Ankle sprains are definitely one of the most frequent injuries we see at South Cowichan Physiotherapy. What always strikes me is that they tend to occur to a wide variety of people. We see injured athletes, workplace ankle sprains, or just the everyday person who stepped into a pothole and twisted their ankle. Whether it be a mild or more severe sprain, the key to successful rehab is re-training your balance after one of these injuries.
Why is it important to re-train your balance?
Well, when you “sprain your ankle” what you have really done is over-stretched some of the ligaments in your ankle. These ligaments line the outside and inside of your ankle and prevent excessive inversion (think bending your foot inwards) or excessive eversion (think bending it outwards). By far, people tend to more commonly sprain the ligaments on the outside of the ankle as they inadvertently let their foot roll too far inwards. However, the way to retrain your balance for either type of sprain is actually the same (more on that a bit later).
What happens in the first few days after a sprain is that the ankle usually swells and depending on how severe the sprain is then there may also be a fair amount of bruising and pain. Within a few weeks this usually subsides and most people are basically pain-free within 4-6 weeks. However, despite the lack of pain, you still are left with permanently over-stretched ligaments. This is the single greatest problem with ankle sprains! You feel better before you have fully corrected the problem.
With over-stretched ligaments your body will not be able to resist excessive inward or outward movement of the ankle. This will make you more prone to developing future ankle sprains. With each additional sprain you stretch the ligaments that much further, until at some point they may actually snap completely. Don’t panic though, because there is an easy solution!
The body’s built-in redundancy
The ankle is one of the few joints in the body where you can sprain the ligaments quite severely (even tear them fully) and still manage to compensate such that you’d hardly know the difference. How is this possible? Well, we have several muscles that run right alongside the ligaments on the inside and outside of your ankle. These muscles, if they are strengthened properly, can actually pick up the extra slack for the sprained ligaments. The more times you’ve sprained your ankle, the stronger they have to be to. So, how do we strengthen them? By doing balance training!
When we hear balance training we tend to think of some kind of crazy slack line or those half dome contraptions you see people using in the gym. However, the solution that I have found that has worked for more of my patients than anything else is far simpler. The solution is… standing on one leg….and cue the anti-climatic music here, haha.
Believe it or not, this exercise that they made you do in phys. ed. class as a kid is still the best exercise to use when initially trying to re-train your balance. That’s because it requires no specialized equipment and can be done just about anywhere. Why are those two things important? Because in order to re-train your balance you need to work on it a lot! It’s not good enough to just stand on one leg for 20 seconds 2 or 3 times a week. It has to be done just about every day, and ideally several times throughout your day. What’s more, it’s not good enough to do this for just a week or two. Re-training your balance fully will require at least 2 to 3 months or longer.
The number of reps, etc
I typically recommend trying to start with 20 to 30 seconds and doing this for 4-5 reps. That would be ONE set. Ideally, you would complete 4-5 sets a day, but not all at once. Trying to do 20 minutes of balance training all at once will get you no where. The body’s sensory system cannot take it and will typically fatigue after more than 5 minutes (and sometimes less). So the key is, short bursts, frequently throughout your day. I would typically prescribe this for at least the first 2-3 weeks but sometimes longer depending on how my patient’s balance seems when I re-assess them. The next step would be to progress to a more difficult form of balance training, a topic I will address in my next blog article!
One last suggestion
I often recommend that once people become comfortable that they try and stand on one leg while their mind is focused on something else, such as brushing their teeth. Maybe not while chopping vegetables, but I am sure you get the idea. The reason this is important is because it provides context-dependent training. In other words, when you sprain your ankle you typically are focused on something else at the time of the injury. In order to prevent re-injury we need to train the body to be able to deal with distractions.
All ankle sprains are not created equal
While the above guidelines will generally serve most ankle sprains well, there are always exceptions. For instance, if you’ve sprained your ankle, but you’re also recovering from a surgery where you’ve had a metal plate put in to your ankle to stabilize a fractured bone, then your surgical guidelines may not want you to be putting full weight on to the ankle right away. Likewise, more elderly patients often find that they need a gentler type of balance training before progressing to single leg standing. These cases outline the important principle that getting assessed by a trained healthcare professional, such as a physiotherapist, is important to ensure that your unique injury is treated in the most appropriate way.
That being said, all of the staff here at South Cowichan Physiotherapy are well trained to assess and treat your ankle sprain so give us a call today at 250-743-3833
MScPT, CGIMS, CAFCI, CSCS
Co-Owner of South Cowichan Physiotherapy
Want to learn more about how he can help you? Then check out his bio by clicking here