Sprained Ankle Physical Therapy and Rehab for Hikers and Backpackers

Sprained Ankle Rehab and Physical Therapy for Hikers and Backpackers

Sprained ankle injuries can take four to eight weeks to heal but it’s important to strengthen your ankle during recovery to prevent a recurrence of the injury. That means engaging in targeted physical therapy exercises that work the ankle from multiple directions using a beginner set of Therabands, household props, and bodyweight exercises. Performing these exercises during your recovery period will make your leg and ankles feel much better day-by-day, increasing your flexibility, balance, and confidence as you regain your ability to walk and hike normally.

If you don’t have easy access to a physical therapist, you don’t have health insurance, or you’re avoiding all but the most necessary medical appointments, here are several very high-quality videos that I’ve been using to rehab my own sprained ankle. These are available on youtube for free and they’re all business without a lot of idiotic chatter. They’re not a substitute for working hands-on with your own physical therapist, which I’d still encourage you to do if you can.

When should you start these exercises? You can start these rehab exercises when you can stand on the sprained ankle without pain. This can take anywhere from 4 days to 14 days, depending on the severity of the sprain and the amount of swelling you’ve experienced. You may still experience some swelling when you start these exercises, but icing the ankle a few times a day can still help, along with rest and elevation.

Don’t let the fact that kids are demonstrating these exercises deter you from using them. Human anatomy doesn’t change with age. They also work. Let these kids inspire you.

Phase 1 Exercises

The Phase 1 exercises are designed to loosen up your muscles, restore the range of motion in the ankle, and help improve your balance. Once the swelling goes down in your ankle, you’ll notice that your calf muscles are still quite tight and impede normal range of motion. Once these loosen up again, you’ll be able to walk normally without a limp or any discomfort. If you want a goal to aim for, run your good ankle through the same exercises as the sprained one during Phase 1, to help you benchmark your progress. I found this particularly helpful in the Ankle 4 way exercise because it helped me see what the normal range of motion is for a  healthy ankle in the same exercises. If you experience pain during these exercises or afterward, it’s ok to back off and take a rest day before taking another crack at them.

Phase 1 Recap:

  • Ice – 10 minutes several times a day
  • Ankle alphabets – repeat 2 times a day
  • Hamstring/calf stretch – hold 30 seconds 3 times
  • Standing gastroch stretch – hold 30 seconds 3 times
  • Soleus stretch – hold 30 seconds 3 times on each side
  • Dorsoflexion on step – 1 set of 30 reps
  • Ankle 4 ways – 3 sets of 10 reps in 4 different directions
  • Towel curls – 3 sets of 10 repetitions
  • Clamshells – 3 sets of 10 repetitions
  • Single leg stance – hold 30 seconds 3 times

You can move to Phase 2 of these exercises when you’re:

  • Pain-free during the Phase 1 exercises
  • Minimal swelling
  • Walking without a cast, boot, or brace if you’ve been prescribed one
  • Ankle range of motion is equivalent to the other side (be patient)

Phase 2 Exercises

The Phase 2 exercises are designed to further strengthen your leg, improve your balance, endurance, and agility. The exercises are more complex and involve the coordination of multiple muscle groups. The requirement movements correspond well to the coordination, strength, and stamina required for hiking and backpacking and are worth doing for both legs not just the one with the sprained ankle.

Phase 2 is a very significant escalation in difficulty from Phase 1, but it’s staged, so you develop strength on easier versions of several exercises before tacking the harder variation. If you find these exercises too challenging or you experience pain during or after doing them, back off and take a rest day. If you don’t feel like you can tackle them all at once, you can increase the difficulty of the Phase 1 exercises by doing more reps and incrementally take on more and more of the Phase 2 exercises. Have some ice handy after you finish your first set of Phase 2 exercises…I certainly needed some.

Phase 2 Recap:

  • Inchworm – 1 set of 5 reps
  • Squat to heel raise – 3 sets of 10 reps
  • Eccentric calf raises – 3 sets of 15 reps; progressing to Single leg calf raises – 3 sets of 15 reps
  • Lateral toe walking – 15 steps right and 15 steps left
  • Lateral heel walking – 15 steps right and 15 steps left
  • Forward lunge – 2 sets of 10 reps on each side
  • Side lunge – 3 sets of 10 reps
  • Double leg jumping; progressing to Single leg jumping (note different reps below)
    • forward and back – 1 set of 20 reps
    • side to side – 1 set of 20 reps
  • Single leg jumping
    • forward and back – 2 sets of 10 reps
    • side to side – 2 sets of 10 reps
  • Y-balance – 1 set of 5 reps

Exercise Props and Form

Form – Focus on improving your range of motion with all these exercises instead of strength, especially during Phase 1, which is the foundation for Phase 2. This will improve noticeably as any residual swelling decreases. When your ankle was more swollen, all of the muscles surrounding the ankle joint were frozen in place to protect the ankle from further harm. Your goal is to retrain them to move and to stretch them out very gradually.

