A sprained ankle is one of the most common injuries in sports as well as everyday life. That said, a sprained ankle shouldn’t be taken lightly, as this sort of injury can definitely interfere with your ability to participate in activities you enjoy, as well as general daily tasks.
Ankle sprains can also have a detrimental affect on overall cardiovascular fitness (Hubbard-Turner et al, 2021), and as such, one of the most common questions I receive in the clinic when treating people with sprained ankles is “How can I keep up my cardio while rehabbing my sprained ankle?”.
This article will discuss some general strategies to help answer that question, with some things to consider for each type of cardio exercise. Keep in mind that it’s always best to visit your local physical therapist for individualized advice to ensure safe and suitable cardio exercises for your phase of rehab.
What type of cardio to avoid with a sprained ankle?
It’s important that we first touch on some safety considerations to minimize the risk of setbacks with your ankle injury. These are important considerations, as delayed recovery from your sprained ankle can keep you out of the activities you enjoy for much longer.
It is typically advised to avoid high impact activities with any ankle injury until that style of exercise is resumed in your physical therapy rehab.
These types of exercises include jogging, sprinting, and jumping. If there is any form of damage to the bone, avoiding impact is imperative to avoid further injury and allow the ankle to recover appropriately without delaying the healing process.
Additionally, after an any form of ankle injury, there will be an associated reduction in ankle mobility, strength, and proprioception.
In terms of stiffness, a stiff ankle won’t be able to accommodate the motion required to efficiently avoid forces going through the ankle joint.
On top of being more stressful on the joint itself, this means the ligaments, tendons, and muscles surrounding the joint will also be taking up a lot more of the force, and given these structures are already injured to some degree, they are much more susceptible to further injury.
In terms of strength, the muscles and their associated tendons are the first line of defence when it comes to avoiding an ankle sprain.
If the muscles surrounding the ankle joint are at all dysfunctional, this again leads to an increased risk of injury with activities that place a high level of demand on the ankle joint.
Restoring ankle strength is a central component in physical therapy for sprained ankles. This usually begins with band exercises, and as boring as they are, they offer an effective way to improve ankle strength while still allowing the ankle to heal.
Eventually, strength exercises may blend into your typical weight lifting workout, but this usually isn’t until the later stages of rehab. This is part of the reason why restoring some form of ankle strength is important prior to initiating lower body cardio exercises that involve being on your feet.
Lastly, proprioception refers to joint position awareness, and is highly involved with balance and reactive control. With ankle injuries, especially sprained ankles when swelling or deconditioning is involved, proprioception will also be highly affected (Schiftan et al, 2015), meaning your control and reaction to unstable conditions will be reduced.
Therefore, with participating in a high impact exercise with an ankle injury is much more risky when ankle proprioception is reduced, as well as when pure ankle strength and mobility is reduced, which is why your physical therapist may advise to work on ankle proprioception exercises before getting back into your usual cardio exercises.
What are good cardio exercises with a sprained ankle?
It’s difficult to say exactly what cardio exercises are best for sprained ankles, as this will depend on the severity of the ankle injury, the structures involved, how far along in your recovery you are, and the degree of ankle pain that you are experiencing.
Nevertheless, the following exercises are typically safe at some point in your recovery, and we will touch on some safety considerations for each exercise.
The stationary bike (upright bike or recumbent bike) is typically a great way to keep up your cardio while still using the muscles in your legs. Given this is a low impact exercise, more often than not, this is a safe activity, but there are a couple things to keep in mind.
First, if you are dealing with a very acute injury that involves lots of pain, swelling, and inflammation, then rest is best, even when the stationary bike doesn’t involve impact.
This is because even mildly stressing the joint, muscles, tendons, and ligaments immediately after an injury can lead to more damage and/or prolonged or increased inflammation, and as a result, delayed recovery and increased ankle pain.
It’s also important to avoid the stationary bike with a high ankle sprain, particularly if you have been advised against any form of weight bearing altogether.
Additionally, if any ankle dorsiflexors (e.g. tibialis anterior) or plantarflexors (e.g. the calf muscles and Achilles tendon) are injured, these muscle will be highly active during cycling and may become further injured or irritated.
If your ankle is recovering well and you have regained some strength and mobility, are beyond the inflammatory phase of healing, and don’t have other injuries that put you at risk, then stationary cycling can be a great way to continue with your rehab and keep up your exercise program at the same time.
