Your child suffered an ankle injury. You went to the urgent care and found out that it is an ankle sprain. You’ve starting treating the ankle sprain. But now, you aren’t sure how to start the process of getting them back to playing their sport.

Read on for more information on rehab for ankle sprains.

The goal of rehabbing an ankle sprain is to continue to control pain and inflammation and to start to work on restoring normal motion and strength in the ankle, while continuing to protect the ligaments.

The progression of rehab is based on both time (how long does it take the ligaments to naturally heal) and function (what motions and activities is the athlete going to be able to have to do).

Each of these areas of focus will overlap with each other and can even progress at different rates, as tolerated.

Restoring normal range of motion after an ankle sprain

Restoring range of motion is important to start on early, even while still in the brace or boot. Early work on calf and Achilles tendon flexibility is important.

An athlete can start pain free towel stretches and move to a wall stretch and then stretching on a slant board or a One Stretch stretching device as pain tolerates.

I personally like the One Stretch platform because it supports the body and allows for incremental control of the intensity of the stretch. Below is a video of how to use the One Stretch. You can find it on Amazon.

Strengthening the foot and ankle after an ankle sprain

Exercises like marble pick-ups and toe curls with a towel will work the muscles in the foot and can help restore strength, as well as help pump the swelling out of the foot. The knee and ankle should both be at 90 degrees during these exercises.

Band exercises will strengthen the muscles around the ankle and tell the body to lay scar down along functional lines of stress. Here is an analogy: rather than a messy desk full of papers thrown everywhere (which is how scar tissue tends to lay), you are telling the body how you want those papers stacked and put on the desk. The scar tissue will function along with the healed ligaments to help stabilize the ankle. Be sure to do strengthening in all four directions: inversion, eversion, plantarflexion, and dorsiflexion.

Pain free seated toe raises that focus on really squeezing the calf can start right away. As the pain free range of motion increases, toe raises can progress to standing toe raises to single toe raises.

The next step is start strengthening activities that are similar to real moves that are performed in sport and general lower body strengthening activities. Things like squats, lunges, lateral steps, etc. These movements require both strength and range of motion of multiple areas and are done in a controlled steps to protect the injury.

These sport specific activities are done through a progression from controlled to chaos, from simple to difficult. Start with simple, body weight activities, incrementally add bands or weights. Start with stationary and progress to movement.

Proprioception retraining after an ankle sprain

Balance exercises should first be done in the boot or brace and then work toward doing them barefoot or in just a shoe. Start easy and progressively make it harder.

• Start with standing just on a solid surface like the tile in your kitchen on the injured leg for 30 seconds. Then close the eyes.

• When that is easy, then try standing on something soft like a pillow, still in the boot or brace.

• Add in tossing a ball against a wall or with a partner, or kicking with the opposite foot if the athlete plays soccer. Tosses should make the athlete move around, while trying to maintain their balance.

Once the athlete has progressed through each step easily and pain free in the boot, repeat the same steps again, but out of the boot or brace.

Agility training after an ankle sprain

When ankle motion and strength have been restored, agility drills can begin.

Agility drills should be sport specific based on the sport type and level the athlete is trying to get back to.

Are they trying to get back to rec soccer or travel baseball? These are different goals. What are the demands of the sport? It may be helpful to include a coach in this part of the rehab to get an idea of specific movements required.

• Single toe hops forward and backward. First over a line and then over a small object to incorporate height.

• Lateral shuffles. In a sport ready position, shuffle side to side, starting with a 5 foot width, and progress to longer distances.

• Figure 8 running or zig-zags. Start with small figure 8s and progress to larger turns or forward and backward zig-zags that change directions.

• “W” sprints. The athlete will face forward and then run in the shape of a “W”, starting backward first, then forward, always facing the same direction.

• Turn and runs. Start running in one direction and sudden shuffle stops and a hard cut and change directions. Direction changes can be random at the direction of the athlete of on demand by an observer.

• Ladders. Ladders can be painted or taped onto a surface or purchased from a place like Amazon. They focus on quick, short foot movements and coordination. Ladder activities should be done in all directions (forward, back, left, right).

These exercises should focus on changing speeds and directions, similar to sport demands. Each athlete’s agility training will be different, but can crossover from many sports or positions.

Cardiovascular training

It is important that the athlete to try to keep in-shape during the rehab process.

Stationary biking in the boot can start a few days after the injury. Biking shouldn’t cause pain or increase swelling, so the resistance should start low and start with about 10 minutes, or less, at first. As pain and swelling are controlled, the time and resistance can increase. Once the athlete has progressed from the boot for daily activity (around 2 weeks), then biking can start in the brace.

Elliptical can start once the athlete has come out of the boot for daily activity (and into the brace) and is able to do stationary biking for 30 minutes in a brace. Like biking, elliptical should start on low intensity and for about 10 minutes at first, progressing as tolerated.

Once the athlete is able to do elliptical for 30 minutes with no pain and is able to run straight ahead pain free, they can start running straight ahead on a treadmill. The treadmill is safe and predictable, it is easy to get off and stop if pain returns or when fatigue sets in.

Sprinting and cutting can start when the athlete is able to run on a treadmill for 30 minutes with no pain. Running and cutting should be done on a predictable surface first, like a court or track, and progress to doing them on the playing surface. At this point, when the athlete is able to run 30 minutes and has a decent cardio base, a functional athletic activities can begin.

Remember, the goal is to regain fitness, so this step will overlap with other parts of the rehab process.

There is one last step before returning to play. In order to return to play, an athlete must be able to run and cut without a limp and be able to pass a functional progression test. Functional progression is sport specific, but check out this post on functional progressions for return to sports.

What questions do you have about rehab for an ankle sprain? Leave your question in the comments section below.

Disclaimer: This post is for informational and educational purposes only, does not constitute medical advice, and does not establish any patient relationship with me. I’m not liable or responsible for any damages related to your use of this information. Information given is a generality of athletic injuries and treatments and is not meant to replace traditional medical advice. Please consult a physician for proper care.