Ankle sprains can be graded as grade 1 (mild), grade 2 (moderate), or grade 3 (severe). Mild sprains include slight swelling with no instability, and typically take 1-3 weeks to return to sport. Moderate ankle sprains involve more pain and swelling with minor instability and can take 3-6 weeks before returning to full activity. A severe sprain will involve significant pain, swelling, and instability, and can take 4-12 weeks to fully heal. Rehabilitation should be initiated immediately and should involve strengthening of the stabilizing muscles to prevent recurrent ankle sprains. The severity of the injury will dictate how aggressively the program can progress. At Back to Function, we utilize an evidence-based rehabilitation program to facilitate full healing and stabilization of the ankle, allowing safe return to activity or sport. 

Phase 1: (Up to 72 hours) 

Goals:  

• Protect the healing ligament 
• Reduce pain 
• Safely promote inflammation (see the following articles for further information regarding this topic: https://backtofunction.com/use-ice-soft-tissue-injuries-actually-bad-idea/ https://backtofunction.com/nsaids-a-bad-choice-for-your-injury )

Activities: 

• Compression (compression bands, NormaTec, compression garments) 
• Elevation 
• Tape/brace/cast 
• Soft tissue therapy 
• Marc Pro electrical stimulation (peroneal & tibial nerves) 

Phase 2: (First week) 

Goals: 

• Restore functional pain-free range of motion 
• Limit proprioceptive loss 
• Early progressive weight bearing within tolerance 

Activities: 

• PROM, AROM (figure 8’s, alphabet) 
• Gastroc/soleus self-stretch, Prostretch 
• Seated rocker board (start with dorsi/plantarflexion, progress to lateral movements) 
• Strength: isometric dorsi/plantar/inversion/eversion 
• Foot intrinsic strengthening: towel scrunch, toe raises, Propriofoot 
• Balance: single leg stance, progress to body blade, eyes closed, unstable surface 
• Calf raises 
• Squats & lunges (stable surface) 
• PRI exercises based on functional screen 
• Bike 
• Continue taping/wearing brace if needed 
• Continue soft tissue therapy 
• A removable air cast or Velcro cast brace can be used to protect the ankle during rehab exercises (Grade I: brace no longer than 1 week, Grade II or III brace may be required for 2-3 weeks) 

Phase 3: (Second week & beyond) 

Goals: 

• Increase strength/muscular stabilization 
• Increase functional stabilization and proprioception 

Activities: 

• Strength: isotonic dorsiflexion, plantarflexion, inversion, eversion (resistance bands, ankle weights) 
• FRC exercises 
• Resisted side stepping 
• Balance: standing rocker board (*start in frontal plane, progress to transverse plane), introduce perturbations (med ball pass, body blade), progress to single leg rocker/wobble board, eyes closed, trampoline one leg ball catch, balance reach lunge 
• Bosu squats, lunges 
• Initiate running 

Phase 4: (Variable) 

Goals:  

• Initiate sport-specific functional training  
• Gradual return to full daily activity/sport 

Activities:  

• Sprinting in a straight line (*if running is pain-free), backwards running, progress to figure 8 running 
• Cutting drills, starting/stopping drills 
• Agility ladder 
• Plyometric jumping: 3D jump sequence, squat jump, one leg squat jump, depth jumps, single leg bounding 

This rehabilitation protocol for ankle sprains has been adapted from the following sources cited below. It is not intended to be a substitute for clinical decision making regarding the patient’s own individual progression. If you have an ankle issue that needs to be evaluated, please give us a call at (310) 534-1900 or email us at info@backtofunction.com. 

References: 

Hyde, T. and Gengenbach, M., 2007. Conservative Management Of Sports Injuries. Sudbury, Mass.: Jones and Bartlett Publishers. 

Massgeneral.org. 2020. Massachusetts General Hospital Orthopaedics. [online] Available at: <https://www.massgeneral.org/assets/MGH/pdf/orthopaedics/sports-medicine/physical-therapy/rehabilitation-protocol-for-ankle-sprain.pdf> [Accessed 14 July 2020]. 

Sanfordhealth.org. 2020. Sandford Orthopedics Sports Medicine. [online] Available at: <https://www.sanfordhealth.org/-/media/org/files/medical-professionals/resources-and-education/014000-01095-flyer-ankle-sprain-rehabilitation-pt-guideline.pdf> [Accessed 14 July 2020].