HIIT workouts are becoming increasingly popular due to the proposed health benefits (Kuehn, 2019), typically shorter time durations per workout, and its inherent high-intensity nature that keeps it interesting for participants.
Questions related to HIIT workouts that I often hear in the clinic include:
“When can I go back to my HIIT workouts?”
“Am I OK to do a HIIT workout with my injured ankle?”
Specific to an ankle injury, it’s not uncommon for me to hear something along the lines of “Can I do a HIIT workout with a sprained ankle?”
These are all understandable questions, as any ankle injury that affects mobility can result in a decrease in activity, including those that are important for both physical and mental health.
This article will discuss some general strategies to resuming a HIIT workout regime as quickly and safely as possible following a sprained ankle.
When can I go back to HIIT workouts after a sprained ankle?
Given the high-intensity nature of HIIT workouts involving rapid repeated movements, and often, a high rate of loading on the ankles (e.g. impact), it’s important to ensure that you don’t go back to HIIT workouts too quickly with a sprained ankle, especially if you ahve an injured foot as well.
This means ensuring adequate time for ligament healing for the injured foot and ankle before returning to intense exercise, as well as adequate time to rebuild the necessary range of motion, strength, and stability after the ankle injury.
Unfortunately, this may mean an initial period of avoiding HIIT workouts in order to allow the sprained ankle to recover.
What I often tell athletes is that the last thing we want to do is take them out of their sport; however, by coming out of the game and focusing specifically on rehab, we are actually making an investment into faster recovery, earlier return to sport, all while minimizing the chance of turning this into a nagging ankle injury that keeps getting aggravated.
The same can be said for HIIT workouts. If you go back too soon, you may risk further injury to the ankle joint and surrounding soft tissue, which may continue to interfere with your ability to participate in HIIT workouts and other important activities.
By taking an appropriate amount of time off to focus on recovery, you are actually investing in your ability to return sooner with a high level of confidence.
So how do you know when it’s ok to go back to HIIT workouts after a sprained ankle?
Recovery – Phases of Tissue Healing
After an ankle injury, the damaged tissue will progress through different phases of healing. In the case of ankle sprains, this will mainly involve the ligaments that were stretched or damaged, as well as any other structures like muscles, tendons, or bones, that were damaged in the process.
Inflammatory Phase of Healing – Rest and Protection
Inflammation is often seen as a bad thing, but in reality, it’s a necessary process in the early stages of healing. Inflammation is bad when it is excessive, prolonged, or is occurring without any identifiable injury or illness.
In terms of ankle sprains, this can be considered the “clean-up phase”, whereby the body is attempting to eliminate dead or damaged tissue from the injured ankle and provide a clean slate for further tissue healing. The ankle is usually quite grumpy during this time frame, and may appear hot, red, and/or swollen.
The inflammatory phase of healing usually lasts 5-10 days, but may be a little shorter or a little longer depending on the extent of injury.
Therefore, it is advised to avoid HIIT workouts during the early inflammatory phase of healing, as this will continue to aggravate the ankle and prolong this inflammatory phase of healing, which ultimately makes it take a lot longer to heal.
Additionally, the ankle will likely be stiff and weak, which will significantly increase the risk of re-injury, and performance will be affected as well. Not to mention this phase of healing can sometimes be quite painful, and provoking the ankle during this time will increase that pain.
During this phase of recovery, it’s important to rest and protect the ankle to ensure a clean slate for further recovery, and to reduce swelling in the injured ankle.
This may include following the RICE principle for the first few days, followed by very gentle strength and mobility that does not place stress on the injured structures.
Proliferative Phase of Healing – Basic Strength and Mobility
The proliferative phase of healing is characterized by the deposition of new healthy cells in the injured region, basically meaning that the damaged ligaments are now in the active healing phase.
This is also when an ankle sprain typically starts to feel better. There may be a reduction in pain and swelling, and increase in ankle range of motion, and less pain overall. The proliferative phase of healing usually lasts 1-4 weeks.
That said, it’s important to keep in mind that the ankle is still quite limited in the early days of this phase and the injured areas are still very prone to being aggravated or further injured.
Your physical therapist may guide you through various range of motion drills and low-impact exercise that allows you to start regaining your strength and mobility in the ankle, and lower body in general, without compromising the healing ligaments.
This may look like active and passive range of motion exercises within a pain-free range that do not stretch out ligaments that are trying to heal. Additionally, strength exercises will likely be very targeted in order to place an emphasis on the muscles surrounding the ankle joint.
For example, with a lateral ankle sprain, performing ankle eversion with a resistance band is a very common, and typically safe, exercise.
Resisted ankle eversion against a Theraband
The tricky part about this phase of healing is that returning to sport and other activities like HIIT workouts is a big grey area.
Times when it is recommended to avoid returning to HIIT workouts during the proliferative phase of healing include in the early stages when mobility and strength are still very limited, if there is pain with daily activity, and if swelling is still present or easily brought on by activity.
As strength and mobility improves with ankle rehab exercises, pain subsides, and swelling is significantly reduced, it may be suitable to gradually reintroduce lower body components of a HIIT workout and slowly progress to a full workout.
When in doubt, we highly recommend an in-person consult with your local physical therapist to ensure returning to your workouts is appropriate.
As a rough timeline, one systematic review conducted in 2008 determined that it took approximately 6 weeks to a full year for patients with ankle sprains to see an improvement in the passive stability of their ankles as assessed by ligamentous laxity (Hubbard and Hicks-Little, 2008).
