What is the recommended home exercise program for a grade 1 ankle sprain (ATFL - Anterior Talofibular Ligament)?

Home Exercise Program for Grade 1 ATFL Ankle Sprain

For a grade 1 anterior talofibular ligament (ATFL) ankle sprain, early initiation of a structured exercise therapy program combined with functional support is strongly recommended as it provides better outcomes for recovery and prevention of recurrent injuries compared to immobilization. 1

Initial Management (Days 1-3)

• Apply PRICE protocol (Protection, Rest, Ice, Compression, Elevation) for the first 72 hours to control pain and swelling 1
• Use NSAIDs or acetaminophen for pain management as both are equally effective for reducing pain and swelling 1
• Apply an ankle brace for functional support rather than rigid immobilization or elastic bandage 1
• Begin early weight-bearing as tolerated with appropriate support 1, 2

Early Phase Exercise Program (Days 3-7)

• Range of motion exercises:

  • Ankle circles: 2 sets of 10 repetitions in each direction 3
  • Ankle alphabet: trace the alphabet with your toes 3
  • Active dorsiflexion and plantarflexion: 3 sets of 10 repetitions 1, 3

• Isometric strengthening:

  • Push foot against immovable object in four directions (dorsiflexion, plantarflexion, inversion, eversion): hold 5 seconds, 10 repetitions each direction 3

Intermediate Phase (Weeks 1-2)

• Progressive strengthening exercises:

  • Towel gathering with toes: 3 sets of 10 repetitions 3
  • Resistance band exercises in all four directions: 3 sets of 10 repetitions 1
  • Heel raises: 3 sets of 10 repetitions 3

• Early proprioceptive training:

  • Single-leg stance on stable surface with eyes open: 30 seconds, 3 repetitions 1
  • Weight shifting in standing position: forward/backward and side-to-side 3

Advanced Phase (Weeks 2-4)

• Progressive proprioceptive exercises:

  • Single-leg stance with eyes closed: 30 seconds, 3 repetitions 1, 3
  • Single-leg stance on unstable surface (foam pad): 30 seconds, 3 repetitions 1, 3
  • Ankle disk/wobble board training: 3 sets of 1 minute 1, 3

• Functional strengthening:

  • Walking on toes and heels: 2 sets of 10 steps each 3
  • Double-leg heel raises progressing to single-leg: 3 sets of 10 repetitions 3, 4
  • Mini squats: 3 sets of 10 repetitions 3

Return to Activity Phase (Weeks 4-6)

• Advanced functional exercises:
  • Hopping in place: 3 sets of 10 repetitions 3, 4
  • Forward/backward and side-to-side hopping: 3 sets of 10 repetitions 3
  • Figure-8 walking/jogging: 3 sets 3, 4
  • Sport-specific drills as appropriate 3

Important Considerations

• Continue using an ankle brace for 4-6 weeks during activities, as this provides better outcomes than elastic bandages 1
• Manual joint mobilization combined with exercise therapy can provide additional benefits for pain reduction and range of motion 1, 5
• Exercise therapy programs should be initiated early as they reduce the risk of recurrent injuries and functional ankle instability 1, 6
• Continue proprioceptive training (especially ankle disk exercises) even after recovery to prevent recurrent sprains 1, 6

Common Pitfalls to Avoid

• Prolonged immobilization (>10 days) leads to poorer outcomes; functional rehabilitation is preferred 1
• Delaying the initiation of therapeutic exercises can lead to prolonged recovery and increased risk of recurrent injury 2, 4
• Using compression bandages alone without proper functional support is less effective 1
• Discontinuing exercises once pain subsides increases risk of recurrent injury; complete the full 4-6 week program 1, 4