So you've injured your ankle, and after reading my last post (or better yet, seeking actual medical advice), you know what kind of injury it is, and you've taken the appropriate steps to take care of it for the first few days. You're probably wondering, “what's next? How can I get this ankle rehabilitated, and how can I prevent this from happening again in the future?” Fear not, my slightly-limping friend, I've got you covered.
Most of what follows is a mash-up of advice I've either found online or heard from medical and/or fitness professionals. That said, please don't take my word for it! At the end of this post you'll find “Further Reading,” and I urge you not only to check those links out, but to get more info from your doctor or physiotherapist. Also, as we saw last time, sprains are the most common way we hurt our ankles, so much of the information below is geared towards that particular injury. If you're dealing with a strain or fracture, seek the appropriate medical advice.
And so, without further ado (or further disclaimers), here are the steps to take when you're rehabbing an ankle injury, as well as ways to prevent a similar injury from occurring in the future.
Regaining Range of Motion
As long as the pain isn't too severe, you can start the recovery process by walking around a bit. Use crutches to help you bear your weight if you need support. I used my trusty baseball bat as a cane, which was not ideal, but did the trick.
Shortly after your injury (within 72 hours), you need to start working towards regaining the Range of Motion (ROM) in the ankle joint. The most common exercise that comes up for this is called “Tracing the Alphabet with your Toe.” To do this exercise you sit in a supportive chair and, you guessed it, trace the alphabet with your toe. This works because it gets the ankle joint moving in all directions, doesn't put too much strain on the affected area, and allows for progressively larger movements as the pain diminishes. Do the full alphabet 1-3 times. You may want to do this right before you plan on applying ice, since you may want to ice it after anyway.
Another ROM exercise is the Towel Curl, where you place your foot flat on the floor on top of a towel. Use your toes to “scrunch” the towel towards you, then to push it away again.
Once your pain has started to subside, it's time for some stretching. The achilles tendon connects your calf muscle to your heel, so stretching this area helps to relieve pressure on the foot/ankle.
Start with a Towel Stretch: Sitting on the floor with a foam roller or folded towel under your foot, loop a towel, belt, dog leash, or something similar around the ball of your foot. Hold an end in each hand and gently pull the toes back towards you, keeping your knees straight. Hold the stretch for 15-30 seconds, and repeat 2-4 times. If you aren't able to feel a good stretch before feeling pain, you may not be ready for this step.
Once you can stand without pain, you can do a standing calf stretch. Stand facing a wall, and lean against it with your hands about head-height. Put the injured foot a step behind the other one, and bend your knee forward with your heel flat on the floor. Again, move slowly and gently, holding for 15-30 seconds and repeating 2-4 times.
When ankle sprains are frequent or severe enough, they become a self-fulfilling prophecy. Spraining my ankle has made it weak, which makes me more likely to sprain it in the future. What better time to focus on preventing a sprain than while you're still tender from the last time? In the early stages, therabands or exercise tubes are great tools for providing the appropriate amount of resistance.
Rather than trying to describe these strengthening exercises to you, I'll direct you to an actual physical therapist (and my favourite source for stretching/rehab/therapy advice), Doctor Jo:
Preventing Future Injury
Once your ankle is sufficiently healed, you can get back to your regular activities, your training program, and your life in general. Everything's back to normal, right? Sure, but you would do well to add some ankle-specific exercises to your normal routine in order to become more stable. Go easy on yourself at first. It is both easy and unhelpful to overdo it.
Start with standing heel raises. Standing in a stable position, using the wall or a chair for balance if necessary, raise both heels off the ground. To make this more difficult you can do one leg at a time, or hold weights for more resistance. Aim for 10-15 reps, 2-3 times.
Standing on one leg is a great way to work on balance, and it's something you can practice anywhere. Do each leg for 30 seconds (or whatever feels challenging to you), repeating each side a few times. You can scale this up by having a friend lightly push against you to force you to engage the ankle. Another challenge is to throw a basketball back and forth while balancing, working your way up to a medicine ball as you become stronger.
Adding a heel raise to a squat is another easy way to include some balance training. Do a normal squat, but once you come back to standing come up onto your toes. For a great cardio challenge do some squat jumps; get into a low squat, jump straight up, land back into a squat, and do it all over again. Other low-body exercises that challenge the ankle are skater-hops, curtsy lunges, side lunges, and single-leg jumps.
