your ankle, you also overstress the muscles that attempted to prevent the ankle from rolling under. This overstress leaves these muscles with weakness. If you don’t restrengthen these mus-cles, the next time you come down on the outside of your foot your ankle will roll under more easily, for these muscles will have less than normal strength to prevent your ankle from rolling under.

To perform the strengthening exercise for the muscles that turn your foot up and out, sit on the front edge of a chair and put both feet into the loop of a stretchable material, as shown in Figure 2A. (A 12-inch bicycle inner tube is available from departments stores for about $3.) The amount of resistance you will feel is determined by the tension of the loop, which varies with the distance between your feet. The initial amount of resistance to feel is that which allows you to perform the exercise correctly.

It is important that all of the motion against the stretchable material is performed at the ankle. To ensure this, the knee and leg of the injured ankle must be kept stationary. Locking your knees straight forward with your hands as shown in Figure 2A limits all the motion to the ankle.

Start position is with the foot of the injured ankle on the floor (Figure 2A). While keeping the heel of your injured ankle on the floor, raise the ball of your foot up off the floor and then rotate your foot out and up against the resistance of the stretchable material as shown in Figure 2B.

For maximum benefit, slowly return your foot to the start position, resisting the pull of the stretchable material as you return your foot to the start position. Each repetition should always begin and end with the foot in the start position–with the foot on the floor (Figure 2A). Perform repetitions of this exercise until you feel a burning on the outside of your leg. This burning represents fatigue of the muscles you desire to strengthen.

As you feel the strength of the muscles increase and do more and more repetitions, spread your feet farther apart to increase the tension of the stretchable material and gain more strength. Continue the exercises until you achieve the goal, which is the capability of balancing on the ball of the foot of your injured ankle for the same length of time you can on the ball of your other foot, usually five to 10 seconds.