M. Patrice Eiff, MD
Associate Professor, Department of Family Medicine, Oregon Health Sciences University and Team Physician, Portland State University, Portland, OR
Courtesy of the Gatorade Sports Science Institute

Injury

Ankle sprains are the most common athletic injury. An ankle sprain happens when the ankle turns in or out. This injury causes a stretch or tear of one or more ligaments (a band of tissue that connects the bones of the ankle joint). Most ankle sprains occur on the outside of the ankle. Most injuries are minor and don't require surgery or extensive treatment.

Signs and Symptoms

You might feel a "pop" when you sprain your ankle. This is due to the tear or stretch of the ligaments, almost like snapping a tight rubber band. Pain and swelling happen early. You may notice bruising around the ankle and foot within the first few days. You won't be able to move your ankle normally and you may not be able to put weight on it.

Early Treatment (First 24-48 Hours)

Getting rid of swelling is an important part of early treatment. It will help decrease pain and speed up healing.
• Keep the ankle raised above the knee as much as possible
• Wrap the ankle with an elastic bandage
• Put an ice bag or bag of frozen vegetables on the ankle for 20 to 30 minutes every 3 to 4 hours
• Use crutches until you can walk without pain

Rehabilitation (After 48 Hours)

Step 1—
Get Rid of Swelling & Get Your Ankle Moving

The sooner you get your ankle moving, the sooner you will get back to your sport. As the swelling goes down, you will be able to move your ankle more. Here are a couple of exercises to get your ankle moving:

• "Alphabet" Exercise: Draw each letter of the alphabet in the air using your big toe as the "pencil." Repeat the entire alphabet 5 times. Do this exercise 3 times per day.
• Motion Exercise: Move by flexing and extending your ankle up and down as far as it will go 10—15 times. Do this exercise 5 times per day.

Continue icing your ankle at least 3 times daily. As long as swelling continues, keep elevating the ankle as often as possible.

Step 2—
Muscle Stretching and Strengthening

Calf muscles get tighter and weaker after an ankle sprain. Once the swelling decreases and you can move your ankle more, you should start to stretch and strengthen the muscles around the ankle. Put ice on the ankle if it begins to swell or hurt after doing these exercises.

Muscle Stretch (see illustration)
Face a wall, standing about 2 to 3 feet away. Place your hands on the wall, heels on the ground, and keep knees straight. Lean toward the wall. Hold for 30 seconds. Repeat 10 times.

Repeat the entire exercise. This time bend the knees slightly, while still keeping heels on the ground.

Attach one end of an elastic band or tubing to the leg of a chair. Loop the opposite end around the foot of the injured ankle. Keeping the heel on the ground, slide the footer outward as far as possible and hold for 10 seconds. Repeat 15 times.

Toe Raises: Rock back on the heels of both feet. Hold for 5 seconds. Repeat 15 times.

Heel Raises: Rise up on the toes of both feet. Hold for 5 seconds. Repeat 15 times.

Step 3—Sport Conditioning

Balance
When you sprain your ankle some balance is lost but can be regained. Stand on the injured foot only and hold your balance—start with 30 seconds and advance to 3 minutes. Repeat this with eyes closed. Make sure you have a wall or chair nearby for support. Do these same exercises with the other leg. Repeat exercises times daily.

Running
When walking is free of pain and limping, you can begin light jogging. Jog on a flat, even surface. Begin with 10 to 15 minutes and gradually increase the time each day. Do not increase your time if you had increased pain and swelling the day before. Ice the ankle for 20 minutes after jogging. Wear an ankle brace for extra support if recommended by your doctor.

Sport Skills
If your sport requires quick changes in direction, your ankle needs to be re-trained to do this. Do these exercises in order:
• Sprints: 40-yard sprints at 1/2 speed, then 3/4 speed, then full speed
• Figure Eights: Run in a figure eight pattern of 5-yard circles
• Zigzags: Run zigzags changing direction every 5 yards

When you can do all these exercises without increased pain or swelling, you are ready to return safely to your sport.

Warning Signs to Seek Help
An inability to bear weight on the affected ankle should prompt further evaluation by a health professional to determine the extent of the injury. Contact your doctor if you experience any of the following:
• Numbness in your foot or ankle
• Increased swelling rather than a gradual decrease
• Re-injury to the ankle
• A sensation that your ankle gives way while walking or running

This information is for educational purposes only and is not meant to replace medical or treatment advice given by your physician.

Copyright © 2002 Gatorade Sports Science Institute - All rights reserved