When a muscle is overstretched, asked to contract hard against a sudden load, or overused, injury can occur. Small tears in the muscle fibers or the fibers of the tendon that connect the muscle belly to nearby bone are called a muscle strain. An ankle strain involves one of the many muscles and tendons that surround the ankle. These include:

• Fibularis longus and brevis muscles on the outer lower leg and ankle
• Tibialis anterior on the front of the lower leg and ankle
• Gastrocnemius and soleus muscles of the calf
• Flexor hallucis longus muscle
• Tibialis posterior muscle
• Flexor digitorum longus muscle
• Extensor digitorum longus muscle
• Plantaris muscle

HOW DO I KNOW IF IT’S A STRAINED MUSCLE?

Ankle muscle strains and ligament sprains can sometimes feel similar. Nonetheless, when a muscle is strained, you will experience pain in that specific ankle muscle when it is contracted strongly or stretched. Because many of the ankle muscles have long tendons and muscle bellies, an ankle muscle strain can be felt higher up in the lower leg. If the strain is moderate in severity, you may also notice some localized stiffness, tenderness, and swelling. You may also observe that the muscle feels weaker than usual. If the strain is severe, the muscle belly can tear completely or separate from the tendon causing range of motion in the joints at either end of the muscle to be either significantly reduced because of guarding or excessive because the torn muscle is no longer limiting it.

It is important to note that in most cases a muscle that has been severely torn will need surgery to repair the injury so the muscle can function normally again. For less severe injuries, physical therapy is just what the doctor ordered. Not only will your therapist help you identify an injury to the muscle versus the ligaments, for example, but they can guide you through a smart and efficient recovery process.

PHYSICAL THERAPY FOR A STRAINED ANKLE

While mild ankle strains often recover on their own within a couple of weeks, you may choose to see a physical therapist to address a more severe strain or if the symptoms of a mild strain are interfering with your activities. The goals and interventions for rehabilitation of an ankle strain can be broken down into three stages:

Early/acute phase (first 5-7 days):

• Protect the injured muscle to allow healing to begin
• Use bracing, taping, immobilization and assistive devices as needed to normalize your walk and minimize painful motions
• Consider ice, ultrasound or other modalities to manage inflammation and promote healing
• Passive range of motion that is pain-free may be used to prevent stiffness, maintain range of motion and reduce pain
• Exercising nearby but uninjured areas of the body is helpful

• Introduce active range of motion
• Wean off assistive devices, bracing, taping, etc
• Begin submaximal exercise to lightly load the muscle and promote good fiber alignment
• Begin very light stretching as needed
• Apply gentle soft tissue mobilization to promote healing, reduce pain and mobilize edema

Late/chronic phase (21 days to many months)

• Begin loading the muscle more intensively while monitoring for signs of acute regression including lasting soreness or inflammation
• Increase the load on resistance training
• Increase stretching and mobility
• Incorporate more dynamic weight-bearing exercises
• Perform work and sport-specific drills

DON’T GO IT ALONE