There are many limitations associated with that study that lead to that timeline being taken with a grain of salt; however, it does drive home the importance of improving active ankle stability through strength and proprioception while the ligaments continue to heal and you enter the remodelling phase of healing.
Single leg balance exercise on a bosu ball to help restore ankle strength, stability, and proprioception.
It may also be advisable to wear an ankle brace, such as an ASO ankle brace (ankle stabilization orthosis) or other lace-up ankle brace, or at least tape the ankle for additional support, especially when you are first going back to your HIIT workouts or any other workout routine.
While this won’t prevent the risk of aggravating your ankle altogether, it can help to add a little bit of support, which will minimize the risk of re-injury to some degree (van den Bekerom et al, 2013).
Remodelling Phase of Healing – Functional Strength and Mobility
The third and final phase of tissue healing is the remodelling phase. This is when the ankle ligaments can be considered healed, but not necessarily strong or tight.
The ligaments of the ankle will adapt and remodel themselves based on the forces applied to them. This is when it’s really important to consider sport-specific exercises, or workout-specific exercises, to ensure safe and effective return to sport and workouts.
Usually (but not always), this is when people start getting back into their workouts, but are still finishing up their ankle sprain rehab.
For example, assuming that general ankle strength and mobility has been largely restored, many people will return to HIIT workouts after they enter the remodelling phase of tissue healing.
They may have some limitations at first. For instance, they may avoid high-impact components of HIIT workouts, and instead start with high intensity interval training on a stationary bike or with other low-impact activities as they continue to work on their balance and ankle control with high impact activities in a rehab setting.
Also, additional support may continue to be used, such as ankle tape or lace-up ankle braces, and the importance of proper footwear cannot be overstated.
As you continue to progress through your rehab, there will be a shift away from rehab-specific physical therapy exercises with a gradual transition back into full return to HIIT workouts.
With severe ankle sprains or chronic ankle sprains, it will likely be recommended to continue with some form of physical therapy maintenance program focusing on ankle stability and balance, just to ensure you can stick with your workouts and minimize the risk of another ankle injury.
Important Ankle Rehab Consideration for HIIT Workouts
The following are a list of tips and other things to think about when rehabbing a sprained ankle with the goal of returning to HIIT workouts.
– If possible, seek an in-person consult with your local physical therapist to ensure a safe and effective injury recovery process.
– Take your time returning to full intensity HIIT workouts, especially if they involve impact. The more time you spend focusing on ankle rehab, the more likely you are to successfully return to HIIT workouts without any setbacks.
– Let the ankle calm down during the initial phase of healing, especially in the first week after injury. This may include incorporating the RICE principle, which stands for rest, ice, compression, and elevation.
– Don’t overcomplicate things during the early stages of your ankle rehab. Focus on gradual restoration of ankle range of motion, especially ankle dorsiflexion, and non-impact strengthening, such as resistance band exercises.
– Place an emphasis on ankle stability and ankle proprioception throughout the entire rehab process. These may take the form of advanced dynamic balance exercises later in the rehab process. HIIT workouts are intense, and as such, you want your ankle to be able to react and perform the required movements under your body weight with appropriate stability without having to over-think it.
– Don’t be afraid to use additional ankle support, especially as you get back into your workouts. This could be in the form of proper footwear, ankle tape, or lace-up ankle braces (or a combination).
– Assess how your ankle responds to returning to HIIT workouts, both during and after the workout. It may feel fine during your HIIT workout, but if there is delayed soreness and swelling that interferes with the overall function of your ankle, then you know you need more time with rehab, or at the very least, to modify your workouts accordingly to be more friendly on the ankle.
– Place an additional emphasis on warming up prior to your workout, even if it’s general ankle mobility exercises, such as ankle circles, to ensure you don’t surprise the ankle with a maneuver that it cannot withstand.
– Start slow with your first couple workouts after an ankle sprain. Consider this a self assessment for your ankle more than a pure whole-body workout. Worst case, you realize you could have done more, so you do more next workout. This will help avoid setbacks that ultimately delay your return to full HIIT workouts.
Summary
An ankle sprain can severely impact your ability to participate in a full body workout, especially HIIT workouts, and as such, it’s understandable that people want to get back to their HIIT workouts as soon as possible.
In order to ensure quick and safe recovery to a full body workout involving intense exercises, and to minimize the chances of re-injuring the ankle, it’s important to take your time at first and focus purely on physical therapy for the ankle sprain.
Additionally, when returning to HIIT workouts, it’s important to gradually progress back into full workouts and employ a maintenance program for your ankle mobility and stability.
For more individualized advice, we highly recommend consulting with a physical therapist in person, as this will allow you to develop a personalized approach to achieving your rehab goals.
References
Hubbard, T. J., & Hicks-Little, C. A. (2008). Ankle ligament healing after an acute ankle sprain: an evidence-based approach. Journal of athletic training, 43(5), 523-529.
Kuehn, B. M. (2019). Evidence for HIIT benefits in cardiac rehabilitation grow.
Van den Bekerom, M. P., Kerkhoffs, G. M., McCollum, G. A., Calder, J. D., & van Dijk, C. N. (2013). Management of acute lateral ankle ligament injury in the athlete. Knee Surgery, Sports Traumatology, Arthroscopy, 21, 1390-1395.
