Ankle Injury Rehab & Prehab Guide
- Mikayla Mantouroglou
- Jun 25
- 4 min read
Ankle injuries are one of the most common setbacks in both recreational and elite athletes. Whether you're coming back from an injury or trying to prevent one, understanding the mechanism, risk factors, and appropriate rehabilitation strategies is key to long-term joint health and performance.
Understanding the Mechanism of Injury
Understanding how ankle injuries happen is the first step in preventing and treating them effectively. These injuries are typically caused by either external contact or non-contact movements that place excessive stress on the ankle.
Contact Injuries
These result from an external force impacting the ankle and are especially common in team sports. The most frequent scenarios include player collisions or landing awkwardly after a jump.
Result from external force (e.g. collision with another player, stepping on another foot).
Common in tackles or landing on uneven surfaces during jumps.
Typically associated with lateral ankle sprains or more severe ligament disruption.
Non-contact Injuries
These happen without any external contact and often stem from internal deficits in control or technique. They are just as prevalent and usually more preventable through proper neuromuscular training.m
Occur during high-velocity direction changes, poor landing mechanics, or fatigue-induced control loss.
Often linked to deficits in proprioception, neuromuscular control, or previous ankle injury.
Common mechanisms include:
Sudden deceleration or cutting
Inversion with plantarflexion
Poor landing biomechanics from a jump
Risk Factors
Risk factors for ankle injuries can come from within the body or from the surrounding environment. Identifying these can significantly reduce injury incidence through tailored interventions.
Intrinsic Risk Factors
These originate within the body and reflect biomechanical, neuromuscular, and anatomical characteristics. Many of these can be improved with targeted exercise and rehab.
History of prior ankle injury (especially if not fully rehabilitated)
Poor proprioception and balance
Muscle imbalances (e.g. weak peroneals, glutes)
Limited ankle dorsiflexion range of motion
Reduced neuromuscular control and coordination
Foot posture abnormalities (e.g. pes cavus or planus)
Extrinsic Risk Factors
External conditions like surface, equipment, and gameplay intensity can elevate injury risk. Awareness and proper preparation can mitigate many of these variables.
Inadequate warm-up or conditioning
Playing surface irregularities (wet, uneven)
Improper footwear (playing on grass versus synthetic and ensuring you have the correct boots)
Fatigue (mental or physical)
Game scenario (e.g. during aerial duels or rapid transitions)
Functional Outcome Measures
Objective measures are essential for tracking rehab progress and informing safe return-to-play decisions. These tests evaluate range of motion, balance, strength, and neuromotor function.
KTW (Knee to Wall Test)
A reliable measure of ankle dorsiflexion, which is critical for running, jumping, and deceleration. Side-to-side differences may indicate lingering deficits.
Assess ankle dorsiflexion range and side-to-side asymmetry.
SLCR (Single Leg Calf Raise)
Calf endurance and strength are vital for sprinting and agility. This test ensures both limbs can withstand repeated load.
Goal: Measure calf endurance—target >25 reps on injured side for return to sport.
SL Balance
Assessing single-leg balance helps detect deficits in proprioception and postural control, particularly important for athletes in dynamic sports.
Eyes open and closed on stable and unstable surfaces.
Vestibular Tests
These assess integration of the visual and vestibular systems, crucial for maintaining balance when the head is moving—key in reactive gameplay.
Head turns during balance tasks to assess VOR (Vestibulo-Ocular Reflex).
Side Hop Test
Evaluates lateral agility, coordination, and reactivity—key elements for direction change and lateral movements in sport.
Lateral hop for speed & control. Compare time and number of faults with the uninjured side.
Prehab & Strengthening Exercises
Effective ankle rehab and prehab focus on building resilience in the muscles, joints, and neuromuscular systems. The following exercises are evidence-based and target common deficits post-injury.
Single Leg Calf Raise
Builds plantarflexor strength and symmetry across limbs. Emphasizing both eccentric and concentric phases supports tendon health and force production.
Eccentric & concentric focus. Aim for endurance and strength symmetry.
Wall Marches
Reinforces ankle stiffness and running mechanics while integrating core control.
Improve ankle stiffness, coordination, and running form control.
Hop & Catch Drills
Promote dynamic stability and reactive control—essential for preventing recurrence during gameplay.
Encourage reactive balance and dynamic stability.
SL RDL into A-Frame Hold
A compound movement that integrates hip hinge mechanics, single-leg balance, and proprioceptive awareness.
Combines hip hinge control, proprioception, and ankle co-contraction.
Pogos (Stiff Jumps)
Designed to increase plyometric capacity and lower-limb tendon resilience for dynamic tasks like sprinting and jumping.
Focus on reactive stiffness and plyometric conditioning.
Banded Crab Walks (Stiff & Bent Calf Raise Variations)
Target hip abductors and foot-ankle co-contractions, which improve control during lateral movements.
Glute medius activation with ankle co-contraction.
Toe Yoga
Strengthens intrinsic foot muscles and enhances arch support, vital for balance and shock absorption.
Improve intrinsic foot muscle control and arch support.
Taping Guidelines
Taping provides temporary support during return-to-play and high-risk scenarios. It helps protect healing tissues and improve joint awareness, but should not replace strengthening work.
Use tape when:
Athletes are returning to play post-injury, during periods of high exposure, or for specific joint pathologies that need external reinforcement.
Taping Techniques
Different taping techniques are designed to address specific structures and types of injuries. The choice of technique should be guided by clinical assessment and, when relevant, the demands of the individual’s activity or sport. Depending on the goal, whether it’s support, stability, or facilitating movement, different types of tape may be used, ranging from rigid sports tape to kinesiology (K-tape).
How Physiotherapy Can Help
Ankle rehab isn't just about exercises; it's about the right exercises at the right time, with expert guidance tailored to your sport, lifestyle, and recovery needs.
Our physiotherapist is highly trained in identifying and addressing the underlying causes of your ankle pain or dysfunction.
We can assist you with:
Comprehensive assessments to identify the root cause and severity of your ankle issue.
Developing an individualised, evidence-based rehab plan from acute care through to return-to-sport.
Manual therapy, taping techniques, joint mobilisation, and load management strategies.
Guiding you through every phase of recovery—from pain relief to performance.
Implementing functional tests to track progress and reduce reinjury risk.
If your goal is to enhance performance or rebuild strength and confidence after rehab, we may also recommend working with our Exercise Physiologist to continue structured strength and movement conditioning, especially for those recovering from chronic instability or previous injuries.
Don't leave your recovery to chance. Early, professional intervention is key to a successful outcome.
Comments