Self Management Program

Ankle Sprains

Improving Care. Improving Business. Self Management Program

What is an ankle sprain? overstressing the injured ligaments. These Ligaments attach to the ankle bones and ligaments are damaged, weak and sensitive allow for normal movement and help to motion and weight bearing. Too much prevent too much motion within the joint. stress on the ankle can cause further injury Ankle sprains commonly occur during sports and prolong the healing process. Appropriate participation, however frequently occur treatment is critical during the first two with daily activities. The most common weeks following the injury to expedite the ankle sprain results from injury to the return to activity. Mismanagment of the ligaments on the outer aspect of the ankle. injury early on can lead to pain and inactivity The ligaments 1-2 months later. are injured when the heel is forced What should I do about mild to moderate inward resulting in pain? the tissues being Pain can be classified as mild, moderate, overstretched and damaged. Pain is usually and severe. If daily activities cause mild to immediate and can increase over the next moderate pain, you could be causing more 2-3 hours. damage to the ankle ligaments – which can prolong your recovery. During the first 2-3 Let pain be your guide! weeks after the injury, wear a brace during The pain associated with a sprain is due to all weight-bearing activities to control pain, the immediate damage to the ligaments and provide stability and improve function. Early the inflammation Let pain be your guide in your recovery, crutches may be needed that occurs when as you put weight on for pain-free walking. ligaments are your ankle and gradually damaged. During increase activities. ANKLE REHABILITATION PROTOCOL the first 2-3 days, swelling and inflammation In order to recover from your sprained ankle, play an important role in the body’s ability to you may have to progress through several “clean up” the injured site and allow healing. phases of rehabilitation. Immediately after However, to decrease pain and speed up your injury, initiate the PRICE (Protect, Rest, the healing process, you should control the Ice, Compress, Elevate) treatment method amount of swelling as quickly as possible. described in Phase 1 of the rehab protocol. If you have not gained full function of your The amount of pain and swelling you ankle at the completion of Phase 1, then you have is a good indication of the severity may need to continue through all phases of of the injury. Reoccurring pain is due to the rehab protocol. 2 Self Management Program

Phase 1

Days 1 - 3

Protect

Rest

Ice

Compress

Elevate

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Protect (Modify Activities) Ice For the first 2-3 weeks, wear an ankle “stirrup 1. While resting, apply ice or cold therapy brace” to protect the ankle when you walk to limit the swelling and reduce the pain. and during all weight- 2. Apply a cold pack. (Depending on the bearing activities. severity of your sprain, you may choose During the first week another form of cold therapy such as a after the injury, you Cold Therapy Wrap or a Cold Therapy Unit should use crutches and Ankle Blanket.) (with the ankle stirrup 3. To apply the ice pack, use the ace wrap brace) until you can provided to wrap the pack snugly, but walk without pain. During this time, you may comfortably around the ankle. progress from two crutches to only one as your ankle begins to heal and it can tolerate Use the following procedures if you do not more of your body’s weight. Walking with a have any cold therapy products. single crutch means you use the crutch on the opposite side of your ankle injury. • Submerge your ankle in ice water (recommended 44-45°F) above ankle Rest level for 20 minutes. Do this 3-4 times Rest is important! Active resting means a day during the first 72 hours (3 days) that you restrict or limit your activity always after the injury occurs. Allow your ankle to using pain as a guide. warm for at least 30-45 minutes between If your ankle Use crutches until you ice treatments. hurts during daily can walk pain-free and or activities or if without a limp. • Apply an ice bag (crushed ice in a zip lock sports activities are resumed too soon, the bag), a frozen freezer ice pack, or a bag healing process is prolonged and the ankle of frozen vegetables (peas or corn) over ligaments may heal in a lengthened position. a moist towel for 20 minutes. Repeat this This can lead to Chronic Ankle Instability procedure 3-4 times a day for the first 72 (and an increased chance of recurring ankle hours (3 days) after the injury occurs. sprains).

