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Ask the PT: Sprained Ankle

Hi WSPT,

I sprained my ankle (inversion) while stepping off a high curb (35 to 40cm) near my home off Hutchinson River Parkway. I could not put any weight on it for 3 days. Slowly, I started to recover (I’m a 47 year old male). Three months later I could put full weight on it, rise up on my toes without pain. However, if I extend my leg and invert my foot when I’m sitting down, I still have acute pain. Are there certain PT exercises I can do to help complete my recovery? Do you recommend massage or other treatment for scar tissue?

Thank you,
James

James,

Thanks for your question. It sounds like you had a severe ankle injury – probably a Grade 2 or 3 sprain. That means that one or more of the ligaments on the lateral side of your foot were either significantly stretched or fully torn. It’s possible that other structures were damaged as well. In either case, it’s likely that you’re ankle was both very swollen and unstable. Any sudden missteps and you could have reinjured the ankle or even hurt it more.

It’s three months later and you’re still experiencing pain when you put your foot/ankle in the position of your injury. This is not unusual. An injury like this often takes 12-weeks or longer to fully recover. Some instability may even persist beyond that point. In order to minimize these effects, it helps to have strong muscles and good proprioception to support the joint.

Typically, the ankle evertors, the peroneal muscles on the lateral side of the lower leg, prevent the foot from inverting. To strengthen these, we have patients first do isometrics by everting (actively pushing the foot outward) against a stable object – https://www.youtube.com/watch?v=c4RCkpkdZ74. The patient holds that position for 5 seconds and does 2-3 sets of 10 reps. Once that is tolerated well, we progress the patient through a series of eversion resistance exercises with progressively increasing theraband resistance – https://www.youtube.com/watch?v=IXNSRa1hoC4.

In addition, weight-bearing exercise on the affected leg increase strength, stability and balance. These exercises can progress from static standing on 1 foot with hand assistance to dynamic exercises like marching and lateral ambulation, up to running and plyometrics.

Before aggressively progressing a strength and stability program, full ankle Range of Motion (ROM) should be established and relatively pain-free. This may require rest, stretching and/or the manual mobilization by a Physical Therapist at one of our Bronx Physical Therapy offices. Functional exercise without normal mobility usually leads to compromised movement and compensations which can lead to further injury.

Your issue right now may be that you haven’t obtained normal mobility following your injury, you may have joint imbalances or the muscles around your ankle are simply not stabilizing the joint through normal movement. There is also the possibility of structural damage causing your pain.

At this point, I would suggest seeing a Physical Therapist at our Bronx Physical Therapy office on Waters Place, to assess your movement. They might be able to help you work through the painful spots in your motion. If they can’t help you resolve the pain, then you might need to see an Orthopedist and have an x-ray or MRI to determine if there is any lingering structural injury.

Thanks for asking,

Daniel Seidler, PT

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