How Chiropractors Can Help After An Ankle Sprain

Ankle sprains are among the most common injuries, whether you're an athlete, weekend warrior, or someone who took an unfortunate misstep. The pain and swelling can be immediate, but the long-term impact on your mobility can be just as concerning. Proper rehabilitation is crucial to ensure a full recovery and prevent future injuries. This is where a well-designed ankle rehab protocol comes into play, and why seeking the expertise of a chiropractor or an athletic therapist can make all the difference.

Understanding Ankle Sprains

An ankle sprain occurs when the ligaments that support the ankle are stretched or torn, often due to a sudden twist, fall, or blow that forces the ankle joint out of its normal position. Ankle sprains often occur when the foot or ankle twists unexpectedly, leading to an injury. Approximately 90% of ankle sprains are caused by an inversion injury, where the foot rolls inward, affecting the anterior talofibular (ATFL) and calcaneofibular (CFL) ligaments, which are the lateral ligaments located on the outside of the ankle. In more severe cases where ligaments are significantly torn, a popping sound or sensation may be experienced. These injuries can happen suddenly during a variety of activities, such as:

• Walking, running or exercising on uneven terrain
• Tripping or falling
• Playing sports that involve quick changes in direction or jumping, like trail running, basketball, tennis, football, and soccer

The symptoms of a sprained ankle can vary greatly depending on how severe the injury is. Common signs may include:

• Pain, which might be felt both at rest and during movement or when putting weight on the foot
• Swelling around the ankle
• Bruising
• Tenderness to touch
• A feeling of instability or that the ankle might give out

In more severe cases, the symptoms may resemble those of a broken bone, making it crucial to seek medical attention promptly.

How Ankle Sprains Are Classified:

Sprains can range from mild (slight stretching of the ligaments) to severe (complete tearing of the ligaments), and the severity of the injury dictates the rehabilitation process. Ankle sprains can be categorised using a number of grading systems, each with unique advantages and disadvantages.

One commonly used system focuses on the condition of one particular ligament:

• Grade I: Slight stretching and damage to the ligament fibres
• Grade II: Partial tearing of the ligament
• Grade III: Total rupture of the ligament

But since the ankle is supported by multiple ligaments, using a system that is intended for a single ligament might not always be straightforward, unless it is certain that only one ligament is injured. Because of this, an additional classification approach assesses ankle sprains based on how many ligaments are injured. However, it is difficult to determine the exact number of torn ligaments unless there is clear, high-quality radiographic imaging or surgical evidence.

Another widely used classification method is based on the overall severity of the sprain:

• Grade I (Mild): Minimal swelling and tenderness with little impact on ankle function
• Grade II (Moderate): Moderate swelling, pain, tenderness, reduced range of motion, and some ankle instability
• Grade III (Severe): Significant swelling, tenderness, loss of function, and pronounced instability

The Importance of Ankle Exercises After a Sprain

An effective ankle rehab protocol is tailored to the severity of the injury and the specific needs of the individual. The goal of these protocols is to progress the individual through rehabilitation to full sport and activity participation. The general guideline below, recommended by Sanford Health, provides an overview of how the treating clinician approaches the framework for ankle sprain rehabilitation, which consists of four phases.

Phase I: Protection Phase (0-2 Weeks, 0-4 Visits)

Overview: During the first phase of recovery, the focus is on protecting the injured ankle. This period typically lasts for about two weeks and may require up to four visits to your healthcare provider. Your doctor will explain the nature of your injury, the rehabilitation process, and the progress you can expect.

Instructions: Avoid any activities that cause pain or swelling. It’s essential to protect your ankle from further injury using supportive devices like braces, splints, or even a cast in severe cases. Your healthcare provider may also recommend using ice, compression, and elevation to reduce swelling.

Exercises: During this phase, gentle exercises are introduced to maintain some movement and flexibility in your ankle, such as drawing the alphabet with your toes, stretching your calf muscles, and practising walking with the help of crutches or other assistive devices if needed.

Goals: The primary goals are to reduce pain and swelling and to restore some range of motion. You can move on to the next phase once you can walk normally without an assistive device and your swelling has significantly decreased.

Phase II: Progressive Range of Motion and Early Strengthening (1-3 Weeks, 2-6 Visits)

Overview: As you enter the second phase, the focus shifts to gradually improving the range of motion and beginning to strengthen your ankle. This phase typically spans one to three weeks.

Instructions: Continue avoiding any activities that cause pain or swelling. The goal here is to start moving your ankle more actively while maintaining control over any discomfort.

Exercises: You’ll start performing exercises that help strengthen the muscles around your ankle, such as using resistance bands for gentle stretches, doing squats and lunges on stable surfaces, and practising balance exercises like standing on one leg. Walking on a treadmill, biking, or using a pool program may also be introduced.

