Ankle Sprain Rehabilitation

The following protocol is designed to strengthen and increase the flexibility of the muscles surrounding the ankle, which should decrease the chances of incurring another ankle sprain. Most ankle sprains involve the ligaments on the lateral (outside) aspect of the ankle. On the lateral portion of the ankle there are three ligaments which help stabilize the joint. They are the anterior talofibular, calcaneofibular, and posterior talofibular ligaments. These ligaments resist the most common mechanisms of injury to the ankle of inversion (rolling your foot in). On the medial (inside) of the ankle there is one broad fan-shaped ligament called the deltoid ligament. This ligament resists eversion (rolling your foot out) of the joint.

There are three different grades of ligamentous injury. A first degree, or grade I sprain, a minor sprain. A second degree, of grade II, is a moderate sprain. If you completely tear the ligament it is a third degree, or grade III. The rehabilitation exercises are the same for all grades however, a third degree sprain will take significantly longer to recover from than a first degree sprain. Often surgery is required following a third degree sprain and if required the rehabilitation process is set even further behind.

Advancement in the rehabilitation protocol depends on the doctor’s orders, amount of swelling, and the level of pain associated with the exercise. All of the exercises should be done in a pain free range of motion. The exercises are performed because the damaged ligament must be stressed to promote a faster recovery without causing further damage or irritation. The exercises also help the contractile elements of the ligament regain dynamic stabilization capabilities and restore the proprioception (the knowledge or awareness of position, weight, and resistance of objects in relation to the body) of the ankle. Weight bearing is allowed immediately following the injury if the symptoms allow. The early pain-free weight bearing will prevent stiffness, maintain proprioceptive input, and provide an active muscle pump to help mobilize the effusion (swelling). The early weight bearing and mobilization allows for an early return to function without increases in pain, chronic problems, or an increase in the rate of re-injury.


Increase strength and endurance of musculature: Increased strength of the musculature surrounding the joint allows the ankle to handle the demands placed on it without causing further injury.

Increase range of motion: Range of motion exercises help decrease the amount of scarring, adhesions, fibrotic contractures, and pain. This will decrease the chance for re-injuring the joint.

Decrease pain: By decreasing pain the patient is able to start strengthening exercises which will ultimately lead to a faster recovery.

Rehabilitation Exercises

The following is a list of exercises and the reasoning for performing the particular exercise. A detailed explanation and diagram of the exercises are on the following pages.

The rehabilitation protocol is separated into three different phases: Phase I, Phase II, and Phase III or a functional phase. Do not advance to the next phase until all exercises are performed the correct number of repetitions without pain or swelling.

During phase I the main emphasis is placed on controlling the swelling, pain, and maintaining range of motion (ROM)and neuromuscular control. Ice, compression (wrap from the toes up towards the lower leg), elevation, electrotherapy, and gentle massage all facilitate a reduction of edema, pain, and a reduction in the inhibition of muscles

Phase I

1. Biomechanical ankle platform system (BAPS): Increases range of motion of the ankle joint.

2. Achilles stretching: Prevents a contracture of the achilles tendon and increases the range of motion.

3. Ankle isometrics: Increase the strength and proprioception of the ankle and stresses the ligament without causing further irritation to the damaged ligaments.

4. Alphabet ROM: Increases the ROM and proprioception of the ankle and stresses the ligament without causing further irritation to the damaged ligaments.

5. Towel gathers: Increases ROM and proprioception of the ankle.

6. Toe curls: Increases the ROM and proprioception of the ankle.

Phase II

1. Stork stands: Increases the proprioception and weight bearing status of the ankle.

2. 4-way progressive resistance exercises: Increases the strength and endurance of the musculature surrounding the ankle.

3. Standing toe raises: Increases the strength and endurance of the soleus and gastrocnemius.

4. Soleus pumps: Increases the strength and endurance of the soleus.

5. T-band kicks: Works the stabilizers of the ankle and increases the proprioception on the joint.

6. Single leg squats: Works the stabilizers of the ankle and increases the range of motion of the joint.

Phase III (Functional Phase)

Works the stabilizers and the proprioception of the ankle in a functional or sport specific manner. This phase is important in preventing the chance of re-injury for the athlete. It teaches the athlete and the injured ankle that they can handle the demands and stresses of the particular sport.

  1. Trampoline exercises
  2. Jump rope
  3. Profitter
  4. Plyometrics
  5. Agility exercises

For more information feel free to contact one of our six convenient physical therapy clinics throughout the Boise Idaho area.

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