What to do after an Ankle Sprain

When all eyes were on each country’s best soccer players competing for the illustrious FIFA World Cup, Brazil’s hopes of winning the cup took a potential hit when their star player Neymar suffered an ankle sprain during the preliminaries. How did one of the best soccer players from Brazil get back to playing in the elimination round of 16s? Was there magic involved? Let’s take a deeper dive into the potential ankle rehabilitation program that got him back so quickly. 

​The most common mechanism of injury of spraining your ankle is when the ankle rolls inwards and stretches the ligaments on the outside of the ankle and the most unstable position of the ankle is when the ankle is pointed down. So, when you are running or jumping and land on uneven surfaces, the ankle may roll inwards, causing you to sprain your ankle and overstretch the ligaments. 
 
When your ankle is swollen and discolored, what do you do? Well in the initial weeks of the injury, it is recommended to follow the acronym PEACE and LOVE (Dubois & Esculier 2019).
 
P - Protect the ankle from any activities or movements that would increase the pain during the first few days.
E - Elevate the ankle higher than the heart to reduce the swelling and promote blood flow back to the heart. 
A - Avoid anti-inflammatories initially as they will slow down the stages of healing and reduce tissue healing. 
C - Compress the ankle by using any elastic bandage, tape, or an ankle brace to reduce the swelling. 
E - Educate yourself about your body and the healing process and avoid unnecessary passive treatments and medical imaging. 
 
L - Load the ankle just enough and allow the symptoms to guide how much activity you do without aggravating the ankle. 
O - Optimism will help with the rehabilitation of your ankle as you slowly move with confidence. 
V - Vascularize the ankle joint by performing symptom-free cardio activity to increase the blood flow to the ankle. 
E - Exercise the ankle to restore mobility, strength, and balance to adapt an active approach to rehabilitation. 
 
Exercises for the Sprained Ankle
Want an active approach to getting back to playing sports but do not know where to start? Here are some exercises to consider performing after rolling your ankle. 
 
Range of Motion:  During the initial days of injury, start with performing ankle circles, ankle pumps and ankle alphabets to help with reducing the swelling and maintaining the range in your ankle. 
 
Weightbearing:  Once the swelling has decreased and you are gaining more movement in the ankle, start loading the ankle by performing weight shifts side to side with a chair nearby to support the injured ankle. 
 
Strengthening:  After feeling comfortable putting weight on the ankle and moving it around, it is time to start working on resistance training to strengthen the muscles around the ankle joint. This would include moving the ankle up and down and side to side against resistance such as an exercise elastic. 
 
Balance & Proprioception:  Now the muscles are strong and so we can begin to work on balancing on the injured ankle. This trains the feedback system from the muscles to the brain to identify where in space the body is (proprioception) and is essential before returning to sports. 
 
Sport Specific Training:  The last part of the active rehabilitation approach includes working on game specific activities related to the sport you play. For soccer, that would be running, jumping, and sprinting while also working on side-to-side movements as you weave through your defenders on the field. A couple of tips to consider for the initial return to sports would be to play with an ankle brace to provide some stability and confidence in your ankle. Additionally, you could [LM1] tape the ankle joint to provide the stability and support to the ankle. 
 
This is an example of an outlined active approach to rehabilitation of an ankle sprain; however, everyone is different! It is recommended to see a physiotherapist for a more individualized treatment plan to get you back on the field playing like the superstar you are!

Written by Bryce Jay,
​Registered Physiotherapist