Have you ever been in a dance class or rehearsal and rolled your ankle? Have you prepped for a jump and upon take off felt a sharp pain in your ankle? The ankle sprain is by far the most common injury among dancers and in this article we are going to address the diagnosis, prognosis and rehabilitation of the ankle sprain. As dancers, our ankle stability and strength is one of the most important aspects of our physical health. This article will provide an understanding of this common injury and how to come back from it and prevent it in the future!
If you are more of the visual and auditory learner just click the YouTube video below outlining everything that is in this article!
Let’s get started!
What is an Ankle Sprain?
An ankle sprain occurs when you have a specific traumatic event when you roll your ankle out to the side. This will typically occur landing from a leap, coming out of a turn, or while doing pointe work and being in that excessive releve position. When the ankle is in releve, it is in what we call a plantar flexed position. A plantar flexed position is known as the loose packed position at the ankle, meaning this is the least stable position of the ankle. If the surrounding musculature is not strong enough to support the ankle, the ankle will roll or invert upon landing or turning and result in an Ankle Sprain.
A “sprain” is a stretching or tearing of the ligaments in the joint. There are three different grades of Lateral Ankle Sprains. A grade 1 ankle sprain is when the ligament(s) overstretch. A grade 2 ankle sprain is where there is some tearing of the ligament(s) but there is not full separation. A grade 3 is a severe ankle sprain where the ligament(s) completely tear and there is little to no stability at the joint anymore. Ankle sprains can involve one ligament or a combination. The Anterior Talofibular ligament (ATFL) is the most commonly sprained ligament in the ankle. The Calcaneofibular ligament (CFL) and Posterior Talofibular Ligament (PTFL) are the other two lateral ligaments in the ankle that are susceptible to being sprained.
Common signs and symptoms of an ankle sprain include:
If you sprain your ankle, you’ll see some of those signs and symptoms. You’ll have pain on the outside part of your ankle, you’ll have some swelling that is localized to the outside part of your ankle and it will be difficult for you to move your ankle. Now, if you cannot put weight on your foot or you have bony tenderness, meaning the bones along the outside of your ankle or foot are tender or painful, the biggest thing you need to do is rule out a fracture. The way to do this is to get an X-ray (or radiograph). The first step is to rule out any fractures and be positive that it’s an ankle sprain. From here, your doctor or physical therapist will be able to do an evaluation and diagnosis an ankle sprain.
For more information regarding ruling out a fracture see this previous blog post article by CLICKING THIS LINK
So, you’ve been diagnosed with an ankle sprain. Well what does that mean? The prognosis on how long you need to recover to get back to dance is going to be variable. No two ankle sprains are the same and no two rehabilitation programs will be the same. It is going to depend on how many ligaments are involved as well. Did we sprain one ligament or two? Is it a grade 1 or grade 3? It’s also going to depend on the possibility of a displaced fibula. If you’re restricted in motion at your ankle and you sprain your ankle, there is a possibility of your fibula displacing or subluxing. So now there’s this mobility issue as opposed to just overstretching the ligament. Once your healthcare provider has determined exactly what is going on with your ankle sprain, you will be able to have an idea of your prognosis and get started on rehabilitating the ankle!
Rehabilitation of the Ankle Sprain
An ankle sprain is NOT the end of the world. Through proper rehabilitation with your physical therapist, you’ll be back to full strength and performing at your best.
Rehab Phase 1
You’re right off the injury. You’ve ruled out a fracture and You’ve just been diagnosed with an ankle sprain. You have some swelling and maybe it’s painful to walk and it’s hard to move. So what should you be doing? During this initial Phase or what we’ll call the Maximum Protection Phase we’re going to want to follow the acronym PRICE-MEM:
|R||Rest – active rest, not complete bed rest|
|M||Manual Therapy- specifically to help decrease swelling and increase a little bit of mobility|
|M||Medication- anti-inflammatory medication|
So our main goal for this phase is to help decrease the swelling, get mobility going in the ankle, and to do some muscle activation exercises. We do not want to forget the other muscles in the leg as we heal from an ankle sprain.
So when you sprain your ankle, you don’t want to shut down the whole leg completely. During this time, we will work with our dancers to engage and strengthen those turnout muscles and activate the hip muscles because they will be important in preventing an ankle sprain in the future. So during this initial phase you may not be able to do a whole lot in terms of exercises for the ankle, but you can do alot of hip and knee strengthening exercises during this phase.
Remember this phase is going to be variable depending on the dancer and the type of ankle sprain you’ve suffered. Some individuals will last in this phase for 1-3 days or up to a week or maybe even 10 days. It’s going to be dependent upon you getting a proper diagnosis and prognosis!
