Ankle sprains are the most common injury when it comes to athletics. I have used this same protocol for high school athletes to elite, professional athletes and everything in between. Before we start, if you just sprained your ankle start here. If you are concerned for a fracture or think you might need an x-ray then start here.
The 4 Phases To Rehab An Ankle
- You isolate and strengthen the ankle
- Compound movements
- Plyometrics
- Return to sport specific activity
The line from one phase to the next for ankle sprain rehab is somewhat blurry. On occasion it may be possible to complete 2 phases in a day. It also could take 2 weeks to complete one phase; it is very dependent on injury severity and individual tolerance.
My criteria to progress from one phase to the next is as follows:
- Ability to perform each ankle exercise with 3-4/10 pain
- Ability to come back for the next session not worse off than you left (more swollen, more pain etc)
#1. Isolation For Ankle Sprain Rehab
Strengthen the calves after an ankle sprain
- Complete 3 sets of 12 reps
- Increase reps before weight
- Progress from 12-15-20 reps, add weight when 20 is achievable and then restart back at 12 reps
- Calf raises can be loaded with anything
- If you don’t have weights, hold literally anything with weight
Strengthen the tibialis anterior after an ankle sprain (for additional variations go HERE)
- Perform 3 sets of 12.
- Add reps before you add weight
- Complete this 3x a week
Strengthen ankle inversion/eversion after an ankle sprain
- Complete 3 sets of 30 seconds both directions
- Progress by adding time to each hold
- Can add weight to continue to overload
#2. Compound Movements For An Ankle Sprain
5 Total Exercises. Pick 3 per session. Plan for 3 rehab sessions/week. Guidelines for all compounds listed below
- Reps/sets scheme is 3×10-12-15
- Add reps from session to session (IE Monday 10, Wednesday 12, Friday 15 and then add weight)
- Moving from double leg to single leg is the easiest way to add intensity without changing weight
3 way step up
- Reps/sets scheme is 3×10-12-15
- Add reps from session to session (IE Monday 10, Wednesday 12, Friday 15 and then add weight)
- Complete 3 sets per direction (9 total)
Walking lunges
Squat
Split squat
KB deadlift
Plyometrics For Ankle Sprain Rehab
Plyometrics are an essential portion of a return to play for an athlete. Plyos increase muscle control and decrease stress on tendons/ligaments during high stress activity. General rule of thumb is that as the demand of the plyo increases, repetitions are decreased. If you are not an athlete and do not need to be able to tolerate extremely strong forces, then I would not progress into this phase.
4 movements, progressing from most simple to most difficult:
Line hops, forward and lateral
- Complete 3 sets of 20 reps for both directions
- Begin then double leg
- As this gets easy/pain free, progress to single leg
Bounding
- Complete 3 sets of 10 reps
Box jumps
- Complete 3 sets of 5 reps
- This begins as a double leg exercise
- As strength builds, progress to single leg
- Jump up onto the box and then step off
Box jump downs
- Complete 3 sets of 3 reps
- This begins as a double leg exercise
- As strength builds, progress to single leg
Return To Sport After Ankle Sprain Rehab
I use a single functional test for all lower extremity injuries: the LEFT. If this test can be completed without much pain or poor performance from the injury, then I have athletes return to their sport as tolerable. This is the final portion of the ankle sprain rehab.
If you want to use this test as objectively as possible, complete this test as a baseline measurement pre-season and time it. When ready to return to sport, complete the test and time it again. If within 90% of baseline, then return to sport/competition can begin.
