Photo by Bev Childress

When you face an injury, there are two components in your comeback: one physical, one mental. Both parts will need to be addressed when it comes time to step back into the gym. The physical component is the more obvious of the two and includes the body’s recovery and readiness to resume training. The mental component can be trickier. You have to convince yourself to begin training again and strike the balance between aggression and prudence as you push through workouts after injury.

Familiar, Painful Territory

I recently sprained my ankle. It wasn’t at the gym; I misjudged a step because I was wearing my glasses instead of my contacts. Lesson learned. I’ve sprained the same ankle and broken this foot in the past, so while I was annoyed that it happened again, I have at least been here before.

Since I sprained it, I’ve been working through the routine of daily swelling and discomfort. Lots of elevation, lots of ice. It has now improved enough that it is time to get back to the gym. There will be a lot of things my ankle won’t be ready for yet, but I feel it has improved enough to give some of the workouts a shot.

Mentally, the first week or two back in the gym after an injury are always a little daunting. More than daunting; a little horrific, if I’m being honest. There is the fear that my ankle may not be ready as I thought. There is also the worry about how difficult the workouts will feel because I have missed so many weeks. There is the dread of a whole body full of sore muscles. But, I must get back to it, regardless of how I feel about it.

Strategies for a Successful Comeback

As I press the “reserve” button for my first couple of classes this week, I know I must set myself up for success mentally. The right recovery plan for both my mindset and my ankle will speed my return as a whole athlete.

Scale, Scale, Scale

I know I will need to scale my workouts to suit what I feel I can do. Right now, it doesn’t feel like much. I know my ankle will let me know if something is beyond what it is ready for. Being smart about workouts is critical in the first few weeks to make sure the injury is ready for movement, and that the rest of the body doesn’t end up overcompensating and causing strain elsewhere. Carefully planning your training during this time will help, and if someone else is programming for you, talk with them about what you feel you can and cannot do.

Stop What Hurts Immediately

Don’t push it when it comes to your injury. I know that jumping is going to hurt my ankle, so burpees and box jumps are not on the table right now. Even cleans could be an issue, due to ankle extension. However, I will push myself on shoulder press, bench press, pull ups, and any exercise that doesn’t involve repeated extension of my ankle. Discomfort is expected, but if I feel pain, I will know it is time to stop.

Stay Patient

Comebacks might be slower than you expect. Even if you think you feel 100%, you must give yourself time to adjust to the warm ups, workouts, and routine. Make sure that you are honest about how you feel, how well you’re moving, and how fast you’re progressing. If you are used to being at the top of the leaderboard, you may need to adjust your competitive nature until you are fully recovered.

Have a Plan for Recovery

Know that you may need to make your foam roller handy to help with sore muscles. Be ready with some Epsom salt baths, ice, and a plan for mobility. Going in with a plan for how to take care of yourself during recovery will help negate any discouragement due to setbacks as you resume training.

You cannot expect to get back into your usual routine after an injury without skipping a beat. We all wish we were never injured. But despite our best efforts, injuries do happen from time to time. Having a workable plan in place to resume training will save you from prolonging your return with unnecessary setbacks.

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The injury can occur while engaging in sports, from a simple fall, from “rolling” or “twisting” your ankle, or from stepping incorrectly off a curb or uneven surface. The mechanisms of this injury can be broad and all encompassing, and can mean a prolonged tenure of disability, if not adequately treated.

What Is an Ankle Sprain?

Knowing some basic physiology and anatomy can afford us a better understanding of this injury and its key anatomic players. The ligaments of the ankle attach bone to bone via their insertions and origins in the ankle. They also allow the ankle joint to have fluid, kinematic motion, which gives balance and stability to the ankle. As result, when these ligaments are injured, it can substantially affect an individual’s movement, balance, and stability.

There are many ligaments of the ankle, but here are some of the more commonly injured ones:

• Anterior talofibular ligaments
• Calcaneofibular ligament and the deltoid ligament

These ligaments and many others are essential for stabilizing the major bones of the ankle, including the talus, tibia, and fibula.

After a sprain occurs, it can be classified as Grade I, Grade II, or Grade III, depending on the severity of the ligament stretch, strain, or tear. Sometimes radiographs (x-rays) are taken to conclude that there is no fracture, subluxation, or dislocation, which may be difficult to determine if there is extensive swelling, bruising, and pain during the physical evaluation.

Treating the Injury

The basic treatments modalities include rest, ice, compression, and elevation (RICE), along with anti-inflammatory medication and immobilization, again depending on the severity of the injury.

But the major component of any ankle injury rehabilitation protocol should include a focused, strategic plan to fortify the proprioception of the ankle. Simply put, proprioception is the ability to know where your extremity is in space, relative to your own bodily movement. If you watch the attached video, I provide an in-depth explanation of this concept.

After an ankle injury, it is crucial that you re-train and re-strengthen your ankle. Often, when individuals suffer this injury, they can essentially lose a sense of where their ankle is relative to their basic body movements and surroundings. This can cause balance and stability issues, which can hinder your athletic performance and increase your chance of further injury.

