Rehab Advice

[justinhamlin]

So, without getting into too great of detail, I injured my ankle last year with a pretty nasty high ankle sprain. Spent the better part of 2 weeks with it elevated and on ice. It hampered me for a few months until it finally started feeling better. I joined a gym and started working out with cardio, mostly elliptical in the beginning as it was less pressure on my ankle, until I finally started to get back into running. Ankle felt great for a good 4-6 months.

Was on a routine of running 3-5 miles daily to improve my cardio and lose a little weight. (weight loss isnt my goal, i am really only about 5-10lbs from my ideal weight of 165lbs, I usually hover around 170-175, and I am 6'2") I headed to the gym one night and hit the stair climber to get a little work in before the treadmill. Everything seemed fine til I got on the treadmill and started out jogging. The ankle just was not agreeing, so I shut it down and called it a night, did not want to push it and injure it more.

So, fast forward 3-4 months now, and I have been back in the gym sparingly, still cannot get back into running as this ankle is nagging me. 2-3 miles of walking and my ankle is in some serious pain the next day.

I really want to get back in the gym, or hell, just back to walking the dogs for 2-3 miles without my ankle killing me. What would be the best route for rehabilitating a badly sprained ankle?

I am open to suggestions, I know the icing and stretching routine, but I guess I am looking more for a time-table/schedule as I dont know if it is good or bad to ice an ankle/muscle for 2 hours when all I really need is 45 minutes, or if I should ice it every few days/hours, etc.

Thanks in advance!

[Alethea]

I am queen of unhealing injuries, but given the time line it's likely your original sprain is healed by now. The problem you're having is with the scar tissue caused by ripped ligaments. Scar tissue is more inflexible than ligaments, and very easy to tear and damage, so that is causing your current discomfort. It's now a question of reducing scar tissue, regaining strength and mobility, and avoiding inflamation until your ankle is well.

1. Support: wear an ankle brace while walking/running, IF you can do such without pain. If you can't, don't do it. Never ever push your ankle to the point of pain or aggrivation - it will just damage you and set you back.

2. Increase Bloodflow to Ankle: This helps ligaments heal faster. Apply heat regularly, and engage in light or moderate exercise that doesn't aggrivate your ankle.

3. Remove Scar Tissue: Massage the ankle. If you're familiar with Active Release Therapy, that's what this is. Firm massage breaks down the scar tissue, helping your body get rid of it. Your ankle will be very tender to start. Begin lightly, then gradually build up to firm thumb strokes.

4. Hydrate: Drink plenty of fluids to help flush the toxins from your body.

5. Active Rehabilitation: This is what will take you from 80% to 100% recovered, and keep you from hurting the thing again in the future.

a. Range of Motion Exercises - can be done almost immediately.

In and Out

Turn your foot inward until you can't turn it anymore and hold for 15 seconds. Straighten your leg again. Turn it outward until you can't turn it anymore and hold for 15 seconds. Do this 10 times in both directions.

Ankle Circles

Sit on the floor with your legs stretched out in front of you. Move your ankle from side to side, up and down and around in circles. Do 5 to 10 circles in each direction at least 3 times per day.

Alphabet Letters

Using your big toe as a "pencil," try to write the letters of the alphabet in the air. Do the entire alphabet 2 or 3 times.

Toe Raises

Pull your toes back toward you while keeping your knee as straight as you can. Hold for 15 seconds. Do this 10 times.

Heel Raises

Point your toes away from you while keeping your knee as straight as you can. Hold for 15 seconds. Do this 10 times.

b. When you can do the ROM exercises pain-free, Stretch and Strengthen. Don't overload - be patient.

Isometric Exercises: These are exercise where the ankle joint itself does not move, yet force is applied and the muscles are contracted. For example: sit in a chair while facing a wall, and then place the ball of your foot against the wall. In this position you can push against the wall with your foot and at the same time keep your ankle joint from moving. The muscles contract but the ankle joint does not move. The above example can be used to strengthen the ankle in all directions. Pushing your foot to the left or right against something immoveable, and pushing down (as above) and pulling up.

Resisted In and Out

Sit on a chair with your leg straight in front of you. Tie a large elastic exercise band together at one end to make a knot. Wrap the end of the band around the chair leg and the other end around the bottom of your injured foot. Keep your heel on the ground and slide your foot outward and hold for 10 seconds. Put your foot in front of you again. Slide your foot inward and hold for 10 seconds. Repeat at least 10 times each direction 2 or 3 times per day.

