Rehab and return to play

Many players return to play far too soon after a sprain. There is strong evidence that athletes have a twofold risk for re-injury after ankle sprain, especially during the first year post-injury. We will cover the different phases of recovery below.

Phase 1 - Acute Phase (0-3 weeks)

(These are general guidelines, rehab protocols are never one size fits all. Some athletes will progress much faster and others more slowly. If you have a low grade sprain or these exercises become too easy, move onto the next phase.)

Goals for this stage:

• Reduce swelling/pain

• Restore motion

• Begin strengthening

• Normal walking/weight bearing

• Protect the ankle from further injury

Reduce swelling

• Movement - Ankle pumps

• Ice as needed for pain

• Compression sleeve/sock

• Elevate above the heart

Restore motion

• Stationary bike

• Active ROM 

• Circles

• ABCs

• Inv/Ev slides

• Seated heel/toe raises

• Intrinsics, Towel curls

  Calf stretch

• Seated

• Standing

• Ankle eversion self mobilization

• Dorsiflexion self mobilization

Strengthening

• Ankle theraband exercises (video)

• I prefer multiple sets with higher reps at this stage. Whatever set/rep range you choose, just make sure you are challenging the muscles and going near failure.

• Ankle eversion/inversion in PF, less stable position

• Goal is to strengthen the peroneal tendons on the outside of your ankle that provide dynamic ankle stability. 

• DF with weight or KB

• SL inv/ev

• Standing HR/TR

• Bent knee

• Isometric as needed

• Inv/Ev

• Seated HR with bar/weight

• Side plank

Normal weight bearing and walking

• Early motion and weight bearing for acute ankle sprains has been shown to significantly increase ankle range of motion and decrease pain and swelling sooner than immobilization.

• Carry on with normal activities such as walking, using stairs, and squatting as long as the pain is not severe.

• Try to avoid activities that excessively aggravate symptoms at this time, which could include running, jumping, cutting, uneven ground, etc. 

Protect the ankle 

• While you do want to begin moving again as soon as possible, you should still try to avoid higher level activities in the acute phase if they are aggravating.

• Most athletes will not need a walking boot, but you may use crutches initially and weight bear as tolerated.

• In most cases I recommend wearing a brace if you are going to be walking on uneven ground or if the ankle feels unstable. 

Should you brace or tape your ankle?

• Taping and bracing the ankle following injury has been shown to reduce the risk of repeated sprains in many studies. The injured ligament can take up to a year to fully heal but athletes will typically return to sport far before this. Therefore I recommend taping or bracing your ankle for 6-12 months following your injury, especially if you have had multiple sprains in the past. 

• More and more research is showing that taping and bracing provide a proprioceptive effect, improving the ability of the ankle to react quickly to inversion stress (rolling the ankle). The actual passive mechanical support is minimal and we see that tape loosens within 10 minutes. Postural control and maintaining balance also seem to improve with bracing/taping.

• I would not recommend bracing or taping if you have not sprained your ankle in the past. There is no convincing evidence showing that bracing or taping reduces injury in athletes who have never sprained their ankle before.

Taping

• Common types of tape

• White athletic tape

• KT or Kinesio tape

• Leukotape

• KT tape is the most elastic and fairly easy to apply. Normal athletic tape is cheaper and more rigid, but does not stick nearly as well in my experience. Leukotape is the most rigid and I prefer this type of tape for high ankle sprains (link to video or article). 

• Benefits of tape 

• No difficulty fitting in cleats

• It does not add any discernible bulk or weight

• Unlikely to affect your touch

• Unfortunately as mentioned above, tape tends to loosen within just 10 minutes, and it can be costly if you are taping your ankle for every training session and game.

Bracing

• There are a lot of different braces on the market now, ranging from bulky to more minimalist.

• The one time cost may save you money in the long run compared to taping.

• Braces will provide more padding and compression to the area.

• Most braces will be more bulky and heavier. Some may be difficult to fit in your cleats.

• Some braces will restrict your motion much more. This can be beneficial in some scenarios but may not be ideal, especially on your dominant foot.

There are many affordable braces online and they may be covered by your health insurance. I would recommend trying both taping and bracing and find what works best for you. You may want to start with the brace initially and transition to tape later on.

Here is an overview of various ankle braces on the market -

• ASO ankle brace

  • If you’re in the US, this is usually the brace they will have at the doctor’s office. It’s very affordable and probably more appropriate for the acute injury. The brace is more rigid with lace up and velcro support. Most of these take awhile to get on unless you get the speed lacer model. The fabric is not the most comfortable and they don’t fit well in soccer cleats. I would usually recommend a different brace once you start field training again. ($25)

• Active ankle brace

  • This is a hinged brace that allows very minimal lateral ankle movement. I do not recommend wearing this brace while playing soccer, but it may be appropriate in the acute stage or with other sports.  ($40)

• Zamst A2-DX

  • I believe this is the brace Steph Curry wears. This has very rigid lateral support. It is a bit pricier and I would not recommend it for soccer, but it may work well for other sports. ($70)

• McDavid phantom/stealth

  • Several models with various levels of support. Lower profile than the ASO brace with a better fit in cleats. ($40)

• Shock doctor ultra knit/stabilizer

  • Similar to the McDavid models. ($25-$45)

• Bauerfeind malleotrain plus/sports ankle support

  • Bauerfeind braces tend to be preferred by most players due to the low profile and comfort in soccer cleats. They provide a good mix of compression and stability without restricting motion excessively and messing with your touch. They are also easy to take on/off. 

  • Easily the most expensive on the list ranging from around $70-$135 for various models. However, if you plan on wearing a brace for a season or more it may be worth it. 

• Ankle sleeve

• These can be good for compression and may be all you need once you are ready to return to play. They likely work just as well as tape or better and are very affordable. There are a bunch of different models you can choose from. ($10-$20)