Strengthening exercises after a joint injury such as a sprained ankle can help athletes move away from taping or bracing every day to provide support, reduce risk of reinjury and improve performance.

The guidance of a trained professional such as a physical therapist in strengthening exercises can help you retrain the joint to function properly during sport.

Take these 8 strengthening steps

After an ankle injury such as a sprained ankle, wait for swelling to go down and range of motion to return before beginning strengthening exercises.

Thomas Katz, physical therapist with Marshfield Clinic Health System, recommends an 8-step strengthening series. Progress through these exercises at the guidance of a trained professional as your injury heals.

Download Strengthening Exercises Handout

 

STEP 1: Strengthen surrounding muscles

1. TOWEL CRUNCHES
   1. Sit in chair with feet flat on the floor. Place a towel beneath your feet.
   2. Use the toes of your injured foot to crunch up the towel.
   3. When you reach the end, flatten the towel.
   4. Repeat 10 times with each foot. For extra resistance, add a weight to the end of the towel.
2. MARBLE PICK-UP
   1. Spread marbles on towel below your feet.
   2. Use the toes of your injured foot to pick up the marbles, one at a time, placing them in a jar.
   3. Repeat the pickup 10 times with each foot.

STEP 2: Isometric exercises

With the help of a physical therapist, contract the muscle without moving the joint.

1. First, the therapist pushes the injured foot toward the outside of your body.
   • Resist for 10 seconds.
2. Then, the therapist pushes the opposite direction, toward the inside of your body.
   • Resist for 10 seconds.
3. Next, the therapist pulls the foot away from you.
   • Resist for 10 seconds.
4. Finally, the therapist pushes the foot toward you.
   • Resist for 10 seconds.

STEP 3: Four-way band strengthening

1. INVERSION
   1. Create tension on the inside of your injured foot.
   2. Rotate your ankle inward 10 times.
2. EVERSION
   1. Create tension on the outside of your injured foot.
   2. Rotate your ankle outward 10 times.
3. PLANTAR FLEXION
   1. Hold the band wrapped around the bottom of your injured foot to create tension.
   2. Point your toes down, away from you, 10 times.
4. DORSIFLEXION
   1. Create tension with the band wrapped around the top of your injured foot.
   2. Point your toes up, toward your body, 10 times.

STEP 4: Proprioceptive Neuromuscular Facilitation (PNF)

When a joint is injured, your body’s natural balance can be damaged. PNF is meant to help you improve balance while the joint heals by retraining your body in mass movement patterns, which are everyday motions that naturally occur in diagonal or spiral patterns and cross the body’s midline.

“PNF helps us re-teach the body natural movements that we sometimes shy away from or ‘forget’ when a joint is injured,” Katz said.

Mass movement patterns incorporate three components:

• Flexion and extension: Flexion decreases the angle of the joint and extension increases the angle.
• Adduction and abduction: Adduction means moving the joint toward the midline of the body while abduction means moving the joint away from the midline of the body. (This is the same as inversion and eversion.)
• Rotation: Rotating the joint.

A physical therapist follows two diagonal repetitions during PNF to incorporate the above components and achieve mass movement patterns. Additionally, the physical therapist provides resistance and auditory, touch and visual feedback through PNF diagonals.

1. Point your big toe down and away from your body. Then, up and out.
   1. Repeat 10 times.
2. Turn the bottom of your foot – little toe first – to face down and away from your body. Then rotate it up and in.
   1. Repeat 10 times.

STEP 5: Body weight resistive exercises using heel/toe raises

Progress through heel/toe variations as your sprained ankle recovers.

1. FIRST STAGES OF RECOVERY
   1. Stand with both feet on a flat surface and rock steadily from toes to heels.
   2. Use wall or table for support as needed.
2. INTERMEDIATE STAGES OF RECOVERY
   1. After some time when stage 1 is easily attainable, perform the same motion on the injured foot only.
3. ADVANCED STAGES OF RECOVERY
   1. Once you can accomplish the first two variations, use a slant board for two feet heel raises.
4. NEARING FULL RECOVERY
   1. Perform the same motion on the injured foot only.

STEP 6: Balance exercises

Hold each of these balance exercises for 10 seconds.

1. STATIC
   • Balance weight on both feet.
   • Once balancing on both feet is tolerable, balance with one foot in front of the other.
   • Then try single-leg balancing on your sprained ankle.
2. DYNAMIC
   • Once successful with static exercises, change the surroundings and repeat this sequence on an aerex pad as you get closer to full recovery.
3. SPORT SPECIFIC
   • Put the movements together with ball-handling, or other sport-related movement.

STEP 7: Functional exercise using agility ladder

Work with a physical therapist to determine the best agility ladder exercises for your sport and injury.

In this series, we suggest:

• Run there and back with one foot in each slot.
• Run there and back with two feet in each slot.
• Hop with two feet there and back.
• Side step with both feet there and back.

STEP 8: Return to play

Once your injury is mostly healed, begin easier drills in practice. For example, a two-man basketball drill. As easier drills become more tolerable, work with your physical therapist to determine which of the more difficult drills you can work into as you fully recover.

For more information about sprained ankle recovery, talk to a Marshfield Clinic Health System physical therapist.

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