I suggest the following ankle proprioception exercises, which may not only help to re-strengthen your ankle, but may also assist with re-enforcing your ankle proprioception and balance. These exercises are also demonstrated in the video.

1. Ankle Flexion and Extension Exercises – These are geared toward strengthening your ankle and the muscles of the leg. I recommend 3 sets of 15.
2. Ankle Circle Exercises – These can be done with or without a pulley or cable. Consider doing 3 sets of 15.
3. Ankle Ball Rotations – These will strengthen and improve your proprioception as you roll the ball in multiple directions. I recommend 3 sets of 15 reps.
4. Bosu Ball Standing Balance Exercises – These can be done with shoes on or off. The goal is to have multi –directional movement while standing on the ball. Ultimately, you want to feel stable and to have awareness about where your ankle is in space. Consider doing 3 sets of 15 reps.
5. Bosu Ball Lunges – Side and front Bosu ball lunges may be quite challenging, yet they are essential in rebuilding your proprioceptive capacities, while also training your legs and core. Go at your own pace and listen to your body. The earlier exercises are an excellent platform for progressing to more difficult exercises like this Bosu ball lunge.

Consult A Professional

As an orthopedic surgeon, I am fortunate to treat patients with aggressive therapeutic modalities for reestablishing proprioception strength and a sense of wellness. I hope these exercises are helpful to you, too. Be sure to consult your physician before conducting this or any other exercise program.

If you find that you have any specific questions regarding the aforementioned anatomical components or exercises feel free to post your questions on the forums and I will answer them as soon as I can.

More on the ankle:

• Fix Your Weak Foundation: Your Ankles
• 2 Drills to Injury Proof Your Ankles
• Effects of Ankle Taping on Performance and Safety
• What’s New On Breaking Muscle Today

Photos courtesy of Shutterstock.

The post A More Effective Way to Rehab Your Ankle Sprain appeared first on Breaking Muscle.

Think about what so many people do if they do suffer a sprain: they wrap up the ankle for extra support. But what if your own body provided sufficient support for the vast majority of activities, even capable of handling a wrong step?

Making Your Body Injury Proof

The other day I was talking to someone about trail running. He commented that he couldn’t believe so many people ran in this particular area because there are so many roots and rocks that it would be easy to roll an ankle.

While it is true that trail running presents more opportunities for injury, as opposed to running on a flat track, that misses the great point. With the proper build-up your body can handle things that might otherwise cause sprains. And in fact, running on uneven ground can help build this ability as well.

You have a choice. You can either avoid things that could hurt you, like working out in general, and then you’ll be weak and fragile. Or you can take the right steps to make your body more injury proof. While a general workout program will help with injury prevention, a few outside-the-box drills will better serve your efforts.

And beyond injury proofing you, these drills may also be helpful in rehab and retaining your flexibility and mobility into old age. Mobility training alone is great. However, most of it is done with your body not supporting any weight. The following drills all help with mobility, but in weight-bearing positions.

Drill 1: Sides of Foot Walk

Many people place too much weight either on the inside or the outside of their foot when they stand and walk. This exercise is used to help correct this by going the opposite way of our natural gait tendency. It also trains the lateral tilting action of the ankle joint.

1. From a normal standing position, raise the insides of your feet so the weight comes to the outside of both feet. Now, walk around.
2. For the second half of this drill, start with your feet slightly wider than shoulder width. The knees must cave inward as you roll your weight onto the insides of the feet. Now, walk around in this manner.

Both of these drills look funny, but they train your body in a position you’re not used to. A little practice of both is great, but you’ll want to primarily focus on the one opposite to how you use your feet naturally when you walk.

So, if you walk duck-toed and more weight is typically on the insides of your feet, you’ll want to balance it out with walking on the outsides of your feet. If you walk pigeon-toed, you’ll correct this by walking with the weight on the insides of your feet.

Since most ankle sprains occur when the ankle is rolled to one side or another, these two exercises train your ability to bear weight in these compromised positions.

Drill 2: Top of Foot Kneeling Balance

This drill stretches the top of the foot and the ankle joint. From a seiza, or kneeling position, with the top of the feet on the ground, lean back so that your knees lift off of the ground. You’ll balance across the top of your feet, though you can support yourself with your hands against a wall if needed. Hold this position for time.

If you don’t have the flexibility to get into the seiza position, you can place a rolled-up towel between your feet and butt to support you, allowing you to sit on the towel and still get into the desired position.

Doing all three of these exercises will only take a minute or two, yet can go a long way towards keeping your ankles and feet mobile and injury free. There’s plenty more possible drills, but you don’t need more than these three really. And it doesn’t take long. Just a couple minutes every few days is sufficient to get a positive training effect.

Photo 1 courtesy of Shutterstock.

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Our ankles are stability joints that must very quickly absorb force, then help shift and stabilize weight for the next movement. This occurs faster than we can think, so we rely on learned motor patterns and reactions. This article will provide you with quick but accurate screens to assess your current mobility plus strategies to improve performance in any sport or activity.

