Ankle sprain exercises – What, when, and how

The two best types of ankle sprain exercise are those that restore the strength and the position sense in your ankle and foot. All the exercises in this article can be done at home. We start off with ankle sprain strengthening exercises for plantar flexion, and then move on to balance exercises, including how to achieve excellent balance with a balance board. Remember, if you need more help with an injury, you're welcome to consult one of our physios online via video call.

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In this article:

1. Ankle sprain strengthening exercises

2. Balance exercises for ankle sprains – stable surface

3. Ankle sprain exercises on a balance board

4. How we can help

We've also made a video about this:

The exercises in this article are appropriate for inner (medial) ankle sprains and outer (lateral) ankle sprains. The treatment for high ankle sprains is somewhat different.

Ankle sprain strengthening exercises

What muscles should you strengthen?

You must make sure that all the muscles in your foot and around your ankle are strong. These include:

• The small intrinsic muscles in your foot

• The muscles that turn your foot in (invertors); the main one being tibialis posterior

• The muscles that turn your foot out (evertors); the three peroneal muscles

• The muscles that bend your foot up (dorsiflexors); the main one being tibialis anterior

• The muscles pointing your foot down (plantar flexors); gastrocnemius and soleus (the calf muscles).

We’ve previously demonstrated exercises for strengthening the foot muscles and tibialis posterior as well as the peroneal muscles. However, it is usually best to get guidance from a physiotherapist before starting with those, because they directly work the muscles you commonly injure when you sprain your ankle and can make things worse if done at the wrong time.

In this article, we will focus only on the strengthening exercises for plantar flexion, because they are usually safe to start with for everyone with an inner or outer ankle sprain.

Why are plantar flexion exercises so important for ankle sprain rehab?

In short, they help you to:

1. Regain your range of motion

2. Strengthen the muscles you use to propel yourself forward when walking, running, and jumping

3. Strengthen your foot muscles

4. Improve your ankle stability.

Wondering how they achieve all of this?

Plantar flexion is when you point your toes down or stand on your tippy toes. To do this, your calf muscles contract and pull on your Achilles tendon, which, in turn, pulls your heel bone up.

In practical terms, you use plantar flexion when you go up on your toes, when you push off when you walk and run, and when you jump. The same muscles and tendon come into play when you need to cushion yourself, e.g. when landing after a jump or if you land on your forefoot when running.

All of these functions are reduced when you’ve sprained your ankle, so it needs to be strengthened back up.

The plantar flexion movement also helps you to regain the range of motion in your ankle after you’ve sprained it – your ability to move your foot up and down freely.

When you do plantar flexion in a controlled way (more about that below), you're also asking all the muscles around the ankle that are in charge of stability to co-contract. So, you're actually strengthening the muscles that stabilise your ankle at the same time.

These exercises also strengthen the foot muscles, because as you lift up, your foot muscles have to work harder.

Therefore, it's a lovely all-in-one type of exercise.

An ankle brace can be useful

Before we get stuck into the exercises, keep in mind that an ankle brace might be useful for providing some extra stability for your sprained ankle while you do these exercises, especially early in your rehab.

The right type of brace will allow plantar flexion but prevent side-to-side movement of the ankle – the type of movement that most likely caused the sprain in the first place. Here’s our full article on braces for sprained ankles.

An ankle brace is not appropriate for the balance exercises I will be discussing lower down. If you have to wear an ankle brace for those, you’re not ready for them yet.

Exercise 1: Seated heel raises

This is a nice and easy exercise for regaining range of motion, strength and control for plantar flexion in the early stages of rehab, when the ankle is still quite weak and painful.

All you do is sit on a chair, feet on the floor, and slowly raise your heels up and down – both of them.

Some tips to get the most out of this exercise:

• Don’t bounce your heels up and down. Research shows that you gain better control if you do these slowly.

• Ensure that you have an equal amount of pressure under the ball of your big toe and the ball of your little toe, so that you go over the middle of your foot; people tend to want to turn their feet out on the little toe.

• Some people get calf muscle cramps if they lift their heels up very high, so just go to where it’s still comfortable, and then come back down.

• If you have your feet really close underneath you, it’s going to stretch your ankle and ligaments, so that position can sometimes be uncomfortable. Simply move your feet out in front of you a bit until you find a comfortable position.

