Specialista in Ortopedia Pediatrica
Ankle sprain (rehabilitation)
Home Exercise Program
Not every exercise listed here is suitable for every child: the selection is individual and is defined during the consultation.
1.Early mobility (alphabet)
INITIAL NON-WEIGHT BEARING PHASE - Start as soon as acute pain allows
As soon as acute pain subsides (usually 2-3 days after injury): seated with raised foot, "write" alphabet letters with toe tip. This moves ankle in all directions without loading. Small controlled movements, never painful.
Complete alphabet, 2-3 times daily
2.Active mobility (flexion/extension)
NON-WEIGHT BEARING - Recover ankle range of motion
Seated with leg extended. Actively move foot up (dorsiflexion) and down (plantarflexion) without forcing. Try to gradually increase range of motion. Add inversion/eversion movements (rotate foot in/out). All movements should be pain-free.
15-20 reps each direction, 3-4 times daily
3.Band strengthening (4 directions)
NON-WEIGHT BEARING - Progressive strengthening seated, especially eversion
Seated with band around foot. DORSIFLEXION: pull foot up. PLANTARFLEXION: push down. INVERSION: rotate inward (caution, this is the injury movement!). EVERSION: rotate outward - this is most important to strengthen as peroneal muscles protect from future sprains. Start with light band.
3 × 15 each direction. Emphasis on EVERSION
4.Peroneal strengthening (band eversion)
NON-WEIGHT BEARING - Key exercise to prevent recurrence
Seated, band fixed to external lateral point (table leg). Wrap band around forefoot. Starting from inversion, push foot outward (eversion) against resistance. Control return phase. Peroneal muscles are main lateral stabilizers of ankle.
3 × 15-20 reps per foot
5.Calf stretch (standing)
PARTIAL WEIGHT BEARING - Recover flexibility after first days
Facing wall, injured leg behind with heel on ground. Push hips forward keeping knee straight (gastrocnemius), then slightly bent (soleus). Start with light stretches and increase gradually. NEVER force in early phase.
3 × 30 seconds per position, twice daily
6.Progressive calf raises
PROGRESSIVE LOADING - Calf and ankle strengthening
PHASE 1: Calf raises with both feet, feet parallel. PHASE 2: Calf raises with more weight on injured leg. PHASE 3: Single-leg calf raises (injured leg only). PHASE 4: Single-leg calf raises on step edge. Each phase must be pain-free before progressing.
3 × 15 reps, progressing phase every 1-2 weeks
7.Proprioception (progressive balance)
WEIGHT BEARING - ESSENTIAL to prevent recurrence
After sprain, proprioception (position sense) is often compromised. PROGRESSION: Level 1 - single-leg balance, hard floor, eyes open, near support. Level 2 - eyes closed. Level 3 - cushion/wobble board, eyes open. Level 4 - cushion, eyes closed. Progress only when stable for 30 seconds.
3 × 30 seconds per level, progressing gradually
8.Balance board training (wobble board)
ADVANCED WEIGHT BEARING - Exercise for complete stability recovery
On wobble board, maintain balance trying to keep board parallel to floor. PROGRESSION: 1) Two feet, with support. 2) Two feet, no support. 3) Two feet, controlled movement. 4) Single leg. Always have support nearby for safety.
3-5 minutes, 1-2 times daily
9.Light hopping and plyometrics
ADVANCED PHASE - Preparation for return to dynamic activities
ONLY when balance and strength are almost fully recovered. Start with light two-foot hops, then single leg. Lateral hops. Hops on soft surfaces. Each progression must be pain-free and without feeling of instability.
2-3 sets of 10-15 hops, progressing gradually
10.Running with direction changes
PRE-SPORT PHASE - Before return to sport
ONLY when all previous exercises are completed pain-free. Light straight running → jogging with wide turns → tight turns → zig-zag → sudden direction changes. If pain or instability returns, step back in program.
Gradual progression over 1-2 weeks before return to sport11.Sport-specific exercises
FINAL PHASE - Last step before full return to sport
Practice sport-specific movements: for soccer, dribbling and shots; for basketball, stops and starts; for volleyball, jumps and landings. Start at 50% normal intensity, then 75%, finally 100%. Return to competition must be gradual.
Gradual plan to agree with specialist
RED FLAGS - When to stop and contact the doctor immediately
Stop the exercises immediately and contact the specialist (or go to the emergency department if severe) if any of the following occur:
- Acute or sudden pain during exercise
- Significant swelling after exercises
- Pain that progressively worsens over days
- Fever or general malaise
- Difficulty walking or using the limb after exercises
- Any neurological symptoms (tingling, numbness, sudden weakness)
- Fever, redness or warmth of the joint, or inability to bear weight
In case of doubt, always prefer a check-up over continuing the exercises.
Dott. Daniele Priano
Ortopedia Pediatrica - ASST Gaetano Pini-CTO
ortopediaevolutiva.com • 26/08/2026
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MioDottoreBefore You Start
Who is this guide for?
Adolescents recovering from ankle sprain, after the acute phase. Proprioception exercises are key to preventing recurrence.
What you need
Clear floor space, mat or soft surface, comfortable clothing. Some exercises may require resistance bands or supports.
Suggested frequency
Start gradually, increasing frequency and intensity. After acute phase: 1-2 times daily.