It may seem silly to look for gains in strength in such a small joint, but having an effective and efficient base will translate to improving all other standing movement patterns. First we need to establish proper range of motion and then stabilize the joint.

Once we have control of the joint we will enhance the performance through improved ground reaction time, coordination, and power output. This follows the same patterns put forth in the squat and deadlift articles posted previously.

Using the following screens, you will examine both flexion and extension of your ankles:

Start position for screenings.

Screen #1: Active Dorsiflexion Lying Against Wall¹

Lay on the ground with feet together and flat against the wall. Have your legs flat and together, with arms by your sides and palms facing up. From here, pull your toes back and as far away from the wall as possible while maintaining heel contact with the wall.

Flex the toes and feet toward yourself as much as possible.

• Inability to move the ball of the foot from the wall constitutes failure of the test
• 0.1-1 inch from the wall is acceptable
• 1+ inch from the wall is optimal (if you are able to slide the opposite big toe behind your flexed foot this would clear your 1+ inch range)

Examine flexibility one foot at a time. If you can fit big toes behind with no contact, you are greater than 1 inch.

Screen #2: Active Ankle Plantar Flexion Un-Weighted²

Begin lying on your back with your feet in a vertical position. Under control, point your toes away from you as far as possible and hold at your end range of motion.

Passing extension test – greater than 20 degrees.

The goal is to achieve at least 20 degrees range of motion, and ideally 30. Visually if you reach a flat line between your foot and shin you have optimal range of motion passing the test. If you are unable to reach 20 degrees you fail the screen.

Failure of extension test.

Screen #3: Passive Dorsiflexion Weighted³

Stand with your right foot perpendicular to the wall, with your big toe 1 inch from the wall and knee in line with the second toe. Flex the right knee and attempt to touch the wall while keeping the entire foot flat on the ground paying specific attention to the heel. If successful, move 2 inches from the wall and repeat the process until maximum distance is found.

• <2 inches = failure of the test
• 2-4 inches = acceptable range
• 4+ inches = optimal range

If you have optimal range of motion in all three tests, you may then skip the mobility portion and jump ahead to the performance section. If you failed any of the tests or are in the acceptable range continue through the mobility drills first.

Corrective Pattern Sequence

Now you know where you stand, so to speak. Use the following movement sequences and exercises to start fortifying your foundation.

• Mobility – re-establishing functional range of motion

• Sitting stretches (pictures below) – perform these once per day, focusing slow lowering into a seated position until you can fully relax and there is no muscle tension while in these positions
• Perform the third screen and hold the stretch for thirty seconds and up to three minutes
• Banded stretch
• Self-Myofascial Release on calves and tibialis anterior (front shin muscle) using foam roller, lacrosse ball, Theracane, The Stick, etc.
• Range of motion movements – drawing the alphabet with your toes while leg is extended
• Static Stability – using the joint/muscle/movement pattern that stresses the area needing correction by moving other joints and requiring it to remain static
  • Balance on 1 leg for 30 seconds with good posture
  • Balance on 1 leg and throw a medicine ball against a wall or with a partner
    • Chest Pass 3×10
    • Overhead Throw 3×10
    • Side Toss 3×10
• Dynamic Stability – moving the joint/muscle/movement patterns through a range of motion requiring dynamic motor control. Focus on soft landings, not maximum force/distance of jumps
  • Calf raises three foot positions: neutral, internally rotated, and externally rotated
  • Double leg jumps – air jump, forward jump, lateral jumps
  • Single leg forward hops, side to side hops
• Full Re-patterning of Movement –moving correctly through a full range of motion
  • Perform bodyweight squats with correct form using the squat article
• Strength –weighted calf raises, vertical jump for height, and broad jump for distance
• Power – box jumps, lateral jumps, agility ladders, sprint accelerations and decelerations
• Performance –sport/activity-specific training

When you arrive at the dynamic stability section of the progression make sure you slowly progress through the jumps. According to the NSCA guidelines for plyometrics a beginner should only have “80-100 foot contacts per session,” however for those who are deconditioned, overweight, or older should begin with 40-50 contacts per session.⁴

As a general training rule, start conservatively. You can always add more the next session, however you can never take back work already over-done. 

Left photo: Seated stretch, toes under. Right photo: Seated stretch, toes pointed.

Banded stretch – keep both legs straight and flex toes toward you.

Strengthen all your weak links:

• 7 Exercises to Maximize Hand, Wrist, and Forearm Strength
• Muscular Imbalances – The Lazy Man on the Assembly Line
• Lower Extremity Pain? Check Your Lateral Subsystem
• What’s New Today on Breaking Muscle

References:

1. “Chapter 3 Assessing Flexibility” accessed February 12^th 2013 

2. “Ankle Goniometry” accessed February 12^th 2013 

3. “Reliability of Three Measures of Ankle Dorsiflexion Range of Motion” accessed February 14^th 2013

4. “Practical Guide for Plyometric Intensity” accessed February 15^th 2013

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