Therabands – It is really worth paying the $15 bucks for a set of beginner Therabands. They help provide resistance through the entire range of motion which is optimal for retaining your ankle and lower leg muscles. The lighter the band color, the less resistance it provides. For example, green has more resistance than yellow.

Dorsiflexion on Step – If you don’t have a suitable step for this exercise, a 30-pack of Pabst Blue Ribbon is the perfect height. You can start drinking the contents when you finish Phase 2. Piling books on the floor can also work but is less stable and not as caloric.

Ankle 4 ways – Prop your calf on an accordion-style foam sleeping pad, if you have one, for these exercises. This will increase the range of motion of your heel more than if it rests on the floor.

The forward and side lunges are tough but get your ankle used to controlled impacts. Try keeping your chest up and torso as vertical as you can when doing them.

The double and single jumps don’t have to be big. Try to keep your landings soft and controlled.

When Can You Resume Hiking?

When can you start hiking again? That’s going to depend a lot on the difficulty of the trails you plan to hike, but common sense dictates that you avoid hiking while there’s still swelling in your ankle. Compare it to your healthy ankle for reference. Ideally, you’ll want to be able to finish all of the Phase 2 exercises without pain before heading out.

When you resume hiking, ramp up very gradually. For example, you might start by walking 1 mile a day on pavement for a week before venturing onto an unpaved trail. Watch for swelling and be prepared to ice your ankle if it recurs.

It will likely take several weeks to build up your lower leg coordination and endurance to what’s was before your injury. I’d recommend wearing a compression sock or ankle brace during this phase of your recovery to help increase blood flow through the ankle and an ankle brace to help prevent a recurrence of the sprain.

How do I know all this stuff? I sprained my ankle and this is the physical therapy routine I used to get back on the trail. It took me 5 weeks before I could hike and it’s going to take a few more weeks of gentler hikes to build my ankle strength up to where I feel confident that I can hike much harder trails.

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7 comments

  1. >When Can You Resume Hiking?

    The day afterward, obviously

  2. Ankle alphabets. I forgot about those. It’s hard to believe it’s been a decade since I was doing them.

    One other piece of advice–although my brother says free advice usually isn’t worth the price:

    DON’T OVERDO IT!

    Your body is recovering from an injury and it will take time. The old bromide, “No pain, no gain” doesn’t necessarily apply. Powering on through pain can exacerbate the injury and set you way back on your rehab. If in PT, listen to the therapist. When I was in rehab for an ACL reconstruction, I was impatient to get back to my activities, so when the therapist told me to do two sets of twenty of some exercise, I’d do three sets of thirty. I ended up with tendinitis, which ended my rehab for a couple months to allow that injury to settle down. Instead of quickly getting back to the athletics I loved, it was a year before I could run again.

    • I’d add, it’s important to do these exercises every day. Especially with the stretches. If you skip a day you go back to the start. You really need to build on the previous days progress.

  3. Philip Henderson

    I a a retired physio and there is one v important thing that gets overlooked in in rehab and exercise in general. quite simply an ankle or muscle group the is painful after a session need the pain to go away before it is exercised again. Exercises therefore need to be done in the body’s recovery time- not necessarily every day or x times per day… I believe in making every exercise session count. it is really easy to overdo things. The body will heal in its own time with a bit of gentle help.. no need to go overboard. I will say that it is necessary to keep up with balance exercises and not assume that an ankle is ‘cured’

  4. I severely sprained my ankle while tripping over something in my home office. My PT told me I’d been better off to have broken it. He explained that the tendons involved are like rubber bands. Once you stretch them to an extreme point, they are never as strong again. I asked, “is this true even a my age (early 70s)”. He said “yes, the bones heal and are just like new.” I do not recall how long it was before I resumed hiking. I know my ankles are not that strong and always wear boots, not hiking shoes like many hikers today.

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