Common mistakes to avoid
- •Performing exercises too quickly without control
- •Pushing beyond the pain threshold
- •Skipping days or doing occasional very long sessions
- •Not warming up before strengthening exercises
⚠️ Red flags — when to stop and contact the doctor immediately
Stop exercises immediately and contact the specialist if any of the following occur:
- Acute or sudden pain during exercise
- Significant swelling after exercises
- Pain that progressively worsens over days
- Fever or general malaise
- Difficulty walking or using the limb after exercises
- Any neurological symptoms (tingling, numbness, sudden weakness)
Detailed Exercises
- 1
Early mobility (alphabet)
INITIAL NON-WEIGHT BEARING PHASE - Start as soon as acute pain allows
As soon as acute pain subsides (usually 2-3 days after injury): seated with raised foot, "write" alphabet letters with toe tip. This moves ankle in all directions without loading. Small controlled movements, never painful.
Complete alphabet, 2-3 times daily - 2
Active mobility (flexion/extension)
NON-WEIGHT BEARING - Recover ankle range of motion
Seated with leg extended. Actively move foot up (dorsiflexion) and down (plantarflexion) without forcing. Try to gradually increase range of motion. Add inversion/eversion movements (rotate foot in/out). All movements should be pain-free.
15-20 reps each direction, 3-4 times daily - 3
Band strengthening (4 directions)
NON-WEIGHT BEARING - Progressive strengthening seated, especially eversion
Seated with band around foot. DORSIFLEXION: pull foot up. PLANTARFLEXION: push down. INVERSION: rotate inward (caution, this is the injury movement!). EVERSION: rotate outward - this is most important to strengthen as peroneal muscles protect from future sprains. Start with light band.
3 × 15 each direction. Emphasis on EVERSION - 4
Peroneal strengthening (band eversion)
NON-WEIGHT BEARING - Key exercise to prevent recurrence
Seated, band fixed to external lateral point (table leg). Wrap band around forefoot. Starting from inversion, push foot outward (eversion) against resistance. Control return phase. Peroneal muscles are main lateral stabilizers of ankle.
3 × 15-20 reps per foot - 5
Calf stretch (standing)
PARTIAL WEIGHT BEARING - Recover flexibility after first days
Facing wall, injured leg behind with heel on ground. Push hips forward keeping knee straight (gastrocnemius), then slightly bent (soleus). Start with light stretches and increase gradually. NEVER force in early phase.
3 × 30 seconds per position, twice daily - 6
Progressive calf raises
PROGRESSIVE LOADING - Calf and ankle strengthening
PHASE 1: Calf raises with both feet, feet parallel. PHASE 2: Calf raises with more weight on injured leg. PHASE 3: Single-leg calf raises (injured leg only). PHASE 4: Single-leg calf raises on step edge. Each phase must be pain-free before progressing.
3 × 15 reps, progressing phase every 1-2 weeks - 7
Proprioception (progressive balance)
WEIGHT BEARING - ESSENTIAL to prevent recurrence
After sprain, proprioception (position sense) is often compromised. PROGRESSION: Level 1 - single-leg balance, hard floor, eyes open, near support. Level 2 - eyes closed. Level 3 - cushion/wobble board, eyes open. Level 4 - cushion, eyes closed. Progress only when stable for 30 seconds.
3 × 30 seconds per level, progressing gradually - 8
Balance board training (wobble board)
ADVANCED WEIGHT BEARING - Exercise for complete stability recovery
On wobble board, maintain balance trying to keep board parallel to floor. PROGRESSION: 1) Two feet, with support. 2) Two feet, no support. 3) Two feet, controlled movement. 4) Single leg. Always have support nearby for safety.
3-5 minutes, 1-2 times daily - 9
Light hopping and plyometrics
ADVANCED PHASE - Preparation for return to dynamic activities
ONLY when balance and strength are almost fully recovered. Start with light two-foot hops, then single leg. Lateral hops. Hops on soft surfaces. Each progression must be pain-free and without feeling of instability.
2-3 sets of 10-15 hops, progressing gradually - 10
Running with direction changes
PRE-SPORT PHASE - Before return to sport
ONLY when all previous exercises are completed pain-free. Light straight running → jogging with wide turns → tight turns → zig-zag → sudden direction changes. If pain or instability returns, step back in program.
Gradual progression over 1-2 weeks before return to sport - 11
Sport-specific exercises
FINAL PHASE - Last step before full return to sport
Practice sport-specific movements: for soccer, dribbling and shots; for basketball, stops and starts; for volleyball, jumps and landings. Start at 50% normal intensity, then 75%, finally 100%. Return to competition must be gradual.
Gradual plan to agree with specialist
Frequently Asked Questions
When can I return to sports after an ankle sprain?
Return to sport depends on sprain severity. Generally: grade 1 (mild) after 2-3 weeks, grade 2 (moderate) after 4-6 weeks, grade 3 (severe) after 6-12 weeks. The main criterion is functional stability: stable single-leg balance, pain-free running, safe jumping.
How to prevent ankle sprain recurrence?
Proprioception is key: single-leg balance on unstable surfaces, peroneal muscle strengthening with bands, and reactivity training. A proprioceptive exercise program reduces recurrence risk by up to 50%. Braces or taping may be useful in the initial return-to-sport phase.
Is an X-ray needed after an ankle sprain?
Not always. The "Ottawa Rules" guide the decision: X-ray is indicated if there's specific bone tenderness over malleoli or base of 5th metatarsal, or if the child can't take 4 steps. In children it's important to rule out growth plate injuries.