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Feldenkrais Method
Ankle Sprains, Biomechanics, Injury, Treatment Strategies

Ankle sprains are one of the most common injuries yet one of the most poorly treated injuries because they are not taken very seriously. Yes, they can heal without much medical attention but they also tend to reoccur and become chronic problems.


First let's look at ankle anatomy. The ankle joint is what is known as a mortise joint. The two lower anklebones form an expandable "mortise" which sits over the spool-shaped head of the talus bone. (See ill. 1, 1.5, 2, 2.5)

Notice as you look at illustration 2 that the front of the talus head is slightly wider than the rear. As the foot is flexed upwards the talus head rolls beneath the mortise. Because the talus is wider in front, the more the foot is drawn up, the more the two anklebones spread. A strong band of fibrous tissue runs between the two bones to keep them together as does the ligaments around the ankle joint. (See ill. 3, 4)

Mechanism of injury

The ankle normally makes a sweeping tipping motion from side to side as well as pointing up and down. The most common ankle sprain is what we call an inversion injury. All it takes to turn the foot inwards (inversion) is to step on and uneven surface suddenly.

If the lateral ligaments (ones on the outside of the ankle) are over-stretched causing micro tears, it is considered a strain or grade 1 sprain. (See ill. 5) There can be moderate tearing of the ligaments called a grade 2 sprain. (See ill. 6) A complete tear or grade 3 sprain is quite serious and could result in the application of a cast.


Ankle sprains, especially first time sprains, should be taken very seriously, because they can lead to chronic instability. I carry Homeopathic Arnica 30c tables with me at all times because if taken within minutes of any injury one can reduce the pain, swelling and bruise that accompanies injury. See link above for precautions.

One should seek immediate medical care following an ankle sprain especially if you hear/feel any noise. X-rays can determine if there is a fracture. If not, then one would follow the rules of PRAICE.

Minor Soft Tissue Injuries should be respected and treated with PRAICE: PROTECTION, REST, ANTI-INFLAMMATORIES, ICE, COMPRESSION, and ELEVATION

PROTECTION: Protect the ankle as long as there is pain or hyper-mobility (excess play in the joint). (See clip 7) Wear a support when you feel a definite injury has occurred and you need stability while walking especially outdoors or on uneven surfaces.

The Aircast does a very good job of stabilizing the ankle while allowing some flexion of the ankle up and down. (See Products) It offers the most stability when worn inside a lace-up shoe (See clip 8). Aircast makes a lighter weight training model that can be worn for sporting activities or when walking on unpredictable ground.

Taping can be done to temporarily stabilize a joint while it is healing, while its being strengthened or prior to a sport to prevent re-injury. Tape helps resist the direction of the injury. Taping should only be done by trained professionals and when swelling is minimal. Some people get an allergic reaction to certain tape adhesives, so a layer of under-tape is used by professionals to avoid skin irritation.

(See these clips for various types of taping: 9, 10, 11)

REST: Use crutches and remain non-weight bearing or partial weight bearing as long as your doctor recommends or until you can put your foot flat and step on your foot with minimal pain. If you have considerable swelling you should be on crutches. Avoid prolonged standing or walking for more than is functionally necessary. Avoid doing more than necessary stair climbing. If you can fit into them, wear supportive shoes to avoid strain on the arches.

ANTI-INFLAMMATORY MEDICINE, either homeopathic or allopathic should be taken to reduce pain and inflammation.

Take the maximum recommended dose and frequency for the most severe injury. Ibuprofen (Motrin, Advil), Naproxin (Aleve) and Aspirin are all anti-inflammatories, but remember they need to be taken with food, plenty of water and may require checking with your doctor to see if there may be contraindications, particularly if you are on other medications, have stomach problems, or are not to take blood thinning medications. These non-steroidal anti-inflammatory medicines are not meant to taken for more than a month. They may in fact have a destructive effect on cartilage if taken long term. Remember Acetaminophen (Tylenol) provides pain-relief and lowers a fever; it doesn't reduce swelling and inflammation.

