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GENERAL INFORMATION, STRETCHING, PROPRIOCEPTION, AND STRENGTHENING FOR
  ANKLE REHABILITATION

PLEASE CONSULT WITH YOUR OSTEOPATH PRIOR TO COMMENCING THIS PROGRAM

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The key elements of rehabilitation of your ankle are:
  1. Regaining full range of motion (Stretching exercises)
  2. Improving neurological feedback to restore normal ankle function (Balance and Proprioception exercises)
  3. Restoring strength (Strengthening exercises)
  4. Learning and practicing good posture and balance on both ankles (the rehab program will assist with this)
  5. Regular exercise (This will increase as your ankle strength and balance is restored)

Using good body mechanics during everyday activities. Important things to remember:
How your lower limbs function each day can have an impact on your recovery. Don’t place unnecessary stress on the muscles and joints of your ankle by attempting activities that you know will aggravate your symptoms. This will potentially delay your recovery.

General Information
  • Please cease exercises with the onset of any abnormal discomfort or sharp pain.
  • Contact your osteopath if there is any abnormal discomfort or if you do not understand any of the exercises.
  • It is important to avoid painful & high impact exercises.
  • he warm up and cool down need to be long and slow to allow appropriate range of motion and proprioceptive (neural awareness) of the muscles and joints. This will decreases the likelihood of further damage and encourage proper strengthening.
  • How many weeks you perform these exercises for will be determined by your osteopath (the severity and grading of your ankle sprain will indicate how long your recovery will be). As a general guide, it is never harmful to do these exercises consistently all the time (especially if you suffer from recurring ankle sprains).

 


Stretching for Ankle Rehabilitation


When stretching muscles it is recommended that you ensure that your posture is stable, that you are constantly breathing, and that you increase the tension at a very slow pace. Generally a stretch is held for 20 seconds with 10 seconds rest and is repeated 5-10 times (slowly adjusting according to tension each time). Please aim to perform the following stretching exercises 2-4 times a day. Stop any stretch at the onset of any abnormal pain and contact your osteopath.

Click here for guidelines on stretching


Gluteal Stretch
Your gluteal muscles work in many different directions so they need to be stretched in many different directions.
(1) The first image shows you lying on the floor and gripping your knee with one hand and stretching your hip across your body. You can gently place your hip in different angles and feel a different stretch each time.
(2) Lie flat on the floor, place one foot on your opposite thigh (just below the knee). Loop your hands around that thigh and gently pull that knee up (the picture displays a left gluteal stretch).





Quadriceps Stretch
(1) The first stretch displays a standing quadriceps stretch. Maintain an upright posture with head and back straight as you pull your foot up and press your hip forward.
(2) Whilst lying on your front with head and back straight as you pull your foot up and press your hip forward.






Note: Take care with this stretch. If your ankle is painful with pulling it up, skip this stretch until it is comfortable to perform.


Hamstring Stretch
To stretch the hamstrings keep your knee and back straight, lean forward (Bend through your hips) until you feel a stretch in the back of your thigh. The following images display alternative ways of effectively stretching the hamstrings.






Inside of leg (Adductor) Stretch
These stretches target the muscles on the inside of your leg from your groin to the inside of your knee.
(1) For the first stretch sit on the floor with the soles of your feet placed together. Place your elbows on your knees and gently push them down so you feel a stretch in your groin area. This stretch is adjusted by bringing your heels toward or away from your body. Do not lean forward during this stretch as it places abnormal pressure through your low back.
(2) For the second stretch keep your feet placed relatively straight (slightly pointed outwards). The leg on side you are stretching will remain straight while you bend the opposite knee to create a stretch (the picture displays a left adductor stretch).

 
Note: Take care with this stretch. If your ankle is painful with standing, skip this stretch until it is comfortable to perform.


Calf Stretch
(1) The first stretch is a safer calf stretch that should be performed initially until the ankle is less painful. With a towel (or other pulley) wrapped around your foot, gently pull up toward your body causing a gentle stretch to the calf muscle.
(2) The second image shows a standing stretch against a wall (or stable object). Perform this stretch on Keep your feet straight (with a slight angle outwards) and lean forwards where you should feel a stretch at the back of your leg. Remember to keep your back foot flat on the floor and straight.


