9 Rehabilitation Tips for Ankle Sprains in Competitive Athletes

Ankle sprains are one of the most common injuries faced by competitive athletes across various sports.

Whether it's a sudden twist while landing awkwardly or an overextension during a high-intensity game, ankle sprains in competitive athletes can sideline them for weeks if not treated and rehabilitated correctly.  

The good news is that with the right rehabilitation strategies, athletes can recover quickly and reduce the risk of future injuries. In this article, we will discuss nine key rehabilitation tips for physical therapists working with athletes recovering from ankle sprains. 

Related: From Accident to Ambulance: Emergency Action Plans for the Injured Athlete 

Early intervention and rest 

The first step following an ankle sprain is early intervention. Immediate care is important for minimizing further injury and promoting quicker recovery. Following the injury, athletes should avoid weight-bearing activities and rest the ankle as much as possible.  

The R.I.C.E. protocol is the standard approach during this initial phase: 

• Rest: Avoid putting weight on the injured ankle. 
• Ice: Apply ice packs for 15-20 minutes every 1-2 hours to reduce swelling and pain. This should only be used initially to reduce swelling as it can slow healing in the long run. 
• Compression: Use an elastic bandage or ankle brace to control swelling. 
• Elevation: Keep the ankle raised above heart level to help reduce fluid buildup. 

These initial steps can significantly reduce swelling, limit pain, and prevent additional damage. All these are key to the healing process. 

Managing swelling and pain for ankle sprains in competitive athletes 

Swelling and pain management are very important during the first 48-72 hours post-injury. If swelling is not properly controlled, it can delay healing and prolong recovery time. Besides using ice and compression, physical therapists can introduce light massage techniques to promote fluid movement and reduce swelling.  

Also, pain management may involve over-the-counter anti-inflammatory medications. Take care to avoid masking pain and encouraging activity before the ankle is healed enough. 

Related: Therapy Diagnosis & Management of Common Running Injuries

Key methods for managing ankle sprain swelling 

• Ice packs 
• Compression wraps 
• Elevation 
• Massage techniques such as manual lymphatic drainage 
• Over-the-counter anti-inflammatory medications 

Restoring range of motion 

Once the acute phase of swelling and pain management has passed, it’s important to restore the ankle’s range of motion (ROM). Stiffness can develop quickly after an ankle sprain in competitive athletes, so early, gentle mobilization is key to preventing long-term issues.  

Start with pain-free passive and active ROM exercises to regain mobility without stressing the injured tissue. Some exercise examples include: 

• Ankle circles: Move the foot in circular motions. 
• Alphabet tracing: Use the toes to trace the alphabet in the air. 
• Dorsiflexion and plantarflexion: Gently bend the ankle up and down. 
• Inversion and eversion movements: Gradually rotate the ankle inwards and outwards. 

Incorporating ROM exercises as early as tolerated prevents the ankle from stiffening up. This allows for a quicker transition to more advanced rehabilitation. If the exercises are painful or too difficult, the athlete can use a towel or belt wrapped around the foot to help move it in a range of motion. 

Progressive strengthening exercises 

As the ankle’s mobility improves, rebuilding strength is the next priority. Weakness around the ankle joint increases the risk of instability and future injuries. Focus should be placed on strengthening the muscles that support the ankle, particularly the peroneals, tibialis anterior, and calf muscles.  

Resistance band exercises and body-weight exercises can be introduced at this stage. Some examples include: 

• Ankle dorsiflexion with resistance band 
• Ankle eversion and inversion with resistance band 
• Calf raises (seated and/or standing depending on tolerance) 
• Towel scrunches to strengthen the arch of the foot 

These exercises should start with very little resistance and gradually progress in difficulty as the athlete regains strength and confidence in the ankle. 

Proprioception and balance training 

After an ankle sprain, proprioceptive feedback from the ankle can be impaired. This means that the body’s ability to sense the position of the ankle in space becomes disrupted, leading to poor balance and increased risk of re-injury.  

Balance training helps to re-establish proprioception, improving coordination and stability. Some ankle proprioception exercises include: 

• Single-leg or staggered stands: Stand on the injured leg for increasing periods of time. 
• Balance board exercises: Use a wobble board to challenge the ankle’s stability. 
• BOSU ball exercises: Perform squats or leg lifts on a BOSU ball to engage the ankle muscles and improve balance. 

Starting with basic balance exercises and progressively challenging the athlete’s proprioceptive system is key to restoring ankle stability. 

Functional movement drills 

A rehabilitation plan should include a phase of exercise that mimics the movements that an athlete will encounter during their sport. Functional movement drills are a great way for transitioning from basic rehabilitation to return-to-sport activities.  

These drills should focus on recreating the multi-directional movements athletes perform during competition. They may include: 

• Lateral shuffles: Mimics quick side-to-side movements common in sports like basketball and soccer. 
• Agility ladder drills: Helps improve footwork, speed, and coordination. 
• Jumping and landing drills: Teaches athletes how to land safely and minimize impact on the ankle. 

Functional movement drills prepare the athlete to regain confidence in the ankle and set them up for a safe return to competition. 

Agility and plyometric training 

Agility and plyometric exercises build explosive power and quickness, both of which are important aspects for competitive athletes. Introduce these exercises as the athlete progresses through rehabilitation. These exercises should replicate the intensity of their sport. 

Exercise examples include: 

• Box jumps: Focuses on explosive power and safe landings. 
• Shuttle runs: Improves directional changes and lateral movements. 
• Lateral hops: Increases ankle stability and prepares athletes for high-impact movements. 

Gradually increasing the intensity of these exercises allows the athlete to regain explosive power without putting the healing ankle at risk. 

Taping and bracing for support 

In the later stages of rehabilitation, athletes often benefit from the use of taping or bracing. These methods provide additional support to the healing ankle, helping to prevent excessive motion during athletic activity. Physical therapists should instruct athletes on proper taping techniques. They might also recommend a functional ankle brace to wear during practice and games as they return to their sport. 

Benefits of taping or bracing for ankle sprains in competitive athletes 

• Limits excessive motion 
• Provides psychological support 
• Allows for safer participation in sport 

While bracing or taping can be useful, the long-term goal should always be to wean athletes off external support as they regain full strength and stability. 

Gradual return to play 

One of the most important aspects of rehabilitation is not rushing the athlete back into competition too soon. A gradual return-to-play protocol makes sure that the athlete is physically ready to handle the demands of their sport without risking re-injury.  

The protocol should involve: 

• Monitoring: Regular assessments of strength, ROM, and proprioception. 
• Gradual intensity: Slowly increasing the intensity and duration of practice drills. 
• Functional tests: Use sport-specific functional tests to gauge readiness. 

Athletes should only return to full competition once they have shown that their ankle is stable and capable of handling high-intensity activities without discomfort or instability. 

Conclusion 

Ankle sprains in competitive athletes can be managed effectively with a well-structured rehabilitation program. By following these rehabilitation tips, physical therapists can help athletes recover quickly and return to their sport stronger than ever. Rehabilitation is more than just healing the ankle. It’s also about preparing the athlete for the challenges of competition and reducing the risk of future injury.