An ankle sprain occurs when the ligaments supporting the joint are stretched or torn, typically resulting from the foot turning inward (inversion). Severity ranges from a mild stretch (Grade I) to a complete rupture (Grade III), which dictates the recovery timeline. While initial treatment focuses on protection and managing discomfort, a structured rehabilitation program is necessary to restore full function, flexibility, and strength. This guide provides a framework for safely progressing recovery stages to prevent future sprains.
Determining When to Begin Movement
Beginning movement too soon can hinder the healing process. It is important to wait until the acute inflammatory phase has passed, which usually involves a few days where pain and swelling are most pronounced. Only initiate movement once significant swelling has subsided and the pain is manageable.
Consulting with a healthcare provider, such as a doctor or physical therapist, is the most appropriate first step before starting any exercise program. They can assess the sprain’s severity and confirm that no fracture is present, which requires a different approach. Your readiness to move from the protection phase to mobilization is indicated by your ability to bear some weight on the foot without excessive discomfort.
The goal of this early stage is to transition to gentle, controlled motion without causing further tissue damage. Even for a mild sprain, ligaments need time to heal, but prolonged immobilization can lead to joint stiffness. Progressing rehabilitation based on the absence of sharp pain helps guide a safe progression.
Initial Gentle Range of Motion Exercises
The earliest movements focus on restoring basic joint mobility lost due to swelling and rest. These exercises should be performed while seated or lying down to ensure the ankle is not bearing any weight. The aim is to move the joint slowly through its available range without resistance or pain.
One effective exercise involves “writing” the alphabet in the air with the big toe, known as the Ankle Alphabet. This technique encourages the ankle to move gently in all four main directions: plantarflexion, dorsiflexion, inversion, and eversion. Start by tracing small letters and gradually increase the size as motion improves and discomfort allows.
Simple “Ankle Pumps” are also beneficial. Perform them by moving the foot up toward the shin (dorsiflexion) and then pointing the toes away (plantarflexion), like pressing a gas pedal. Repeating these motions slowly helps promote blood flow and reduce stiffness without stressing injured tissues. Side-to-side movements, mimicking a windscreen wiper, restore gentle inversion and eversion.
Specific Flexibility Stretches
Once the ankle can tolerate gentle active movement without pain, the next stage involves applying light tension to lengthen surrounding muscles and connective tissues. Tightness in the calf muscles (gastrocnemius and soleus) often develops after a sprain and can restrict dorsiflexion, which is necessary for walking. These stretches address that tightness, which can hinder full recovery.
The seated Towel Stretch is a common technique to target the calf and Achilles tendon. Sit with the leg extended and loop a towel or resistance band around the ball of the foot. Gently pull the towel toward your body while keeping the knee straight, creating a stretch in the back of the calf. Hold the stretch for 20 to 30 seconds, repeating it two to four times.
Standing Wall Stretches progress flexibility by incorporating body weight. Face a wall and place the injured foot behind the uninjured one, keeping the back heel flat and toes pointed forward. Lean forward slowly until a stretch is felt in the calf of the back leg, ensuring the heel remains down. Bending the back knee slightly targets the deeper soleus muscle.
Building Strength and Stability
Full recovery requires rebuilding the strength of stabilizing muscles and restoring proprioception. Proprioception, the body’s awareness of the joint’s position in space, is often impaired after a sprain, increasing re-injury risk. Strengthening exercises should only be introduced once range of motion and flexibility exercises are pain-free.
Resistance band exercises are effective for isolating and strengthening the muscles controlling ankle movement. Use a light resistance band to perform dorsiflexion (pulling the foot toward the body), plantarflexion (pushing the foot away), inversion, and eversion against the band’s tension. Eversion strengthens the peroneal muscles on the outside of the ankle, which is important for preventing the common inward rolling sprain.
To improve proprioception, balance training is essential, starting with simple single-leg standing exercises. Stand on the injured leg, using a stable object like a counter for support, and gradually build up the time you can hold the position. As stability improves, increase the challenge by standing on an unstable surface, such as a folded towel or pillow, or by balancing without support.