Pilates is a wonderful tool for helping a client who is recovering from an ankle injury, as weight and impact on the ankle joint can be less during Pilates than during many other forms of exercise.
Most of us have rolled an ankle. We trip while walking, running, dancing or playing sports—and often we try to self-diagnose and self-treat with rest, ice, compression and elevation. While this approach may suffice with a very minor injury, a true ankle sprain requires more attention.
Ankle sprains are among the most neglected injuries in the United States, according to the American College of Foot and Ankle Surgeons (ACFAS 2013). Neglecting them leads to ankle instability, chronic sprains and even fractures; what’s more, what we think is a sprain might actually be a fracture. Therefore, if you or a client suffers an ankle sprain, it’s important to consult with a doctor and begin rehabilitation immediately.
Before we address Pilates-related strategies for dealing with ankle sprains, we need to explore the mechanisms of ankle injuries.
Severity of Ankle Sprains
About 85% of ankle injuries are sprains, and 85% of those are lateral-inversion sprains (Balduini & Tetzlaff 1982). An inversion sprain happens when you roll the ankle laterally, stretching or tearing the ligaments on the outside of the ankle.
Ankle sprains have three degrees of severity:
- First degree. Ligaments are stretched but not torn. Common symptoms are mild pain, swelling, stiffness, and difficulty with high-level activities such as running, hopping and jumping.
- Second degree. Ligaments are partially torn; this is the most common level of sprain. Symptoms include significant swelling, bruising, moderate pain, loss of motion, and pain with walking.
- Third degree. Ligaments are torn completely; this is the most serious level of sprain. Common symptoms include severe pain (especially when walking), swelling, joint instability and loss of motion.
Even a first-degree sprain can lead to further complications, so in almost all cases it’s best to consult with a medical professional. Taking this step will also rule out fracture and assist in providing the exercises and strengthening needed to return safely to normal activities. (See the sidebar “Testing for Ankle Strength/Stability” for cases where you are dealing with a client who has not yet sought medical attention for an ankle injury.)
Pilates for Acute and Chronic Ankle Sprains
Pilates can help an ankle sprain whether it’s acute or chronic. An acute sprain is a one-time injury; a chronic sprain persists over a long period of time. Make sure your client gets specific advice from a rehabilitation professional for assistance with exercises and progression of care.
An acute sprain is swollen, painful and stiff, so respect the boundaries of the injury. Initial goals are to reduce swelling and gently increase range of motion, strength and stability. During the first stages of recovery, it is advisable to wear a compression sleeve or tape for stability.
Have the client perform footwork at light resistance on the jump board, as this gives the ankle more stability and foot contact. The jump board also allows you to observe articulation and ROM.
Have the client perform the following exercises (within pain-free ROM):
- Do pliés or squats in parallel, 10x–15x.
- Do relevés or heel raises in parallel, 10x–15x.
- Combine movements: Begin with plié or squat, roll up to ball of foot, straighten knees and lower heel, 10x–15x. Repeat in reverse direction.
Work in parallel until pain has subsided and ROM has improved, and then progress to Pilates-V and/or a second position, repeating the same series as above.
With a chronic sprain, the ankle is stiff and weak. Goals are to continue to increase ROM, strength and balance. At this point, wearing a compression sleeve or tape is not necessary, but it may provide comfort. Have the client do the footwork outlined under “Acute Sprain,” but with heavier resistance, and add the following exercises:
- Perform series for acute sprains (above) on single leg (both involved leg and uninvolved leg).
- If client is pain free and shows good ankle alignment and stability with single leg, then do jump work. Begin with light resistance to decrease impact on foot. Observe articulation of foot with push-off and landing. Client should roll through entire foot.
- Jump in parallel, 10x–20x.
- Jump in Pilates-V, 10x–20x.
- Jump in second position, 10x–20x.
- Progress to single-leg jumps.
- Progress endurance and balance by increasing resistance with jump work and going through jump series with no rest between sets. This challenges ankle stability and endurance. Stop immediately, however, if client fatigues or complains of pain.
Carefully observe patterns and alignment. This is a great way to begin with a client and then progress to standing work or any other useful Pilates exercise.
Testing for Ankle Strength/Stability
Given that many ankle injuries are not followed up by a visit to the doctor, how can we detect a risk of further injury or ankle instability?
Here are two quick tests to assess ankle ROM and balance. Have the client perform these in front of a mirror so you can show how to monitor alignment. Remember, it is not within your scope of practice to diagnose. Don’t hesitate to refer out to a doctor or a physical therapist.
Pli├® or squat. Client stands with feet hip width apart (hips, knees and ankles are stacked on top of each other). Keeping heels on ground and knees pointing forward, she bends as far as she can without pain or discomfort. This maneuver demonstrates active ankle ROM. Observe if the motion is equal (from side to side), painful or stiff.
Single-leg balance. Client stands with hips, knees and ankles stacked. He stands on each leg (uninvolved and involved) separately. This demonstrates ankle stability. Observe posture and alignment, joint mobility, inability to hold balance, or pain.
If these assessments raise concerns, instruct the client to discuss appropriate care with a medical professional.
ACFAS (American College of Foot and Ankle Surgeons). 2013. Foot health for women. www.acfas.org/content.aspx?id=294; retrieved June 12, 2013.
Balduini, F.C., & Tetzlaff, J. 1982 Historical perspectives on injuries of the ligaments of the ankle. Clinics in Sports Medicine, 1 (1), 3–12.
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