| Program is intended for uncomplicated grade I and II lateral ankle sprains and grade I medial (deltoid) ankle sprains. |
Time required: - Phase 1 (basic mobility): 6 to 9 minutes total (3× daily; day 2 to about day 5)
- Phase 2 (single-leg balance): 6 minutes total (3× daily; day 3 to conclusion)
- Phase 2 (strengthening): 8 minutes total (2× daily; day 3 to conclusion)
- Phase 3 (full mobility): 6 minutes total (2× daily; about day 5 to conclusion)
- Phase 4: Gradual return to full sport/heavy labor
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| Assuming Phase 3 begins when Phase 1 ends, this program requires approximately 20 minutes per day; times can be shortened if preferred by reducing activities from 3 to 2 times daily and/or reducing the number of sets per exercise. If the sprain is mild, symptoms resolve quickly, and healing is rapid, the program can be accelerated provided all phases are completed. |
- Following injury and before starting rehabilitation program, perform 24 to 48 hours of protection, rest, ice, compression, and elevation until swelling has subsided.
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- Phase 1: Ankle motion to regain mobility – Start 24 to 48 hours after injury; continue for 3 to 7 days total depending on severity of sprain. Can discontinue once ankle is pain free and exercises require only minimal effort.
- Alphabet exercises: While sitting, use the big toe of the injured foot to trace the alphabet (upper- and lower-case) for 2 to 3 minutes. Perform 3 times per day.
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- Phase 2: Balance and early strengthening to regain effective ankle function – Start exercises once able to stand 1-legged on injured ankle with only minimal or mild pain, typically 3 to 5 days after injury. Continue throughout functional rehabilitation program until return to full activity.
- Single-leg balance drills – Stand on injured leg only for 1 minute, repeat once (2 sets total). Perform 3 times per day. Make this more difficult as able by adding 1 or more of the following: balance barefoot, close eyes, stand on soft surfaces (folded towel or thick carpet), add fore-to-aft or side-to-side sway. For maximum benefit, keep exercise challenging.
- Strengthening: Perform twice daily while seated (wear footwear):
- Place outside of the foot against a wall or other immobile, large object. Rotate foot out against the wall. Hold for 15 seconds, repeat twice (3 sets total).
- Place inside of a foot against sturdy table leg or other immobile object. Rotate foot inward against the object. Hold for 15 seconds, repeat twice (3 sets total).
- Place heel of non-injured foot on top of mid-foot of injured extremity. Keeping heel of injured foot on the ground, raise the forefoot (ie, dorsiflex ankle) against resistance provided by non-injured foot. Hold for 15 seconds, repeat twice (3 sets total).
- Raise heel and push ball of injured foot against the floor (ie, plantarflex ankle). Hold for 15 seconds, repeat twice (3 sets total).
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- Phase 3: Ankle stretching to regain full motion – Start 5 to 10 days after injury and continue throughout functional rehabilitation program until return to full activity.
- Towel stretch of calf and Achilles tendon – Sit on floor with leg of the injured ankle extended. Loop a small towel around the ball of the foot. While maintaining a fully extended knee, pull the towel towards you, stretching the calf. Hold for 30 to 45 seconds, repeat 3 times (4 sets total). Between each stretch, take 30 seconds and point toes straight down (maximum plantarflexion), then down and in as much as tolerated (inversion), then up and out as much as tolerated (eversion), 10 seconds each. Perform the entire routine twice per day.
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- Phase 4: Gradual return to physically demanding work/recreational activity/sport
- Start with walking/running in single direction (road running, walking around office) – Can begin 7 to 10 days after injury; continue for 5 to 10 days (through day 12 to 20 after injury). Add more challenging movements (next step in Phase 4) when pain is resolved, ankle function feels normal, and you are comfortable placing greater demands on ankle.
- Next, add some lateral movement and use slightly uneven surfaces (working at field sites, hiking on easy trails/low gradients, sport-specific drills) – Usually begins 12 to 20 days after injury; continue for 5 to 10 days (through day 17 to 30 after injury). We advise wearing a functional ankle brace.
- Finally, add full lateral movement and high-function activities (field/court/rink sports, physical labor [eg, lifting equipment/work on uneven terrain/climbing ladders], hiking on uneven trails/steep gradients) – Usually begins 17 to 30 days after injury and continues indefinitely. We advise wearing a functional ankle brace.
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- Patient should continue program until ankle feels stable, pain is minimal or resolved, and overall function is at least 90% of uninjured, contralateral ankle.
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