Having your feet too far back when doing this exercise can cause the injured ankle ligaments to stretch and hurt.

Work towards three sets of 20 heel raises with a minute’s rest between sets. But don’t go hell-for-leather right from the start. If your ankle is still painful, start with, say, three sets of five repetitions, and then add a few every day.

Exercise 2: Plantar flexion with an exercise band

The obvious benefit of an exercise band is that it strengthens the calf muscles as you push down.

But also, when you control that movement slowly on the way back from plantar flexion and don't allow your ankle to swivel all over the place, you're working on the control of your ankle. So, you are strengthening all the muscles that are working to keep your ankle in a straight line, not just the plantar flexors.

Another benefit of this exercise is that it's lovely for when your ankle is still painful and doesn't want to go all the way down or all the way up. So, you just stay in the range of motion that's comfortable for it.

This is not a stretch exercise. Yes, you can use it to stretch your foot back, but if you're going to really pull on the band every time your foot comes back from plantar flexion, you're just going to make your pain worse. This exercise is usually introduced when the ankle is still painful and the ligaments are still sensitive.

The bands come in different strengths. Below are some examples of sets of exercise bands, each with a different strength, that you can find on Amazon. Yellow and red are usually on the easier side, while dark blue and black have usually much more resistance.

How to do the exercise:

• Sit on the floor with the injured leg straight out in front of you. Place a foam roller or something similar under the lower part of your calf muscle so that your heel and ankle can move freely.

• Hook the exercise band under the ball of your foot and hold the two ends with your hands. Don’t pull it too taut – just so there’s no slack in the exercise band for starters.

• Start with your foot in the neutral position, not bent upwards towards you.

• Slowly point your toes down into plantar flexion, pause for a moment, and then slowly bring your foot back in a controlled manner to the point where you feel you can control it and it's comfortable.

Start with about three sets of 10 repetitions, with a minute’s rest between sets. If you find it too hard, you can start with three sets of five or six, or even four or five sets of five or six. And remember, the rest between sets is important, because the muscles need to recover so that they can work again.

Start with an easy resistance. When you can do about three sets of 10 to 15 repetitions with that exercise band, you can consider switching to a harder band. But to be honest, if you can do three sets of 15 with a red band, you are probably ready to move on to the next exercise in this list.

Exercise 3: Standing double-leg heel raises

This is the same ankle movement as in the seated heel raises above, but this time you’re standing, so you’re lifting your whole bodyweight.

Some tips:

• This is not a balance exercise, so hold on to something. A chair is not ideal because it can tip over if you really go wobbly; something like a dining room table or a kitchen counter is better.

• Have your feet about hip distance apart and, again, there should be equal pressure under the ball of your big toe and the ball of your little toe.

Same as for the seated heel raises, don’t bounce up and down. Especially on the down movement, it is important not to let gravity do the work for you. You're going to get much more benefit from this if you go down nice and slow and controlled.

• Avoid doing this exercise in bare feet on a hard surface – it can injure the ball of your foot and cause metatarsalgia. If you can’t find a soft surface, rather wear something like running shoes for a bit of cushioning.

• If it hurts to lift all the way up, just go to what you can do without pain. It will improve over time so that you can eventually go all the way up.

You’re aiming for three sets of 20 repetitions, but start with fewer – maybe three sets of five – and gradually add a few every day. Rest at least one minute between sets; two minutes is also fine.

Once you can do three sets of 20 double-leg heel raises, it’s time to move on to single-leg heel raises, using the same approach as for the double-leg ones.

Sport-specific exercises

If you think about the forces that go through your ankle when you run – much greater than just your bodyweight – it makes sense for runners and people who do sports that involve running to add some extra weight to their single-leg heel raises at some stage. And to get back to sports that involve jumping, you would have to progress to plyometric exercises.

Balance exercises for ankle sprains - stable surface

Why do balance exercises for an ankle sprain?

The research shows that people who have sprained an ankle are more likely to sprain it again in the year after than people who have not sprained an ankle. This is thought to be due to the injury causing reduced strength and position sense in the ankle.

You're at increased risk of spraining an ankle for up to a year after an ankle sprain.

You can reduce the risk of recurring ankle sprains if you improve the strength, control, and position sense in your ankle. (Wearing an ankle brace also helps, but this is not an attractive long-term solution.)