Goals: The aim is to restore full movement and begin rebuilding strength. You should also work on improving your overall body balance and control. You’re ready to move to the next phase when your range of motion is nearly the same as your uninjured ankle and you can exercise without increasing pain or swelling.

Phase III: Advanced Strengthening and Neuromuscular Control (2-6 Weeks, 4-16 Visits)

Overview: In the third phase, you’ll focus on more advanced strengthening exercises and improving your neuromuscular control. This phase can last from two to six weeks, depending on your progress.

Instructions: Continue with your previous exercises, adding more challenging movements as your strength improves. Core and hip stability are crucial, and you should aim for balanced strength on both sides of your body.

Exercises: This phase includes more dynamic exercises like running on a treadmill with varying inclines, side-stepping with resistance, and performing squats and lunges on an unstable surface. You’ll also work on agility with exercises like hopping, planking, and jogging.

Goals: The goal is to enhance your strength, agility, and overall movement control. You should also work on improving your body mechanics and stability. Before moving on, you should be able to run lightly without limping and balance on one leg without losing stability.

Phase IV: Return to Sport (3-8 Weeks, 6-12 Visits)

Overview: The final phase is designed to get you back to your regular activities, especially if you’re returning to sports. This phase can last between three and eight weeks.

Instructions: Continue with the exercise program from the previous phase, focusing on advanced strengthening and agility exercises tailored to your sport.

Exercises: Exercises in this phase are more intense and sport-specific, including single-leg hops, agility ladder drills, box jumps, and sprinting. You’ll also practise landing on unstable surfaces to prepare for real-life movements.

Goals: The objective is to return to your sport or regular activities safely and confidently. You’ll work on refining your movement patterns, building strength and agility, and overcoming any fear of re-injury. You’ll be ready to fully return to sports once you can perform all exercises pain-free and without any signs of instability.

Why See a Chiropractor or an Athletic Therapist?

Both chiropractors and athletic therapists are trained to assess, and treat musculoskeletal injuries, including ankle sprains. Here’s why you might consider seeing these professionals for your ankle rehab:

Chiropractor

Diagnosis: After a comprehensive initial assessment, chiropractors are able to provide a diagnosis and propose a plan of care moving forward. If required a chiropractor is able to refer for x-rays of the ankle.
Holistic Approach: Chiropractors take a whole-body approach to treatment, considering how the ankle injury might affect or be affected by other parts of the body, such as the knees, hips, or lower back.
Joint Manipulation: Chiropractors are able to perform adjustments to restore proper function of the joints, which can be particularly beneficial if the injury has led to compensatory movement patterns.

Chiropractor & Athletic Therapist

Sports-Specific Rehab: Both professions are able to provide rehabilitation for athletes and anyone with an active lifestyle. They can design rehab programs tailored to your specific sport or activity, ensuring a safe and effective return to play.
Functional Movement Training: Both Chiropractors and Athletic Therapists focus on restoring functional movement, which is essential for performing daily activities and athletic movements without pain or risk of reinjury.
Education and Prevention: Both professions can help with injury prevention, teaching proper movement mechanics and exercises to strengthen the ankle and prevent future sprains
Soft Tissue Therapy: Chiropractors & Athletic Therapists use soft tissue techniques to address muscle tension, stiffness and adhesion. Techniques such as myofascial (active) release techniques (MRT/ART), massage, gua sha/instrument-assisted soft tissue mobilization or cupping therapy may be incorporated into your treatment.

The Bottom Line

Whether you choose to see a chiropractor, an athletic therapist, or both, the key is to seek professional care early in the injury process. With their guidance, you can follow a structured ankle rehab protocol that not only gets you back on your feet but also reduces the risk of future injuries. Your road to recovery can be smooth and effective with the right approach, ensuring that a simple ankle sprain doesn’t turn into a chronic problem.

So, the next time you roll your ankle, don’t just walk it off—take the necessary steps to heal properly and consider consulting with our experienced chiropractor, Dr. David Tam, or our knowledgeable athletic therapist, Andy, at HealthyToDos Markham Health & Rehab Clinic to optimise your recovery.

References

Kruckeberg, B. M., Beahrs, T., & Haddad, S. L. (2022). Sprained ankle. OrthoInfo. https://orthoinfo.aaos.org/en/diseases--conditions/sprained-ankle/

Physiopedia contributors. (2024, January 9). Ankle sprain. Physiopedia. https://www.physio-pedia.com/Ankle_Sprain

Sanford Orthopedics Sports Medicine. (2024, January). Ankle sprain rehabilitation guideline. Sanford Health. https://www.sanfordhealth.org/-/media/org/files/medical-professionals/resources-and-education/014000-01095-flyer-ankle-sprain-rehabilitation-pt-guideline.pdf