  
Note: Take care with the second stretch. If your ankle is painful with standing, skip this stretch until it is comfortable to perform.


Soleus Stretch
The soleus muscle is a deep calf muscle that does not cross the knee joint. The key to targeting your soleus is to bend your knee. Stand with both arms against a wall and both feet planted on the ground. Twist your back foot slightly outwards and bend both your knees. Concentrate on feeling a stretch through the back leg by adjusting the bend of the knee in your back leg.



Note: Take care with this stretch. If your ankle is painful with standing, skip this stretch until it is comfortable to perform. 



Foot Lift (Dorsiflexion) Stretch
Both images display two effective ways to stretch your foot locally in an upward direction. The first image displays kneeling with your toes flat on the floor and your weight applied to your legs (keep your feet aligned with your leg!). The second image is a more gentle stretch applying an upward force with your hand.






Note: Take care with the first stretch on the left. If your ankle is painful with sitting on it (as it may be in the first few weeks), then skip this stretch until it is comfortable to perform.


Foot Pointing (Plantar-flexion) Stretch
Kneeling with your toes pointed flat and the top of your foot planted as close to the floor as possible. The weight applied to your legs should be enough to cause a stretch (keep your feet aligned with your legs). If this is painful in the initial few weeks just stretch by simply pointing your toes/foot straight and hold.




Note: Take care with this stretch. If your ankle is painful with sitting on it (as it may be in the first few weeks), then skip this stretch until it is comfortable to perform.



Ankle Outward and Inward Stretch (Inversion & Eversion Stretch)
To perform this stretch you simply place your foot on the floor and gently turn your foot outward and hold a stretch then slowly turn your foot inward and hold.

 





Balance and Proprioception for Ankle Rehabilitation

What is proprioception?
Proprioception is a nerve function that sends messages to the brain so that the brain can control how we balance. When you injured your ankle it lost some of its ability to transmit its position sense to the brain.

How Often to perform these exercises?
Aim to do at least 2-3 of the 4 listed basic exercises 5-7 times per week (You can perform all 4 if you like).Once you move onto the advanced exercise you can also continue doing the others. Ensure that you do your stretches prior to commencing these exercise. Stop any exercise at the onset of any pain or abnormal discomfort and contact your osteopath.

(1) Standing on 1 Foot
Stand on one leg and work up to be able to hold for 30 seconds. Once you become able to hold in a stable position for 30 seconds then work towards being able to perform this exercise with your eyes closed. Once you become proficient at this exercise you can then moved to the advanced proprioception exercise (see below).

(2) Tooth Brush
Stand on one leg whilst brushing your teeth each day. Hold for 30 seconds, working up to one minute per leg.

(3) The Alphabet
Sit on a chair with your foot dangling in the air or on a bed with your foot hanging off the edge. Draw the alphabet one letter at a time by moving the injured ankle and using the big toe as your "pencil."

(4) Golf Ball under Foot for plantar fascia (+ Proprioception)
This exercise helps make the Plantar Fascia (tissues on the sole of your feet) supple and flexible. You can do this exercise any time of the day, even when you're watching TV or reading a book. Use a golf ball, tennis ball, rolling pin or drink bottle. While seated roll the ball with the arch of the foot back and forth from your heel to the toes. If this feels okay and doesn't hurt you can take it further by doing this exercise while you are standing up, making the exercise a little stronger. Keep doing this for about 2-5 minutes.



(1A) Advanced Proprioception: Unbalanced Surface (Pillow or wobble board)
A good starting point is to use a pillow. The type of pillow (i.e. soft or hard) will determine how much balanced is required. You are required to test some different pillows and work from most stable to least stable. Standing on the pillow with one leg work up to be able to be stable for 30 seconds, then perform with eyes closed.

Note: You must become proficient on a stable surface before moving onto the advanced exercise.No need to purchase a wobble board immediately. We will discuss the purchase of a wobble board if we evaluate that you need it.