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Compression elevation when resting and sleeping. Research shows one of 3. Combine elevation with early, but gentle the most effective ways range of motion exercises. Pull the ankle to reduce swelling is toward your knee, push down toward the to apply compression floor, turn the ankle inward and outward to the swollen area as very gently 10 times – using pain as your soon as possible after the guide. Muscle activity helps move fluid injury. out of the ankle and speeds the healing 1. To compress, use a 4-inch elastic wrap. response. 2. To apply the elastic wrap, begin wrapping at the base of the toes and continue When to discontinue upward to four Loosen the wrap imme- Cold Therapy inches above the diately if you experience Swelling usually stops about 3 days after the ankle. Overlap numbness, your toes initial injury. When it does, discontinue the the wrap one- turn blue or the wrap is use of ice. If swelling returns at third to one-half uncomfortable. If the swelling has any time, start ice stopped, the ankle the width of the wrap with each layer as treatments again. it is applied. Larger feet and ankles may will not be warmer require 2-3” wraps. than body temperature.

Elevate Moist Heat 1. Raise the ankle above the level of your To improve blood supply to the injured heart. This position allows gravity to help ligaments, apply moist heat or soak your ankle in warm reduce the swelling. If applying heat 2. Keep your ankle elevated (preferably on water (100-103° increases the pain or 2 or 3 soft pillows) when icing, resting, F) for 20 minutes. swelling, discontinue and sleeping. Combine compression with Perform ankle immediately and resume range of motion ice treatments. exercises as you apply moist heat. How Often? 2-4 times a day until the swelling is gone.

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Phase 2

Days 4 - 10

Continue protection

Begin ROM exercises and muscle strengthening

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Remember: Continue to use your ankle 2. Put your injured foot and stirrup brace during the first 2-3 weeks for ankle behind you with protection. your knee straight and injured heel down. Bend your ankle Range of Motion (ROM) Exercise opposite knee (unaffected Alphabet leg) forward. Use your big toe as your focal point and 3. Keeping your injured heel write the entire alphabet (A-Z) in capital down, bend the opposite letters. Try to aggressively achieve full knee until you feel a stretch in your calf motion of your ankle; again, using pain as and Achilles tendon. Hold for 15-20 your guide. seconds. How Often? 4 times a day until you have How Often? Perform 5 repetitions with full ROM. If you experience pain, reduce the the knee straight and 5 reps with the knee intensity level until the pain resolves. slightly bent, 4 times a day.

Heel Cord Stretching Ankle Strengthening exercises Non-Weight Bearing Plantar Flexion Use this exercise if the ankle is still painful Wrap your exercise band around the sole to stand. Perform the of your injured foot/ankle. With your leg exercise while sitting. straight, slowly point your toes forward, • In a sitting position, pressing your foot down. stretch your calf How Often? Perform and Achilles Tendon 3 sets of 10-15 by looping a towel around your foot and repetitions one time pulling back as far as you can. Hold for a day. 15-20 seconds. How Often? Perform 5 repetitions 4 Dorsi Flexion times a day. Use pain as your guide. Wrap the end of your exercise band around a table or chair to anchor the band. Slip Weight-Bearing Calf and Achilles your injured foot/ankle into the loop of the Stretching exercise band. With your leg straight, slowly Use this exercise if you can tolerate walking pull your toes toward you, pulling your foot up. in your ankle stirrup brace. Perform the How Often? Perform exercise standing. 3 sets of 10-15 1. Place your hands on a wall with your repetitions one time elbows slightly bent. a day.

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EVERSION ExerciseS Walking Wrap your exercise band around your You should make walking part of your injured foot and under the sole of your non- rehabilitation program when you can bear injured foot. Move your injured foot/ankle weight on your ankle pain free and without outward away from assistance (crutches). This usually occurs your body performing around day 10 (post injury) as the ligaments three sets of 10-15 continue to heal and get stronger. repetitions each time. The average American takes about 15,000 steps a day. So, during the first 10 days, inversion Exercises your daily activities will be enough. Wrap the end of your exercise band around a table or chair to anchor the band. Slip Start with 15 minutes of walking at a your injured foot/ankle into the loop of the comfortable pace. Again, avoid hilly terrain exercise band. Move your injured foot/ankle initially. Each day, add 3 minutes and very inward performing gradually increase your walking speed. three sets of 10-15 repetitions each time. Ice for 20 minutes after all walking How often? Perform activities for the first 3 weeks if you these exercises daily experience any swelling. for one week, then three times per week, for the next 4-6 weeks. Three weeks after the injury, a goal could be to walk for 45 minutes. Use pain as Cycling your guide to determine the intensity and Riding a stationary If cycling on the duration of your activities. If you experience or street bike is an road, avoid hilly soreness during or after a walk, take the excellent way to apply terrain and go for next day off. Use common sense and give healthy stresses to an easy ride. Stay your body time to recover if you do too close to home in your ankle and work on much. case your ankle ROM. 15-20 minutes begins to hurt. of easy cycling is recommended while wearing your ankle stirrup brace. Let pain be your guide.

