Sprained Ankle Not Getting Better?
Addressing multi-year ankle injuries, this case study documents how targeted movement training helps high-intensity physical workers resolve the issue of a sprained ankle not getting better, restoring joint stability and motor function.
【Case Background】
This case involves a male in his early 50s who works as an interior renovation contractor. He sustained a severe ankle sprain years ago. At the time, he felt he could still work, so he didn’t seek dedicated rehabilitation.
Recently, the discomfort has progressively worsened. Whether standing on one leg, standing on both legs, or walking, he experiences persistent discomfort throughout the ankle. He previously consulted an orthopedic physician and had X-rays taken. The evaluation showed no structural abnormalities or fractures, and the physician recommended exercise training to improve ankle stability.
【Movement Screening & Observations】
Inability to Withstand Static Weight-Bearing
Under assessment, the individual experienced discomfort even during simple bilateral standing. This indicates that his ankle struggles to bear his baseline body weight, let alone the high demands of his profession, which involves extensive walking, climbing stairs/ladders, and lifting heavy materials.
While his perseverance in enduring this discomfort for years is admirable, it also means the tissue has undergone chronic adaptations. Continuous intervention and more patience will be required to see meaningful improvement.
Chronic Ankle Instability & Anterior Ankle Impingement
In cases of chronic ankle instability, it is critical to assess for anterior ankle impingement. The most straightforward test is observing a deep squat.
When the ankle ligaments fail to stabilize the joint effectively, the bones cannot glide correctly within the joint capsule, leading to localized compression.
Observations: During a deep squat, he exhibited restricted ankle mobility and noticeable discomfort.
Manual Feedback: When manually guiding the bones into correct alignment , his discomfort temporarily subsided. This strongly points to joint impingement.
Long-term Risk: If left untreated, chronic, repetitive impingement can eventually lead to osteophyte formation (bone spurs), which would require orthopedic surgical intervention.
Weakened Arch and Tibial External Rotation
Further testing revealed that his affected foot had a significantly weak arch. Providing temporary arch support immediately made his ankle feel more comfortable, indicating a clear need for foot arch activation and stabilization exercises.
Additionally, both of his tibias exhibited habitual external rotation. These are overall alignment issues that can be optimized through corrective exercise.
Note: Given his demanding work schedule, progress might be slightly slower than average. Heavy labor places constant stress on the ankle, which can interfere with tissue recovery.
【Movement Training Progression Notes】
Short-Term Goal: Alleviate Baseline Discomfort
To accelerate recovery, we suggested collaborating with a physician for prolotherapy if needed. Prior to exercise training, we implemented lower-extremity postural corrections and kinesiology taping to bring the ankle closer to a neutral alignment. Re-centering the joint first makes subsequent training much more efficient.
Early training focused primarily on ankle strength and proprioception, paired with consistent homework exercises. The routine included various balance and single-leg control drills designed to progressively restore functional capacity. The overarching objective was to enhance muscle function and motor control to compensate for the compromised, overstretched ligaments.
Mid-to-Long-Term Progress: Rebuilding Function
At 1 Month: After a month of diligent training, he experienced no noticeable discomfort during deep squats. He was able to manage his daily workload without major issues, though intense, long days still caused mild fatigue. Encouraged by his progress, he chose to continue training to build higher physical resilience.
At 3 Months: We progressed to agility and plyometric drills. At this stage, he could work full days without any ankle swelling or post-work throbbing. Most importantly, he successfully returned to his weekend hobby of recreational cycling.
His rate of improvement far exceeded expectations! This success is largely attributed to his active participation in medical treatments and strict compliance with the training regimen.
Ultimately, we achieved the long-term goal: fully restoring both his work capacity and his favorite weekend recreational habits.
Note from the Author:
This category features “Training Case” documenting the process of clients progressively optimizing their physical functions through systematic training under professional athletic training guidance.“Train after injury.” While many believe that rest is the only option after an injury, true recovery often requires rebuilding motor control and strength under appropriate loading.
This involves more than just movement optimization and strategies for balancing muscle groups; it is about preparing the body to handle higher-intensity challenges and returning to the sports and lifestyle you love.
These case studies are intended to share training perspectives and do not function as medical diagnosis, treatment, or clinical prescriptions.
Training results vary depending on individual participation frequency, physical baseline, and recovery status; please do not attempt to replicate movements without a professional assessment.
If you experience acute pain or have concerns regarding an injury, please consult your primary physician for a medical diagnosis.
This article was originally composed in Chinese and translated to share these clinical insights with the global athletic training community. Our goal is to bridge the gap between movement science and practical application across languages.
About the Author｜Andy Hsu, MS, Athletic Trainer
Train Smarter After Injury.
Precision Movement Optimization & Return to Play (RTP)
- Former Athletic Trainer, Landseed Sports Medicine Center
- Former Athletic Trainer, National Sports Training Center (Taiwan)
- Former Athletic Trainer for National Teams (Table Tennis, Volleyball)