ICE should be used within the first 24/48 hours and if there is warmth and or swelling. For stationary ice packs, a thin, moist, protective layer against the skin is advisable. This could be a paper towel or bath towel.

Warmth can be used if swelling is gone, 48 hours after pain/strain. (See site for Bed Buddy microwavable moist heat packs.) Thermal therapy may be used for 20 minutes at a time, as frequently as every two hours if needed. Alternating heat 10 minutes with cold 10 minutes is also helpful after the first 48 hours has passed, assuming major swelling minimal.

COMPRESSION: Immediately and especially when swelling is present use a 3" wide Ace wrap. Apply in a figure eight fashion, starting on top of the foot then wrapping first so that the pull under the foot goes from big ball to outside ankle (for lateral sprains). Keep wrapping in a figure eight fashion with each pass of the bandage over-lapping slightly. The wrap should be less tightly wrapped as it goes upward. This provides a slight upward pressure differential to move swelling upwards. Remember, do not wrap too tightly, as circulation may become compromised. Remove and reapply if any discomfort develops, and look for any swelling below the wrap and or redness of the skin as an indication that the wrap is too tight or wrinkled.

ELEVATION: When swelling is present or when pain is felt while the foot is pendent, elevation is helpful. For feet it is sufficient to have the limb horizontal or slightly higher than horizontal. Because veins in the back of the calf, knee and thigh draw venous blood upwards it is important not to have the leg heavily resting on the calf, back of knee or thigh. This can occur on the leg rests of many recliners. A soft pillow under the heel/calf and another under the knee/thigh prevent occlusion of these veins. Be careful not to merely jack up the heel on a surface higher than the knee, leaving the knee unsupported because you can cause hyperextension and strain of the back of the knee.

How long do you elevate? Well try lowering your foot for short time periods and see how it is tolerated. Swelling and pain will help guide you.


Initially after and ankle sprain exercise should be kept to a gentle minimum. Very gentle active upward and downward movements of the foot can be done as long as it is relatively pain free. Avoid turning the ankle into the direction of the inversion sprain. Turning the ankle outward into eversion to activate the peroneal muscles can be done if tolerated. If it is too painful or swollen you can simply do toe clenches. This will at least activate the ankle muscles isometrically.

As pain and swelling are minimal, resisted strengthening of the peroneal muscles can be done with therapy band. (See clip 12).

Stabilizing and proprioceptive retraining can be done with a balance board. (See clip 13, 14) One word of caution, I have seen patients be given exercises on the balance board for stretching purposes. If done too soon or if the mortise is over stretched one can get a rubbing of the talus head on the inside of the anklebone. This can be very painful and other soft tissue work should be done to help the tissue heal before that level of stretching should be tackled, especially with weight on the foot.


  • Avoid walking or running on uneven unpredictable surfaces if you are prone to ankle sprains.

  • Consider wearing an Aircast or having your ankle taped before if you must walk or run on unpredictable surfaces.

  • Wear low-heeled shoes, the higher they are the easier it is to tip.

  • If running wear shoes with a wide flare out heel for greater stability. The narrower the heel they easier it is to tip.

    • Check and replace heels of shoe when worn between 1/8 and 1/4". Otherwise the heel strikes the ground with a ready made inclination to turn.

    • Avoid sitting with feet crossed placing ankles into inversion for prolonged periods. This stretches the outer ankle ligaments and biases them to turn.

    • Have your alignment checked by a NUCCA practitioner. A short leg is more prone to inversion sprains.

    Chronic Instability

    If you are prone to repeated ankle sprains, Prolo (proliferative) Therapy may help you. This involves multiple injections of an irritant into ligaments that help stimulate the formation of new collagen fiber. These injection plus nutritional supplementation help grow new, stronger tissue. The series of injections are generally given about a month apart and may involve 3-6 months of treatment. See link to Dr. Hauser's web site:

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MovementWise Christine Inserra P.T.
Certified Teacher of the Alexander Technique & Feldenkrais Method
Physical Therapy serving Chicago and the Greater Chicagoland Area