How to recover from an ankle sprain

An ankle sprain can be a frustrating setback, but with the right approach, recovery is not only possible but during your rehab you may have more strength and stability than you did before. As a physical therapist, I've guided countless individuals through the rehabilitation process post-ankle sprain. Three key considerations emerge as crucial for optimal recovery: rest, rehabilitation, and gradual return to activity.

Firstly, correctly diagnosis it as ankle sprain. Following an ankle sprain, it's essential to make sure we don’t have a fracture. Luckily you may not even need to get an X-ray to find out. There is a test called the Ottawa ankle rules that allows physical therapists and health professionals to do to see if you need to get an X-ray or if it’s likely negative and you can avoid going. If the tests are all negative then we can assume for now there is no need for X-ray and can begin rehabbing.

Secondly, although we may not be ready to jump right back into our sport we actually don’t want to rest it too much. Everything depends on how much pain you’re having , how swollen the ankle is, and etc. Your physical therapist should be able to help guide you to how much rest and support you need, and how much you can push it. IF we rest too much it leads to stiffness and weakness, however if we’re too aggressive we may be going though some unnecessary pain and swelling. I do recommend doing some gentle ankle exercises to start. Even walking around if your symptoms aren’t too bad is helpful according to the research.

Thirdly, a structured rehabilitation program is essential for restoring strength, flexibility, and proprioception to the injured ankle. This typically involves exercises to improve range of motion, strengthen the surrounding muscles, and enhance balance and coordination. The balance and coordination is key. Even if you weren’t someone who struggled with it before an ankle sprain, the sprain has put some stress on the ligaments that help with balance and it’s vital we train it to go back to sport.  As a physical therapist, I tailor these exercises to each individual's specific needs, gradually progressing as tolerance increases to ensure a safe and effective recovery.

In conclusion, recovering from an ankle sprain requires patience, dedication, and proper guidance. By Listening to the body's signals and respecting the healing process, following a structured rehabilitation program, and gradually returning to activity, individuals can not only recover from their injury but also build resilience and prevent future occurrences.

Run longer/faster and with less pain

If you’re an avid runner, you know that your legs can take a beating. The miles of impact can add up. Although running is a skill we’ve been doing for thousands of years, aspects of our modern lifestyle have made it hard for us to develop the fine stabilizing muscles needed for efficient running. In the realm of running, the focus often falls on the legs—strengthening the calves, quads, and hamstrings. However, one critical muscle often overlooked is the glutes. From a physical therapy standpoint, prioritizing glute strength is paramount for runners seeking to improve performance and prevent injury. The gluteal muscles play a pivotal role in stabilizing the pelvis and controlling hip movements during running. Any weakness in the glutes can lead to biomechanical imbalances down the chain causing compensation to the knees, ankles, and low back. This weakness can contributes to issues such as IT band syndrome, patellofemoral pain syndrome, and even lower back pain.

By incorporating targeted glute strengthening exercises into their training regimen, runners can enhance their hip stability, stride efficiency, and overall running mechanics. If you have more muscles working as a team, this not only reduces the risk of overuse injuries but also lets you run faster and longer. So, whether you're a seasoned marathoner or a novice jogger, don't overlook the importance of glute strength in your training routine.

If you are unsure if you have a glute weakness in your running, it’s best to go see your physical therapist for a running analysis. However if you want to get a head start here are some of my favorite glute strengthening exercises.

https://youtube.com/shorts/08en9Adlz7I?si=5qfKlOGbr99rI2_Q

How to pick you physical therapist?

Having a good physical therapist in your corner can change your life, but the field is really new and not all physical therapists are the same. Even the requirements to become a physical therapist in the United States has changed a lot in my lifetime.

For instance, not a lot of people know that some physical therapists have a bachelor degree and some have a doctorate degree. Some do additional training after graduate school (if they went), and some work immediately.

Here are a few different things to consider when selecting your physical therapist.

1. Level of training- Did they just finish school and go straight into the field or decided to residency? Unlike MDs, residency is optional for physical therapists and very few choose to do it. For instance, I chose to do one and less than 10% of my classmates in graduate school did it with me. It makes a big difference if you do one because if you complete one you can be a specialist.

2. Insurance- Sometimes a PT not accepting your insurance, or even taking insurance to begin with may not be a bad thing. Cash based clinics (no insurance) often means you get more time with the therapist and may get better results in less time.

3. Niche- Different clinicians have different niches. For instance, a lot of my clients are stunt performers and martial artists because I happen to be one too. I understand their needs and it makes it easier to treat them. Finding a PT that understands your needs is very helpful to getting great care.

There are few more reasons I outline in this video. Check it out and let me know if there are any other questions I can help you with regards to picking a physical therapist so you can improve your health and performance.