If you're really interested in improving agility, be sure to look into some athletic agility training using ladders, cones, etc. There are many variations, so I'll spare you more of my clumsy exercise descriptions, but if you're looking to get better at sudden changes in speed and direction, athlete-style training might be just the thing.
So there you have it! You're healed up, stronger than ever, and ready to help a friend when they suffer from a similar injury. Now all that's left is to be more careful when doing something crazy like walking down the sidewalk...
As many of my clients, friends, colleagues, strangers, and anyone who will listen to me complain already know, I twisted my ankle really badly last week. I was taking part in the extreme activity known as “walking,” and I just rolled it over. This is nothing new for me. My right ankle is a constant issue, and is often tender from whatever stress I've put it under most recently. This time, however, my left side is the one that went down. I've had enough. I decided to learn more about what the heck is going on with my ankles, and now I'm sharing that with you. In Part 1 I'll be looking at some stats, types of ankle injuries, and how to care for your ankle when you hurt it.
A study looking at the Canadian Community Health Survey examined the data of Canadians who suffered injuries from 2009-2010. You can check out the Stats-Can article explaining the findings here, but in the meantime, here are some key points:
So if you've never experienced an ankle injury, you likely know someone who has. More importantly, as someone who engages in regular physical/athletic activity, you are more likely to experience this type of injury than your sedentary friends. The article also says that after falls, overexertion was the biggest cause of injury, which points to the importance of prevention (something we'll look at in part 2).
Types Ankle Injuries
You've likely heard the terms “Sprain,” “Strain,” “Twist,” and of course “Broken” to refer to ankle injuries, but they are not all the same, and the treatment of each is different. The diagnosis is extremely important in determining whether you need a cast, rest/ice, or even surgery; as always, a visit to the doctor is the best way properly diagnose your injury (unless, of course, you do your own x-rays at home).
Twist – This is often thrown around as a diagnosis, but it more accurately refers to the method by which the injury occurred. I don't have a twisted ankle, I have a sprained ankle because I twisted it.
Broken/Fractured – This is when one or more of the bones that make up the ankle joint is, well, broken or fractured. A fracture that occurs as the result of a twist or impact may be accompanied by damage to the soft tissue in the surrounding area, which can make self-diagnosis difficult. To determine if you require an x-ray, you can check yourself against the Ottawa Ankle Rules. In short, if you have pain in specific areas of the ankle/foot, or if you can't walk more than 4 steps immediately following the injury and in the emergency room, you need an x-ray.
Strain – A strain is when there is damage to the muscles and/or tendons. While acute ankle strains can occur from twists or impacts, it is more common for a strain to be the result of chronic overuse such as running long distances or repeated hard impacts from jumping. If your ankle is strained you may also be experiencing tendonitis, and injuries from overuse may mean that you need to reevaluate your training program, your technique, your footwear, etc.
Sprain – This is the most common type of ankle injury, and it occurs when the ligaments in the ankle joint are stretched or torn. This can be due to the foot rolling past the normal range of motion, making a sudden rapid motion with the feet planted, or just walking on uneven ground, like me. You'll feel pain right away, followed by swelling, redness, and possibly bruising. In a more severe sprain you might even hear a pop or a snap, and if it's bad enough you may not be able to walk or bear any weight on the ankle (which may mean it's time for an x-ray, as mentioned above).
Depending on the severity of your injury, your ankle could take anywhere from a couple of days to a few weeks or more to heal, and taking the right steps immediately following the incident will allow the healing process to start right away. The RICE process is pretty universally accepted has been described many times, but here it is anyway!
Rest – This may not take much convincing, but avoid walking or standing, and move the ankle as little as possible as it heals.
Ice – To reduce pain and swelling, apply icepacks to the area for 20-30 minutes at a time, 3-4 times throughout the day. Putting ice directly against the skin can cause tissue damage, so wrap your icepack in a cloth and avoid more frequent icing schedules.
Compression – Use an elastic bandage to reduce swelling and provide support to the joint. Immobilizing the area will prevent further damage, but be sure not to wrap so tightly that circulation is cut off.
Elevation – Keep the ankle elevated above the level of your heart for the first 48 hours following the injury, which will help with swelling and discomfort. Plus, you get an excuse to put your feet up for a couple of days! Silver linings, my friend.
In Part 2 I'll take a look at rehabilitating your ankle once the initial healing is done, as well as some preventative measures we can take to avoid future injury.
Ryan Casselman is a personal trainer, musician, and the founder of Real Trainers. Stay tuned as he finds out what he's going to write about each week or so!