Step Up

Put your injured foot on the first step of a staircase and your uninjured foot on the ground. Slowly straighten the knee of you injured leg while lifting your injured foot off the ground. Slowly put your injured foot back on the ground. Do this 3 to 5 times at least 3 times per day.

Sitting and Standing Heel Raises

Sit in a chair with your injured foot on the ground. Slowly raise the heel of you injured foot while keeping your toes on the ground. Return the heel to the floor. Repeat 10 times at least 2 or 3 times per day. As you get stronger, you can stand on your injured foot instead of sitting in a chair and raise the heel. Your injured foot should always stay on the ground.

Stretch: Stretch your ankle, your calf, and your shin. Gently, of course.

c) Once your ankle is feeling stronger, work on Balance and Proprioception. These are 2 of the most overlooked aspects of fitness, and are very important (and incidentally are one of the biggest reasons why yoga is fantastic for athletes and people recovering from injuries, as it focuses on this. See everyone? I worked in a yoga reference. Smooth, I know). Your nerves were damaged as well, and you need to re-learn how to control your ankle and tell what it is doing.

Balance Exercises

Stand and place a chair next to your uninjured leg to balance you. At first, stand on the injured foot for 30 seconds. You can slowly increase this to up to 3 minutes at a time. Repeat at least 3 time a day. To increase the difficulty, repeat with your eyes closed. Then try wobble or rocker boards, or bosu balls.

d) finally, to progress from a healed ankle to an athletic, hardcore ankle, build up Plyometric Exercises. These are fast, explosive, contraction/expansion, weight-bearing exercises like hopping/jumping/skipping/running. Jump-rope, box-jumps, running with a long, bounding stride. The best one I've seen that provides fantastic all-around ankle strengthening is a little beauty that I call:

Cross Hop. Stand on 1 or two feet. Hop forward about a foot. Hop to center. Hop left, hop to center, hop back, hop to center, hop right, hop to center, repeat. You're hopping in a t shape, providing balance and strengthening in all directions your feet would move. You can switch this one up so you do a X shape, or forward/back, left/right instead of a circle, switch directions every 2 rounds... whatever. It's also, incidentally, a great cardio intervaul activity. Plus you get to look like a hoppin' madman. I don't believe in dignity.

This really shouldn't be an issue for you if you are taking proper care of your ankle, but IF it gets sore and swollen,

Reduce Inflamation: After your mobility exercises, running, or any time you aggrivate the joint, ice it. Ice 10 - 20 minutes on (take it off when your skin feels numb), then 10-20 min off, for 3 cycles or until it stops being sore. Then lay off the ankle for a few days as punishment, and start to build back up again when it's not sore.

[justinhamlin]

I could have sworn I did this before, but I wanted to make sure I got back on here and thanked you immensely for the response.

I have already clipped this out to evernote so that I can refer to it whenever I need.

I have started to wear the ankle brace more regularly now, whenever I am active (and times when I am not) and I can already see how there is less pain from regular activities.

Next on the list is to apply heat to the area and get some basic exercises in. Going to start in on that tonight.

Thank you again, this has been a huge help.

[tasty`]

I am queen of unhealing injuries, but given the time line it's likely your original sprain is healed by now. The problem you're having is with the scar tissue caused by ripped ligaments. Scar tissue is more inflexible than ligaments, and very easy to tear and damage, so that is causing your current discomfort. It's now a question of reducing scar tissue, regaining strength and mobility, and avoiding inflamation until your ankle is well.

1. Support: wear an ankle brace while walking/running, IF you can do such without pain. If you can't, don't do it. Never ever push your ankle to the point of pain or aggrivation - it will just damage you and set you back.

2. Increase Bloodflow to Ankle: This helps ligaments heal faster. Apply heat regularly, and engage in light or moderate exercise that doesn't aggrivate your ankle.

3. Remove Scar Tissue: Massage the ankle. If you're familiar with Active Release Therapy, that's what this is. Firm massage breaks down the scar tissue, helping your body get rid of it. Your ankle will be very tender to start. Begin lightly, then gradually build up to firm thumb strokes.

4. Hydrate: Drink plenty of fluids to help flush the toxins from your body.

5. Active Rehabilitation: This is what will take you from 80% to 100% recovered, and keep you from hurting the thing again in the future.

a. Range of Motion Exercises - can be done almost immediately.

