Spring back from an ankle sprain

Stay off the sidelines and in the game. Our espnW physical therapists dish out cutting edge advice for avoiding (and quickly rehabbing) common sports-related injuries.

The injury: Ankle sprain. We've all been there. Whether we're teetering about in heels higher than our coordination level, cutting too quick on the court, or touching down on uneven ground, in the blink of an eye, you can roll your ankle and overstretch (or even tear) one of the ligaments. The most common type of ankle injury is an inversion sprain where the ankle turns over so the sole of the foot faces inward, damaging the lateral ligaments. Generally the talofibular ligament (which connects the ankle bone to the fibula, the smaller lower leg bone) bears the brunt of the roll, though a bad enough twist can also torch the calcaneofibular ligament (which connects the heel bone to the fibula).

What it really feels like: It depends how bad you twisted it. Ankle sprains are categorized into three grades. Grade I is mild; you may feel the sudden sharp pain on impact, but be able to walk without pain or limping a few minutes later. Grade III is a game ender -- any pressure on the foot sends lightning bolts through your lower leg. Grade II falls somewhere in between.

"You can manage most minor sprains [the kind you can basically 'walk off'] on your own with rest and ice," said ESPN injury analyst Stephania Bell, PT. "But if you absolutely can't put weight on it, get it checked out by a professional." Other signs and symptoms of ankle sprain include swelling, a popping sound during the injury, bruising and difficulty moving your ankle. In more severe sprains, your ankle might also feel wobbly and unstable.

Who's been there: X Gamers are especially at risk for ankle sprains. Skateboarding legend Tony Hawk has sprained his ankle too many times to count, four times so badly he couldn't walk. Last year the Flying Tomato, Shaun White rolled an ankle while training and had to sit out the Skate Open I.S.F Skateboarding World Championships in Boston.

Don't feel their pain: The usual RICE rules apply to ankle sprains. Get off your feet as much as possible. Ice the injury for 20 minutes at a time three to four times a day within the first 12 to 36 hours, wrap your ankle in an ACE bandage and elevate it so gravity helps pull fluid from the injured area. All this will help keep swelling down and speed the healing process.

Wrap and rest the ankle, but don't immobilize it, adds Bell. Every couple of hours do ankle pumps, flexing and extending your foot up and down 15 to 20 times. Then do ankle rolls, 10 clockwise and 10 counterclockwise. Finish by writing the alphabet in the air with your big toe. "You want to maintain as much range of motion as possible as soon as possible, letting pain be your guide," Bell said. "These exercises pump the waste out of the injured area and can accelerate the healing process."

Keep it from becoming chronic: Spraining your ankle (especially if it's bad), puts you at risk for spraining it again. The main culprit behind chronic sprains: damaged proprioceptors, Bell said.

"Proprioceptors are specialized nerve endings in your muscles, tendons and joints that control your balance and sense of position," she said. When your proprioceptors are functioning properly, they sense when your ankle is about to roll and send messages to your tendons and muscles to fire and correct your positioning. If they get damaged in an injury, like an ankle sprain, they often don't come back 100 percent, which hinders your ability to detect and avoid future ankle rolls.

The key to more stable ankles is strength and balance exercise, Bell said. Do two to three sets of these three times a week (remember to work both legs; not just the injured one).

Resistance band pulls: Wrap a resistance band around the ball of your foot and hold the band taut. Slowly press down, pointing your toes and return to start. Repeat 15 times. Then hold the band at the inside of your foot and pull your foot out to the side and return to start. Repeat 15 times.

Towel scrunch: Sit in a chair, feet flat on the floor with a towel under your right foot. Keeping the heel planted on the floor, try to pick up the towel by scrunching it with your toes. Repeat 15 times; switch feet.

Calf raises: Stand on the edge of a step with your heels hanging off. Bend the left knee and hold on the banister for balance. Slowly rise up on your right toes. Then lower back down so the heel is below the step, but not stretched. Repeat 15 times; switch feet.

Heel-toe walking: Walk heel to toe following a straight line across the room. Then return backwards. Repeat three times.

Single leg stand: Stand barefoot and lift your left leg, balancing on the right as long as you can, working up to a minute. (Do this with both legs.) Once you can balance for 60 seconds, try it on a pillow, sofa cushion or BOSU if you have access to one. Work up to one minute per side.

* This does not substitute for medical advice.