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Phase 3

Days 11 - 28

Begin progressive weight-bearing and functional strengthening

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Progressive Weight Bearing • Single Leg Heel Raises. and Functional Strengthening Standing only on the At this point in your rehabilitation, it may be injured leg, raise your necessary to use a functional ankle brace heel (pain-free) and hold ® such as the Element Sport Ankle, DeRoyal for a 10 count. Lower Sports Ankle or the DeRoyal Functional the heel slowly to the Ankle Brace depending on your pain and ground. Then, rest for the severity of your injury. Consult your 1-2 minutes. Perform three sets of 15 physician or medical professional. repetitions, resting between each set. During this phase, perform all exercises on How Often? Three times a day. Use pain your feet (weight bearing). Do each exercise as your guide. in succession — as each one places • Bilateral Hopping. Running involves progressively more stress on your ankle and jumping from one leg to the other. injured ligaments. Hopping prepares you to jump — so, hop! Hop in place (pain free) for 30 seconds. Functional Strengthening Exercises Perform 8-10 sets. Discontinue Bilateral Always use pain as your guide. You Heel Raises. may have mild discomfort as you advance How Often? Three times a day. Use pain through the exercises. If this happens, as your guide. apply ice and Continue the calf • Single Leg Hopping. Standing on your stay at the same strengthening exercise injured leg, hop in place for 30 seconds, exercise level before and after all Phase gradually trying to increase the height of for an additional 3 activities. Continue your day. Then, try to your jump. Perform 8-10 sets. Discontinue walking program daily as progress to the Bilateral Hopping. outlined in Phase 2. next level. How Often? Three times per day. Use • Bilateral Heel Raises. With both feet, pain as your guide. rise up on your tiptoes and hold for a 10 • Improve Balance and Coordination. count. Then, rest for 1-2 seconds. Perform Place 5-6 pieces of tape on the floor 3 sets of 15 repetitions, 3-4 inches apart and hop to each spot. resting between each Continue Single Leg Hopping. set. How Often? Three times per day. Use How Often? Three pain as your guide. times a day. Use pain as your guide.

P h a s e 3 1 0 Self Management Program

Resuming Athletic Activities What should I do for my ankle after I If you are going to participate in athletic start back into my exercise or sports activities, the following activities are routine? recommended. Check with your physician Continue to ice after activity, if swelling or medical professional for guidelines on persists, consult your physician or the frequency, duration, and distance of medical professional. Continue your ankle the activities. Their recommendation will be strengthening and flexibility program for specific to the severity of your individual 4-6 weeks after injury. Continue to wear injury and to your sport. Continue Single your Element® Sport, Functional or DeRoyal Leg Hopping and Balance exercises. Sport Ankle Brace with activities to prevent reoccurring ankle injuries. • Walk/Jog • Jog straight ahead Please contact your physician or medical • Jog in S or Figure 8 professional if you have any questions about • Jog, initiating 45° cutting on your these rehabilitation recommendations. Your injured ankle injury may be too severe to initiate Phase • Jog initiating 90° cutting on injured 2 and Phase 3 of the rehabilitation protocol ankle (Z). within the recommended time frames.

• Running at half speed: Consult your medical professional for • Figure 8’s specific guidelines on how to manage • 45° diagonals your injury. Always follow the individual • 90° cutting instructions of your physician or medical professional. • Running at three-quarters speed: • Figure 8’s • 45° diagonals • 90° cutting

• Cutting on command and sport specific activities or skills may be added by your personal physician or medical professional.

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With any injury or medical condition it is advisable to consult a physician or other medical professional before beginning any treatment or rehabilitation program. DeRoyal strongly recommends that you contact your physician immediately if you experience any of the following symptoms: • Numbness or tingling in your feet or ankle. • Cold or discolored toes (Try loosening or removing your elastic bandage if it is being worn. If the problem continues, consult your physician or medical professional). • An increase in swelling with decreased mobility. • Severe pain that does not ease after rest. • Inability of your ankle to bear weight more than four days after your injury.

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