The American Academy of Orthopaedic Surgeons states that an estimated 25,000 people, athletes and non-athletes, suffer an ankle sprain every day. Unfortunately many go untreated or are self-managed, which can lead to recurring pain, stiffness and instability. Proper immediate diagnosis and treatment are essential for proper healing and strengthening of the damaged ligaments.
Ankle Injury Classification and Symptoms
Typically, ankle sprains are classified as grade I, II or III. A grade I sprain is a stretching of the ligament with no tearing. A grade II sprain is considered to have a partial tear of the ligament and some instability. A grade III sprain is considered a complete tear of the ligament or ligaments, with instability.
Immediately after injury and depending on the severity, the ankle will be painful, you'll have decreased function and mobility, and localized swelling and bruising or discoloration may occur due to bleeding and leakage from the damaged tissues. To avoid recurring pain, joint stiffness, chronic laxity and re-injury, a proper diagnostic evaluation by a physician, physical therapist or athletic trainer is essential to determine the extent of the injury and set you on the road to recovery.
Strengthening Ankle Ligaments
The groundwork for strengthening ankle ligaments begins immediately after the injury. RICE -- Rest, Ice, Compression and Elevation -- plays an important role in the ability to retrain and strengthen ankle ligaments. Controlling and limiting the amount of swelling with ice, compression and elevation can accelerate the healing process. Swelling and inflammation are the key limiting factors in regaining mobility and function. Resting the ankle limits further damage and may include a period of immobilization or protection with a stabilizing brace. Complete immobilization with a cast should be avoided, as collagen tissue will not heal properly.
Following the initial inflammatory stage of 24 to 48 hours, during which the RICE applications should be repeated every three to four hours, early protected pain-free movements can begin. Dr. Kevin Stone, M.D., orthopaedic surgeon at the Stone Clinic in San Francisco, states that “the stimulation of new collagen formation along the lines of maximal stress is critical to achieve a strong healed ligament.” Active movements like pointing your toes (plantarflexion) and then pulling them up as far as you can (dorsiflexion) can begin early ligament stimulation post-injury.
Each ligament has millions of nerve endings running through the collagen fibers. These nerves are called proprioceptors. Proprioceptors translate information to the brain on the actual position and movement of the joint in space. The nerve receptors lose that ability with an injury. It is absolutely necessary to retrain and reformulate the ability to send messages to the brain, or you risk re-injury and instability.
The simplest exercise that will help stimulate the receptors and strengthen the ligament is to stand on both feet, then slowly transfer your weight over to your injured foot and lift the uninjured foot off the ground and try to maintain your balance. Initially you will notice and feel your foot moving side to side to keep your balance. As you get better this will become easier. Once you have mastered this exercise, try it with your eyes closed, then on an unstable support like a pillow. Progression through these stages of exercise is best monitored by a therapist.
Functional Exercises and Return to Sport
The next step in strengthening the ligaments is to begin functional exercises that put the ankle and foot through movements that we do every day. Partial knee squats, heel raises and stair climbing and descending are exercises and movements that we do repeatedly. Proper movement, flexibility and range of motion and function are required to perform these tasks and movements.
The final step to strengthening the ligaments is protected sports-specific exercise. Returning to your activity too early will only lead to re-injury, chronic instability and recurring pain. Depending on the severity of the injury, a ligament can take several weeks to heal properly, so retraining the ligaments progressively along the lines of maximal stress, as Dr. Stone discusses, are required to limit re-injury and chronic instability and pain and build a strong healed ligament.
Strengthening ankle ligaments following an injury begins immediately with the RICE applications. Follow that with a proper diagnosis and treatment plan that includes early protected range of motion exercises, progressive balance or proprioceptive exercises, strengthening of the surrounding muscles and tendons and a progressive return to sport or activity with a protective brace or taping.