Rehab Phase 2
The main focus of this phase is to begin strengthening the muscles in and around the ankle which will be essential for proper healing, as well as utilizing specific manual therapy techniques such as manipulation mobilization techniques to the ankle because of a restriction in dorsiflexion or the flexed position of the ankle. So, dancers if you’re having pain with plies then there are some specific manual therapy techniques that can help alleviate that pain and help you to get through your ankle sprain.
This seems to be the most overlooked part of ankle rehab in dancers. Many times we see a dancer in an aircast for 4 weeks, or even 6 weeks and once getting out that, they’re having a lot of pain and stiffness and they can’t flex their ankle. Utilizing the manual therapy techniques and self mobilizations techniques to help improve the ankle mobility is a huge part of this phase.
So overall, our main goals in this phase include moderate protection of the ankle, strengthening the muscles in and around the ankle and promoting mobility at the Joint.
Rehab Phase 3
This is our third and final rehab phase, known as our minimal protection phase. The main goal here is to strengthen the ankle and develop neuromuscular control of all of your leg muscles from the hip all the way down to your foot. We need to establish normal movement patterns and we want you to have the balance and strength to control your leg when you’re doing single leg movements in dance. This is so you can control your ankle when your landing from a leap or coming out of a turn or doing any work en pointe. To restore this neuromuscular control we’re going to focus on more functional exercises. Everything you’re going to be doing in this phase is going to be on one leg and in a closed chain position, meaning your foot is on the ground. At this point we’re not doing any exercises on the table and we’re progressing forward to those functional exercises so we can ensure a safe return to dance.
Before you return to dance fully, what is essential is for your body to go through?
Specific plyometric training. Plyometric exercise help to re-establish the dynamic neuromuscular control you will need to have so your body can control your ankle in space. This is where you’re starting your jump training and you’re starting with two legs, progressing to one leg. You’re doing exercises in different planes, jumping forwards and backwards and side to side. You’re working through doing sissones and pas de chats. We want to focus on those dance specific plyometric training to fully prepare our dancers to return safely to dance.
This is the last phase of rehab. You should never be going from doing band exercises on the table to being back in a dance class. You need this last phase to progress you through plyometric exercises so your body is ready to perform at the full out level again. We want to re-establish the resiliency of your body, strengthen your body and go through rehab properly the first time to prevent ankle sprains in the future!
Are you a dance parent who is wondering what it will cost your daughter in the long run if she continues to work through the pain?
Have you seen other medical providers in the past that just tell you to stop dancing?
We have a unique treatment approach that focuses on solving these problems with our clients.
Our goal is to help keep your dancer active while recovering from injury by staying in the studio and guiding them in ways to modify their training, rather than eliminating dance!
We combine manual hands-on techniques with guided supervised exercises to help your dancer get stronger, pain-free, and perform at their peak level to get them back in the classroom and on the stage.
The SPARK Physical Therapy Commitment
If you’re in the Wallingford, CT area and are a dancer that has been dealing with injuries we can help. We’d love to chat for a few minutes and see if you are a good fit for what we do. Fill in the contact request and we’ll set up a free 15-minute phone consultation with a doctor of physical therapy
Thank you for taking the time to read,
– Duane Scotti, PT, DPT, PhD, OCS
A special thanks goes out to Allie Eldridge, SPT for her contributions to this article
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“I developed IT band syndrome during my first marathon training cycle last year and ended up in physical therapy for about 3 months. I was told not to run if I had any pain at all. I lost so much time “recovering” that I ended up deferring my registration to the next year. I spent the next summer training for the same marathon when about 6 weeks out, that familiar IT band pain returned. I could barely finish a mile. I didn’t want to go back to my physical therapist because I knew what he was going to tell me. Stop running. I was so frustrated and started to feel like marathons weren’t for me. I stumbled upon the healthy runner podcast and learned that I don’t have to stop running in order to recover from injury! I was skeptical about an online physical therapy session. But I reached out to Dr. Scotti and he was able to give me the tools to mitigate my pain within the first session! I was able to complete my training cycle and made it to the finish line of my first marathon with his help! I highly recommend!”
“I’d been dealing with Proximal Hamstring Tendinopathy (PHT) for about 4 years and had been doing PT, but still had lingering pains. I just figured I’d have to suck it up and deal with it because that was as good as I was going to get. But then, I came across a podcast of Duane being interviewed by Jason Fitzgerald on PHT and how he overcame the injury, and my curiosity was piqued. I met with him virtually and he has been a GODSEND! I’m able to sit as I type this! I can bend over and get in and out of cars without pain! And, I’m RUNNING again!!! It is amazing to be able to do things that I haven’t been able to do without pain since 2016!!! Thank you so much Duane for being an incredible PT!!”
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