By: Dr. Vivian Zhang, PT, DPT, MS.
Introduction to Ankle Injuries and Physical Therapy
Providing support and articulation for the foot, the ankle joint plays a critical role in our mobility. Injuries involving the ankle can, therefore, be particularly frustrating, not only due to the pain of the initial injury but also to the accompanying immobility. Common injuries of the ankle include sprains, strains, and fractures, all of which can vary in severity and recovery time. During the acute inflammatory phase of injury treatment with R.I.C.E. (rest, ice, compression, and elevation) plays an important role to accelerate the healing process by minimizing swelling, pain, and opportunity for further injury. Other more severe injuries may require immobilization in a cast/boot and/or surgical treatment. Injury to the ankle can increase the risk of re-injury, making rehabilitation through physical therapy extremely important not only to restore normal function but also to reduce the chances of injuring the joint again.
Recovery after injury involves exercises focused on restoring range of motion (ROM), strength, and neuromuscular control. Rehabilitation exercises begin with non-weight bearing exercises and progress to weight-bearing exercises, while gradually increasing reps and resistance. Exercises should always be performed in a pain-free range and should never increase pain or swelling in the joint after completion. Below are examples of physical therapy exercises specific to addressing common impairments post ankle injury that you can try at home. If you or someone you know is currently recovering from an ankle injury consult your local physical therapist to help guide you through an appropriate rehabilitation program aimed to relieve your symptoms so you can get back to doing the things you love!
Range of Motion (ROM) Exercises:
Loss of ankle joint ROM secondary to immobility, pain, swelling, and scar tissue build-up often accompanies ankle injuries. Thus, starting your rehabilitation program with exercises focused on restoring normal ROM, unless prohibited by your doctor, is extremely important. Here are a few simple ROM exercises that can be done at home.
- Ankle Alphabets: While seated in a chair extend your injured leg out and trace each letter of the alphabet with your foot. Repeat a couple of times throughout the day.
- Dorsiflex Towel Stretch: Sit comfortably on the floor with your injured leg stretched out in front of you. Place a towel around the ball of your injured foot. Gently pull back the towel to bring your toes towards your head until you feel a stretch in the back of your calf. Repeat 3 times holding each stretch between 30 seconds-1 min at a time.
- Standing Calf Stretch: Stand facing a wall stagger your stance so that your injured ankle is behind you and your non-injured ankle is in front of you. Place both hands on the wall. While keeping your back foot straight and flat on the floor slowly bend the knee of your front leg until you feel a stretch in the calf of your back leg. Repeat 3 times holding each stretch between 30 seconds-1 min at a time.
- Kneeling Anterior Tibialis Stretch: Sit on your feet with your toes untucked and your hands in front of you. Lean back until you feel a gentle stretch along the tops of your feet and shin. Repeat 3 times holding each stretch between 30 seconds-1 min at a time.
Joint Strengthening Exercises:
Not only is it important to restore full ankle ROM, but it is also important to strengthen your ankle. Developing the muscles around your ankle helps to support the joint, improving stability which reduces the risk of re-injury. Some simple ankle strengthening exercises include:
- Seated Heel Raises: Sit in a chair and lift your heel up and down off of the floor. To add resistance, place your hand on your knee and apply a downward force while rising up and down on your tip-toes. Repeat 10 times and perform 3 sets.
- Standing Heel Raises: Stand facing the back of a chair or countertop. Place two fingers on the sturdy surface for balance. Lift both heels off of the floor to come onto your tip-toes. To increase the challenge and if it is pain-free to do so stand on your injured leg only and perform a heel raise while standing on one leg. Repeat 10 times and perform 3 sets.
- Resistance Band Exercises:
- Dorsiflexion: Sit comfortably on the floor with your injured leg stretched out in front of you. Wrap a resistance band around a sturdy surface such as the leg of a chair or bedpost. Loop the resistance band around the top of your foot just below your toes. Pull your toes back towards your head into the band. Hold for 1 second and return your foot to a neutral position. Repeat 10 times and perform 3 sets.
- Plantarflexion: Sit comfortably on the floor with your injured leg stretched out in front of you. Wrap a resistance band around a sturdy surface such as the leg of a chair or bedpost. Loop the resistance band around the ball of your foot while holding onto each end of the band. Point your toes down into the band like your pressing on the gas pedal of your car. Hold for 1 second and return your foot to a neutral position. Repeat 10 times and perform 3 sets.
- Inversion: Sit comfortably on the floor with your injured leg stretched out in front of you. Wrap a resistance band around a sturdy surface such as the leg of a chair or bedpost. Loop the resistance band around inside of your foot just below your big toe. Push your toes inward towards the midline of your body into the band. Hold for 1 second and return your foot to a neutral position. Repeat 10 times and perform 3 sets.
- Eversion: Sit comfortably on the floor with your injured leg stretched out in front of you. Wrap a resistance band around a sturdy surface such as the leg of a chair or bedpost. Loop the resistance band around the outside of your foot just below your pinky toe. Push your toes outwards away from the midline of your body into the band. Hold for 1 second and return your foot to a neutral position. Repeat 10 times and perform 3 sets.
Physical Therapy Exercises for Improving Neuromuscular Control
Neuromuscular re-education exercises focused on improving balance and proprioception are also a key component to one’s ankle rehabilitation program. Nerve receptors called proprioceptors, a type of sensory receptor that relays information about bodily positions to the brain found within and around tissues of the ankle joint, often get damaged during an injury. When damaged our ability to control the position of our ankle while we move becomes compromised. Thus, by performing exercises aimed to restore the functioning of these receptors you will be able to prevent your ankle from being placed in positions that are more susceptible to re-injury. For improving neuromuscular control in the ankle you can try:
- Single-Leg Stance: Stand in the corner of the room on an even and firm surface with a chair in front of you. Pace two fingers on the chair in front of your to start. Shift your weight onto your injured leg and pick up the non-injured leg up off of the ground so that you are standing on one leg. Hold this position without holding onto the chair for as long as possible. If you fall out of the position, resume the position again. Gradually build up the length of time you can maintain a single-leg stance. To increase the challenge, you may place a pillow or foam block underneath your foot or try standing with your eyes closed.
If you’re in the New York City area and are looking for a physical therapist to treat your ankle injury contact us by filling out the form below or give us a call.