REHAB FROM THE AGony of ankle SPRAIN

Previously in Tennis Life we have discussed the most common type of ankle injury, the sprain.  Part of the recognition and care for an ankle injury is the appreciation and initiation of the appropriate aspects of treatment aimed toward functional rehabilitation. 

               Joint stability is the primary requirement prior to functional rehab.  As stated previously ankle sprain stages one and two are mostly stable and therefore rehab therapy should be started as soon as possible.

               Joint range of motion should be positive and then rehabilitation should begin.  Initially stretching the Achilles tendon in a non-weight bearing scenario is performed by using a towel to stretch the foot, moving your toes toward your head, the heel going away from the body.  If this can be performed in a pain free environment for 30 seconds, times three sets and done three times a day, then rehab can progress to a weight bearing stretch of the Achilles.  Additionally, the ankle range of motion can be performed by moving the foot around the ankle joint and spelling out the alphabet (A, B, C, etc.)  This can be done three times a day.  After each of these exercises the ankle should be pain free and an ice massage should be performed. 

               When there is pain free range of motion and joint stability the next phase of rehab is the strengthening phase.  This is very important for return to proper function and prevention of re0injury due to join weakness and instability.

               The initial series of exercises are Isometric.  This means the muscle action is performed but not with motion.  To achieve this, muscle activity occurs against an immoveable object.  The foot is pushed and pulled in four directions, up, down, inverted and exerted.  There should be no pain in any direction.  Once this is achieved then Isotonic exercises may begin.  These exercises are performed with various resistance bands and elastic tubes, and later weights are added to achieve dynamic resistance.  These motions are performed once again but motion is allowed by the stretching of the bands.  Later is may be possible to include toe walking, heel walking and toe raises to further improve strengthen and balance.   

               As rehab continues in a progressive direction it becomes timely to institute proprioceptive training.  This is important to prepare for return to normal activity and athletic playing condition.  There are therapeutic devices used for this training and should be performed under the supervision of a trained professional.  These should include the wobble board and exercising performed on different uneven surfaces.  These motion s can be performed with the eyes both open and closed, and with and without resistance.

               Finally, to achieve complete rehabilitation and return to activity there must be the ability to function in a pain free climate.  The stages of this begin with walking, followed by light jogging both forward and backwards, and then pattern running (such as circles, and figure eights).

               This represents the final phase of ankle sprain rehabilitation which is essential for stability and good athletic function.  The use of ankle braces, orthotic devices and taping are also a part of the care.  Their use should be determined by the trained medical professional supervising the rehab care.

Simon B. Small, DPM, FACFS, FAAPSM, is a board-certified Sports Medicine Specialist, Podiatrist and President of Pro-Support Systems, Inc.