Strengthening Exercises for Ankle Rehabilitation


The following exercises are to be performed carefully and as instructed. Ensure you have performed your stretches prior to commencing your strengthening exercises. Stop any exercise at the onset of any abnormal pain (rest and attempt the next day). If pain or any abnormal discomfort persists contact your osteopath

Follow through each step of the strengthening sections as you become proficient with each set of the exercises. You can move onto the next step once you have completed the following criteria:
  • You can perform the exercises without aggravating your ankle pain
  • You can perform the number of recommended repetitions competently
  • You have spent a minimum 1 week on each step(or as advised by your osteopath)
Note: you must go through the criteria/exercises with your osteopath prior to commencing strengthening as there may be some changes to timelines and selection of exercises depending on the severity and grading of your exercise.


STEP 1: RESISTANCE & ISOMETRIC STRENGTHENING EXERCISES
Note: Your osteopath will assist you with sourcing a resistance band if required

Ankle Dorsiflexion (Foot Up) & Plantarflexion (Foot Down) with a Resistance Band
(1) Dorsiflexion (resist foot up): Secure the band to an object (e.g. leg of a dining table) at ankle level and sit with legs straight with the band wrapped around your mid-foot as shown (the band running straight away from your foot). Gently pull your foot up towards your body as high as possible and then slowly return it to the starting position.
(2) Plantarflexion (resist foot down): Secure the band around your mid foot as shown and grasp both ends of the band with your hands (in the seated position with legs straight). Gently plant your foot forwards as far as comfortable then slowly return it to the starting position.
(3) Perform 3 sets of 10 repetitions with a small rest between each set.











Inversion and Eversion Isometrics
1. While seated, place the outside of the injured foot against a table leg or closed door (eversion exercise).
2. Push outward with your foot into the object your foot is against causing a contraction of your muscles. This is a static exercise (no ankle movement just muscle contraction)
3. Hold this muscle contraction for 5 seconds then rest/repeat.
4. Perform 3 sets of 10 repetitions.
5. Then perform the same exercise with the inside of your foot against a solid object (inversion exercise)



 
Seated Calf Raise
This is a simple but effect exercise in preparation for the standing calf raise in step 2.
1. Sit in a chair with the injured foot on the floor.
2. Lift your heel as far as possible while keeping your toes on the floor.
3. Return heel to the floor.
4. Repeat 10 times


STEP 2: WEIGHT BEARING STRENGTHENING EXERCISE

Standing Calf Raise
1. Stand on the injured foot while lifting the uninjured foot off the ground.
2. Raise your body up with the injured foot, standing only on the ball of the foot and lifting your heel off the ground.
3. Hold the position for 5 seconds.
4. Relax and put your weight back onto your uninjured foot.
5. Repeat 10 times


STEP 3: ADVANCED STRENGTHENING EXERCISE
Please do not start these exercises until you have been advised by your osteopath that it is safe to commence them. These exercises should be performed on both legs.

Balance and catch
Standing on one leg, catch and throw a ball with a partner. Make certain to throw the ball right, left, high, low. Perform three sets of 30

One leg mini squats
1. Lift the uninjured leg out in front of you
2. Slowly squat down on the injured ankle (drop your body down with your back straight) then come back up. Repeat 10 times.
3. Then perform the same exercise 10 times again performing the squat with the opposite leg bent behind you.

Lateral Stepping
1. Place a rolled towel or short object on the ground to the side of your injured foot.
2. Hop over the object and land, then place you other foot down next to it (repeat to the opposite side).
3. Repeat 20 times.
4. Increase the speed of this exercise as your strength and balance increases

Lateral Hopping
1. Place a rolled towel or short object on the ground to the side of your foot.
2. Hop over the object and land on your foot and hop back.
3. Repeat 20 times
4. Increase the speed of this exercise as your strength and balance increases

Scissor hops
1. Begin in a lunge position.
2. Jump and switch feet in mid-air landing with the opposite foot forward
3. Repeat 20 times
4. Increase the speed of this exercise as your strength and balance increases