Returning to Rock Climbing After an Ankle Sprain

Introduction

Ankle sprains are unfortunately a fairly common injury that we see in rock climbers. This can occur due to problematic landings while bouldering, big whippers while sport climbing, or awkward steps on the trail during the approach. A lot of times, it may seem like these injuries will heal up on their own with some rest. Although there is some truth to this, the risk of re-injury after sustaining an ankle sprain is huge, so doing some rehab and preventative exercises is essential! 

Understanding the Injury

The most common ankle sprain is a lateral ankle sprain. This typically involves your anterior talofibular ligament (ATFL) in most cases, with some also involving your calcaneofibular ligament (CFL) and posterior tibiofibular ligament (PTFL). Severity of an ankle sprain can range from grade 1 to grade 3. Grade 1 involves just the ATFL, and the ligament is just stretched/strained. You are typically able to walk without much, if any, assistance, and swelling and bruising are minimal. Grade 2 involves the ATFL and CFL, and partial tearing of the ligament occurs, and weight bearing without crutches tends to be difficult. Grade 3 involves the ATFL, CFL, and PTFL, and there is complete tearing of one or more of these ligaments. Walking without assistance is impossible without significant pain, and there is extreme and diffuse swelling and bruising. 

Symptoms include (but are not limited to):

• Pain and tenderness on the outside of the ankle

• Swelling and bruising along the ankle and into the foot

• Limited ankle range of motion

• Weakness

If you are unable to bear weight on the ankle and walk, you should seek immediate care to rule out a fracture.

Recovery can range from a few days to a few months, depending on severity and how well you can rest and keep weight off of the ankle initially.

Early Stage: Rest and Protection

Initial rehab should focus on rest and swelling management. If there is no concern for a fracture, gentle active range of motion to help facilitate circulation, manage swelling, and maintain mobility is encouraged. If you feel you can walk normally without limping, then easy walking is also encouraged. 

During this time, climbing should be put on hold, but upper body strength workouts and hang boarding are encouraged.

This stage typically just lasts 5 days up to 2 weeks. 

Hang boarding while in a walking boot

Mid Stage: Restore Mobility & Strength

Once swelling has improved and you can walk normally, this is the time to start focusing on restoring mobility, strength, and proprioception, Initial exercises can include single leg balance, calf stretches, banded ankle exercises, and calf raises.

Easy climbing can be initiated at this stage, as long as falling is avoided. Be careful with moves that involve drop knees and high steps, as this can place excess stress on the joint. Also, during this time crack climbing should be avoided as to not stress the lateral ankle. 

As this stage progresses, you can begin to work on light footwork drills on the wall as pain allows. This stage tends to last about 2-6 weeks. 

Mobilization example to improve dorsiflexion range of motion

Late Stage: Climb-Specific Rehab

The goals prior to transitioning back to “normal” activity and taking falls with climbing are to normalize your dorsiflexion range of motion as well as your calf and peroneal strength. Your physical therapist can help guide you through this process.

As you ramp back into normal climbing and falling, using supportive tape for the ankle or a brace can be indicated to help minimize risk of recurrent injury. This can also be helpful on approaches if you are climbing outside, as we see a lot of ankle sprains happen on the trails as well.

Make sure you are practicing and working on falling and jumping in a controlled environment before getting back to it on the climbing wall. You should feel confident jumping on a single leg side to side, with rotation, and forward and backward before taking uncontrolled falls, especially bouldering.

Example of late stage plyometric exercises

Long-Term Injury Prevention

As initially mentioned, once you have sustained an ankle sprain, your risk of developing chronic ankle instability and/or having recurrent ankle sprains increases drastically. You can work to decrease these risks by maintaining ankle strength and working on things like balance and single leg impact. In addition, utilizing taping and bracing in situations where the ankle could be more susceptible to injury can be useful. 

There are numerous other things that can be addressed based on your specific presentation that can help decrease risk of recurrent problems. These can include working on intrinsic strength of the foot, hip strength and stability, and footwear modifications, to name a few. Working with a physical therapist skilled in gait analysis and functional testing can help to create your own specific plan to maintain strength and minimize risk of injury moving forward. At The Climb Clinic, we see this injury frequently and would love to help get you back to climbing at 100% after an ankle sprain!