In and Out

Turn your foot inward until you can't turn it anymore and hold for 15 seconds. Straighten your leg again. Turn it outward until you can't turn it anymore and hold for 15 seconds. Do this 10 times in both directions.

Ankle Circles

Sit on the floor with your legs stretched out in front of you. Move your ankle from side to side, up and down and around in circles. Do 5 to 10 circles in each direction at least 3 times per day.

Alphabet Letters

Using your big toe as a "pencil," try to write the letters of the alphabet in the air. Do the entire alphabet 2 or 3 times.

Toe Raises

Pull your toes back toward you while keeping your knee as straight as you can. Hold for 15 seconds. Do this 10 times.

Heel Raises

Point your toes away from you while keeping your knee as straight as you can. Hold for 15 seconds. Do this 10 times.

b. When you can do the ROM exercises pain-free, Stretch and Strengthen. Don't overload - be patient.

Isometric Exercises: These are exercise where the ankle joint itself does not move, yet force is applied and the muscles are contracted. For example: sit in a chair while facing a wall, and then place the ball of your foot against the wall. In this position you can push against the wall with your foot and at the same time keep your ankle joint from moving. The muscles contract but the ankle joint does not move. The above example can be used to strengthen the ankle in all directions. Pushing your foot to the left or right against something immoveable, and pushing down (as above) and pulling up.

Resisted In and Out

Sit on a chair with your leg straight in front of you. Tie a large elastic exercise band together at one end to make a knot. Wrap the end of the band around the chair leg and the other end around the bottom of your injured foot. Keep your heel on the ground and slide your foot outward and hold for 10 seconds. Put your foot in front of you again. Slide your foot inward and hold for 10 seconds. Repeat at least 10 times each direction 2 or 3 times per day.

Step Up

Put your injured foot on the first step of a staircase and your uninjured foot on the ground. Slowly straighten the knee of you injured leg while lifting your injured foot off the ground. Slowly put your injured foot back on the ground. Do this 3 to 5 times at least 3 times per day.

Sitting and Standing Heel Raises

Sit in a chair with your injured foot on the ground. Slowly raise the heel of you injured foot while keeping your toes on the ground. Return the heel to the floor. Repeat 10 times at least 2 or 3 times per day. As you get stronger, you can stand on your injured foot instead of sitting in a chair and raise the heel. Your injured foot should always stay on the ground.

Stretch: Stretch your ankle, your calf, and your shin. Gently, of course.

c) Once your ankle is feeling stronger, work on Balance and Proprioception. These are 2 of the most overlooked aspects of fitness, and are very important (and incidentally are one of the biggest reasons why yoga is fantastic for athletes and people recovering from injuries, as it focuses on this. See everyone? I worked in a yoga reference. Smooth, I know). Your nerves were damaged as well, and you need to re-learn how to control your ankle and tell what it is doing.

Balance Exercises

Stand and place a chair next to your uninjured leg to balance you. At first, stand on the injured foot for 30 seconds. You can slowly increase this to up to 3 minutes at a time. Repeat at least 3 time a day. To increase the difficulty, repeat with your eyes closed. Then try wobble or rocker boards, or bosu balls.

d) finally, to progress from a healed ankle to an athletic, hardcore ankle, build up Plyometric Exercises. These are fast, explosive, contraction/expansion, weight-bearing exercises like hopping/jumping/skipping/running. Jump-rope, box-jumps, running with a long, bounding stride. The best one I've seen that provides fantastic all-around ankle strengthening is a little beauty that I call:

Cross Hop. Stand on 1 or two feet. Hop forward about a foot. Hop to center. Hop left, hop to center, hop back, hop to center, hop right, hop to center, repeat. You're hopping in a t shape, providing balance and strengthening in all directions your feet would move. You can switch this one up so you do a X shape, or forward/back, left/right instead of a circle, switch directions every 2 rounds... whatever. It's also, incidentally, a great cardio intervaul activity. Plus you get to look like a hoppin' madman. I don't believe in dignity.

This really shouldn't be an issue for you if you are taking proper care of your ankle, but IF it gets sore and swollen,

Reduce Inflamation: After your mobility exercises, running, or any time you aggrivate the joint, ice it. Ice 10 - 20 minutes on (take it off when your skin feels numb), then 10-20 min off, for 3 cycles or until it stops being sore. Then lay off the ankle for a few days as punishment, and start to build back up again when it's not sore.

I'm about to get off of crutches after completely destroying my ankle, this will help quite a lot thank you