After the initial bleeding phase is over, the goal of treatment is to regain normal, pain-free range of motion. Increased range of motion can be achieved through passive, active or active-assisted stretching exercises as well as by submaximal exercise on a stationary bike. The exercise programme should progress (according to the improvement in function and degree of symptoms) from progressive linear movements (e.g. toe-raises, squats, jogging, jumping in place on two legs, then one, skipping-rope jumping) to cutting movements (e.g. running figures of eight, sideways jumping, sideways hurdle jumps). The goal of this progression of exercises is to gradually progress towards sport-specific exercises.
An important goal in the successful rehabilitation of an ankle sprain injury is the re-establishment of neuromuscular control of the ankle through a programme of balance exercises. Proprioceptive function is impaired in patients with residual functional instability after previous sprains, which can be improved by balance board exercises.
Peroneal strengthening exercises are also an important part of the rehabilitation programme. These should be done with the ankle in a plantar-flexed position. The ankle is least stable in plantar flexion – and this is the position where more ankle inversion injuries occur.
Such programmes can reduce the risk of re-injury to the level of a previously uninjured ankle. Neuromuscular training should be carried out for six to ten weeks after an acute injury.