We’ve already taken the muscles in your ankle that stabilise and control it into account in the strength exercises above. The balance exercises now go further to target these muscles specifically and to improve your position sense (proprioception).

Balance and position sense

Position sense refers to your brain’s ability to know exactly where various parts of your body are and how they are moving without you having to look at them.

Test it. Close your eyes. Do you notice how you still know where body parts like your feet, your hands, and your fingers are? This is because there are little sensors in your tendons as well as your ligaments and your joints that tell your brain where everything is and how you're controlling it. That's why you don't have to look at the stairs when you run up them, for example.

Position sense refers to the ability of your brain to know where your body parts are and how they are moving without having to look at them.

When you sprain an ankle, you injure some of the ligaments and some of the tendons, and the signals to your brain get a bit muddled, which affects your position sense. Your ability to balance is linked to how good your position sense is, and that’s why it can be so difficult to balance on a sprained ankle.

Research has shown that position sense can be restored by doing strength training exercises, like the ones above, very slowly and focusing on good control, and the type of balance exercises below.

Again, we’ll start with the easy ones before moving on to the more challenging ones.

Exercise 1: Balancing with head still

If your sprained ankle is still painful, we want to limit how much it wobbles from side-to-side when you try to maintain your balance, so it’s quite OK to hold on to something when you start with these exercises, just for a bit more stability.

If your ankle is still quite painful, start by wearing shoes and holding on to help you balance.

Stand on both feet, barefoot, and then slowly transfer your weight onto your injured side. You can now start to reduce how much you’re holding on with your hand. If your ankle is quite steady, it’s fine to reduce holding on and eventually let go. But if you’re still a bit wobbly while holding on, keep holding on, even if it’s with only one finger – it will get better with time and practice.

Aim to balance without support and preferably barefoot.

Tips to get the most out of this exercise:

• Hold on with the opposite hand; so, if you’ve sprained your right ankle, hold on for stability with your left hand.

• Bend your knee slightly; it’s easier to balance this way than with a leg that’s locked straight.

• Don’t hunch forwards; stand tall and tighten up your stomach muscles.

• It may help to look at your foot initially, but ideally you should look straight ahead.

• Don’t lift the healthy leg up too high – just above the floor is fine – so that you can quickly catch yourself if you start to keel over.

• For me, it helps to push my big toe gently into the floor, because it activates the muscles in the foot better. But don't overdo it, because that can cause irritation in the foot.

• Doing it on a very soft surface is much harder than doing it on a firm surface.

• Doing it with supportive shoes on is cheating a little bit, but if you've got a really painful and swollen ankle, that's a really good way to start.

You're looking to start with three sets of really short holds; maybe 10 seconds per hold. Rest for a minute between sets. That’s it for the day.

You want to gradually build this up to three sets of 30 seconds where you can stand nice and solid without having to hold on before moving on to the next exercise.

Exercise 2: Balancing with head moving

Now we're going to start moving our heads. Why does this make things more difficult?

To balance, your brain uses input from your ears, your eyes, and those little position sensors in your body tissues. If you’re focusing on a single point, the brain can use all three these systems. As soon as you start moving your head, there’s more input. Now your ears and eyes are moving, so your brain has to rely more on the signals from the position sensors.

Start off with going into the head-still balancing position as described above. Once you’re nice and stable, slowly turn your head to one side, pause for a second, and then turn it to the other side.

Some tips:

• Move slowly, so your brain has time to adjust to the new positions.

• If you lose your balance, pause where you lost it, see whether you can regain it, and then slowly bring your head back to face forwards.

• At the start, you can have your fingers against a wall to make things a bit easier and then remove it as you get better at it.

Like before, try to start with three sets of 10 seconds at a time and work your way up to 30 seconds at a time, with rest between sets.

Exercise 3: Balancing with eyes closed

When your eyes are closed, your brain has to rely fully on the signals being sent from your limbs and ears.

This one is quite difficult, so make sure that you’ve got the previous balancing exercises down pat before you attempt it.

Some tips:

• Make sure there's something to hold on to and use it if necessary.

• Open your eyes immediately if you lose your balance; don't keep them closed and try to balance or catch your balance.

• You may start to feel dizzy. Open your eyes if that happens and reset.

• I find that the first attempt is often the hardest. And then, as you go on, your brain kind of wakes up and goes, “Ah! You want me to actually listen to the foot?” And then it gets easier.

