Ankle Sprain Treatment (Care of the Young Athlete)

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Acute ankle and foot injuries are common in
athletes and other active young people. Sprains account for the greatest number
of acute injuries.

The following is information from the American
Academy of Pediatrics summarizing the treatment phases of rehabilitation for
ankle sprain.

Phases of rehabilitation for ankle sprain

Phase Summary Description
I Phase I treatment involves resting and protecting the ankle to
permit healing, to prevent further injury, and to control pain
and swelling.
  • Rest, protection
    (brace, wrap, splint, and/or crutches)

  • Control inflammation
    (ice, compression, elevation)

  • Early weight bearing
    as tolerated

II Phase II treatment begins once pain and swelling have subsided
to the point where the athlete can comfortably bear weight and
walk from place to place.
  • Reduce residual
    swelling.

  • Restore flexibility
    and joint range of motion.

  • Restore strength
    (with emphasis on peroneals and calf— see
    “Peroneal strengthening exercise” and
    “Calf strengthening exercise”).

  • Resume low-impact
    aerobic training; maintain general fitness.

III Phase III treatment focuses on restoring ankle proprioception
(balance and position awareness) as well as agility and
coordination.
  • Restore
    proprioception (see “Proprioception
    exercise”).

  • Restore
    agility/coordination.

IV In Phase IV treatment, athletes make the transition back to
their sport through what is known as a functional progression.
For running sports, athletes may progress from jogging or
running straight ahead on a flat surface to sprinting.
  • Functional
    progression (jogging, running, sprinting, cutting,
    jumping; sport-specific skills)

V In Phase V, the athlete has completed the functional program and
should be ready to return to practice.
  • Gradual return to
    practice and competition

  • Maintenance
    exercises and long-term protection

Exercises

Peroneal strengthening exercise

Exercises that use elastic tubing can help
restore strength to the muscles of the leg and calf.

  • Attach elastic to secure object.

  • Loop tubing around left
    forefoot.

  • Pull the tubing to the left with
    your forefoot while keeping the rest of your foot in place.

  • Repeat steps 1 through 3 with right
    forefoot pulling the tubing to the right.

Calf strengthening exercise

Calf strengthening can be performed by toe
raises, with or without added weight, and toe raises on the edge of a
step.

  • Stand with balls of feet on a step.
    Hold onto a handrail to keep you steady.

  • Keep your knees slightly bent and
    gently lower your heels.

  • Then slowly raise your heels by
    pushing on the balls of your feet.

  • Repeat steps 1 through 3.

Proprioception exercise

Exercises to restore proprioception are
performed on a balance board, a wobble board, or a mini trampoline, or
simply by standing on one leg while playing catch with a ball or doing some
other distracting activity.

Return-to-play criteria

Because injuries and recovery rates are
different for every athlete, it is difficult to estimate an exact date or time
when return to sports will be safe. However, by plotting the phases of
rehabilitation (see graph), doctors can discuss with athletes the necessary
steps for recovery and will be able to measure an athlete’s progress
against this standard.