5 things to consider when selecting a physical therapist

3 Mistakes people make when rehabbing an ankle sprain:

1. Not getting on their feet as quickly as possible: Believe it or not after you sprain your ankle it’s a good idea to put some weight on it and walk. Wearing a brace to help support is a good idea too.

2. Not working on balance training: After you irritate a ligament and muscles, they need to be challenged in order to return to the previous function. After an ankle sprain, you really want to work on balance training to get the proprioceptors in the ankle functioning as much as possible.  

3. Not using a brace when going back to training: The research really supports the use of wearing a lace up ankle brace, specially if you’re doing an activity where you’re on your feet and need a lot of agility.

If you suffer an ankle sprain, go get evaluated by a physical therapist so they can help you recover sooner. 

How to be more coordinated?

As a professional stuntman, breakdancer, and martial artists, I’ve spent my life trying to learn how to do weird things with my body. Wether it’s a backflip, spinning on my head, or fighting someone who is 100lbs heavier than me, it’s definitely been years of practice. So how do we get better at skills?

The answer which you can guess is practice. You hear it all the time. “Practice makes perfect”. It’s true except there is a subtle difference that I want to explore more. The challenge is not just practicing, it’s practicing well. What does that mean? I have two important criteria for good practice: First, is the task perfectly hard enough? Second, are you getting feedback?

Let’s break down the first one. I think this is the most challenging aspect of practicing, finding the perfect difficulty. We hear all these motivational speeches about getting outside your comfort zone, failing, get back up and get after it again. Yes that does hold merit but the problem is, if you’re picking up a challenge you’re not ready for, you may be making bad habits, you may get frustrated and give up, or you may even get hurt attempting. Instead we want to find the right level of difficulty. When I was learning how to flip, my coach use to say we want to train in the zone of  “Difficult but possible”. That’s because it requires our attention to focus and sync everything up but it’s not so unreasonable we’re not going to make progress. In my opinion, if you’re attempting something and your success rate is less than 50% per trial, you should make it slightly easier so you can work on building good habits and eventually move onto something harder. Once your success rate is higher, on that task close to 90%, that’s where I would make it a little harder to add more challenge. I think this is a very important nuance that allows us to get more out of each session. If you want to get better at something that seems impossible, try to break the task down to something easier to start, master that fundamental than add a little bit more. I wish someone show’d me this while I was breakdancing and I probably could have avoided a few surgeries and have had a better career.

Once we get the right difficulty, we want to address the second problem. Are we getting feedback? If we want to get better at some skill, we need feedback to tell us if we’re doing it right. At the beginning specially we need lots of external feedback to tell us, but as we get better we can switch to internal feedback (Does this feel good or bad?). If you don’t have a coach to give you that feedback that’s where watching footage of yourself and analyzing it is very helpful. Often times you don’t realize your making mistakes till you see it in third person. However I highly recommend getting a coach or physical therapist to watch you instead. 

I hope this helps you accomplish some skill you’ve been wanting to learn, or maybe something that even hurts and you’re trying to adjust. As always go see a physical therapist to help breakdown any barriers so you can better results, faster.

How to activate muscles?

Certain muscles are notorious for being quiet. It may sound silly but that is actually one of the biggest challenges in rehab. What happens is that being sedentary, injured, or doing the same thing over and over again changes the activation pattern of your muscles. This can cause pain, bad movement leading to injury, or just not letting you progress forward. So how do we fix that? 

Well the first question is: Are we seeing a problem because a muscle is in fact “quiet” or is it because another muscle is being too “loud”? If a muscle is being too loud, that is where hands on techniques such as massage, stretching, deep trigger point pressure and more can quiet it down. I like to utilize this before my own training. If I’m trying to squat but my back muscles are taking over instead of my glutes, I will get on the foam roller and stretch those back muscles out to calm them down. Now I’m ready to fire those glutes up.

If instead the muscle is too quiet this is where activation exercises are great. The best one generally in my opinion are isometrics. That’s a really good place to start but some people respond better to different things which is why having a physical therapist analyze that for you is key. For instance, often times people have this called “glute amnesia” which means forgetting how to use their glutes. It sounds silly but it can lead to so many injuries and dysfunctions that cause pain. Getting people to turn on their glutes take a little bit of finesse because you’re asking someone to change a habit. We know that is not that easy. So I will make sure I position someone where there other muscles are quiet and have them do some basic glute exercises. All the while I’m monitoring that they’re not compensating with their bad habits. Once we dial it down, I want the person to turn on those glutes for so long that it starts to burn. This is so the brain can remember what that feels like. If it’s their first session and they don’t have any competitions coming up, I want those muscles sore so that when they’re walking around, going up stairs, sitting down and standing up, their brain remembers that feeling and they learn how to fire those glutes on command. There are definitely a few more nuances hard to explain on a blog post but if you feel like you need help getting certain muscles fired up so you can train harder or get out of pain, definitely consulting with a physical therapist is a great idea.