• If you totally suck the first time round (on any given day that you start this exercise), do a few of the open-eye ones first and then try again with eyes closed.

Same drill as before: Work your way up to three sets of 30 seconds with eyes closed and good, stable balance without holding on.

Ankle sprain exercises on a balance board

An excellent way of progressing balancing exercises even further and really working on that control is using an unstable surface, such as a balance board.

Choosing the right balance board

If you go on Amazon, you'll see that there are many types of balance board.

A few things to consider and look out for:

• It should be big enough to support both your feet, hip distance apart.

• The dome at the bottom should allow movement in all directions. Some balance boards just tilt backwards-and-forwards or side-to-side. Our ankles need to be able to move into all directions, e.g. when you’re walking or running on uneven terrain.

• Look at how “pointy” the dome is; very pointy means it’s going to be harder to balance on. If you already have one and it’s too pointy, you can fix this by placing it on something soft, like a folded towel, a cushion, or a soft carpet that allows it to sink in a bit.

Examples of the type of balance board that will be useful for the exercises below:

Common balance board mistakes

These are some mistakes I’ve seen people make when they do balance board exercises for an ankle sprain:

• They get onto a balance board before being able to balance on one leg on the floor. If you're not able to maintain your balance on your one leg on a stable surface like the floor, it's not the time yet to get onto an unstable surface like a balance board.

• People start these exercises when their ankle joint is still very painful and doesn't have enough range of motion yet. You need to be able to tilt your foot up-and-down and side-to-side with relative comfort and have nearly full range before you start on balance board exercises. And the reason for that is – you'll see when I demonstrate the exercises – it takes your foot through the full range of motion.

• Some people focus solely on balance and don’t incorporate all the other types of exercise you need to rehab a sprained ankle, like range of motion exercises and strength training exercises.

Five balance board exercises (demo video)

Show-and-tell is a more useful way of demonstrating these exercises than writing about them, so here’s the part of my video about balance boards where I wobble about on one.

They are arranged from easy to difficult, so please master the first one before moving on to the second, and so on. Also, please check with the physiotherapist in charge of your ankle rehab before you start with them, because it may be that they're not appropriate for you at this stage.

How to make your balance board exercises more challenging

So, the video shows the basic way of doing these exercises. Once you have mastered them, there are several ways in which you can make them more challenging, and some of these mimic the progression of the floor balancing exercises above:

• Move your head from side-to-side. You can also try looking up-and-down.

• Move your arms around or twist your body from side-to-side.

• When balancing on one leg, move the other leg into various directions.

• Do sport-specific things. For instance, if you play netball, get someone to throw a ball at you to catch and then throw back at them. This can be done while balancing on two legs or one.

You should aim to make your balance exercises sport-specific eventually, so that they properly prepare your sprained ankle for the movements used in your sport.

However, if you’ve sprained your ankle and you just want to get back to walking the dog again, this last batch of exercises is not necessary.

How we can help

Need more help with your injury? You’re welcome to consult one of the team at SIP online via video call for an assessment of your injury and a tailored treatment plan.

We're all UK Chartered Physiotherapists with Master’s Degrees related to Sports & Exercise Medicine. But at Sports Injury Physio we don't just value qualifications; all of us also have a wealth of experience working with athletes across a broad variety of sports, ranging from recreationally active people to professional athletes. You can meet the team here.

About the Author

Maryke Louw is a chartered physiotherapist with more than 20 years' experience and a Master’s Degree in Sports Injury Management. Follow her on LinkedIn and ResearchGate.

References

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2. Fuerst, P., Gollhofer, A., Wenning, M., & Gehring, D. (2021). People with chronic ankle instability benefit from brace application in highly dynamic change of direction movements. Journal of Foot and Ankle Research, 14(1), 1-11.

3. Herzog, M. M., Kerr, Z. Y., Marshall, S. W., & Wikstrom, E. A. (2019). Epidemiology of ankle sprains and chronic ankle instability. Journal of Athletic Training, 54(6), 603-610.

4. Moore, M. L., Haglin, J. M., Hassebrock, J. D., Anastasi, M. B., & Chhabra, A. (2021). Management of ankle injuries in professional basketball players: Prevalence and rehabilitation. Orthopedic Reviews, 13(1).