The above image shows general target heart rate zones for healthy individuals, but in my clinical experience, patients typically respond best by easing their way back into it, meaning to start light for the sake of the ankle and ensuring you feel ok reinitiating your cardio exercises.
This means staying in the saddle at all times (not bouncing up and down on the pedals), keeping the resistance and speed low to begin with, and starting with a short duration for the first 1-2 rides.
The reason it’s advised to start low and slow is to ensure no delayed adverse response, such as reactive inflammation or delayed onset pain. If you feel fine during the 24-48 hours following your first ride, gradually increase your workout by increasing one parameter at a time, such as speed, resistance, or time.
By increasing one parameter at at time, you can more properly self-assess your response to this exercise and will ensure you don’t push the ankle too much too soon.
Lastly, if you’re wondering why I’ve specified “stationary cycling” as opposed to road cycling, the main concern for road cycling is having to put your foot out and tweaking your ankle, or going too far and being stuck in a situation where you have to really push the ankle to finish the ride.
Using an arm bike, also known as an arm ergometer, is an admittedly boring exercise. However, in cases where you are non-weight bearing for some time, this can be a great way to keep up your cardio, as there is zero demand on the injured ankle during this cardio exercise.
The main thing to keep in mind here is that your heart rate usually responds differently to upper body cardio exercises than it does lower body cardio exercises (Leicht et al, 2008).
In this case, it’s important to review appropriate parameters and monitoring strategies with a healthcare professional if you have any heart or lung condition, or if you are on any heart medications, such as beta-blockers.
The elliptical is also a good way to keep up with your cardio while rehabbing an ankle sprain, but even though it’s considered a low impact exercise, you are still technically under your own body weight with this exercise, so it’s very important to consider your weight bearing status before proceeding with this cardio exercise.
The main difference between the elliptical and the stationary bike is the amount of pressure going through your ankles. For ankle sprains where you are advised to be either non-weight bearing or partial weight bearing, we would advise against this.
However, if you are fine to walk, then typically you are fine to go through an elliptical workout. This will provide a more whole-body cardio workout, as it involves both upper body and lower body movements.
Moreover, given there is minimal impact on the ankle joint, and can be considered an exercise that bridges the gap between the stationary bike and jogging.
Just like we mentioned with the stationary bike, it’s important to gradually progress your workouts by adjusting one parameter at a time, and start a bit lighter than you think you can handle to help minimize the risk of delayed adverse responses.
The last cardio exercise we will highlight is the rowing machine, which similar to the elliptical in that it’s considered to be a low impact exercise and combines both lower body and upper body workouts without too much strain on the ankle.
The rowing machine provides a whole body workout, and while technically is a weight-bearing activity, it’s definitely considered to be low impact.
It is important to remember that the rowing machine is considered weight bearing even though you’re not in a standing position. This is because you are still putting pressure through your feet in to the platform, and the more resistance, the greater the degree of weight bearing.
Also, it’s important to consider that your ankle will be moving with this activity, from a more dorsiflexed position at the bottom of the row, to a more plantarflexed position at the top of the row. The ankle movement isn’t large, but it’s still something to keep in mind especially if you have it set to a higher resistance.
Like all the other exercises we talked about above, start lighter than you think, try to adjust only one parameter at a time, and don’t make big jumps in your workout intensity or duration while you are still rehabbing your sprained ankle.
Home Cardio Exercises with a Sprained Ankle
Trying to mix in some cardio exercises with a sprained ankle at home can be tough, as many home workouts involve dynamic movements with a substantial degree of weight bearing.
In my experience, people who use stationary bikes at home tend to use it a little more, especially as they continue to recover, and even once their ankle is fully healed. Stationary bikes take up a smaller amount of space and are safe to use for more ankle injuries compared to something like a treadmill.
Having a sprained ankle can be very detrimental to your activity and can certainly affect quality of life. That said, it’s often safe to perform cardio exercises at home or at the gym when recovering from a sprained ankle, so long as the safety considerations listed above are taken seriously.
When in doubt, we recommend consulting with a physical therapist or related healthcare professional to ensure that your desired cardio exercise is appropriate for your stage of recovery. If cleared to proceed, consider a part of your rehab and make sure to progress gradually, as this will help you recovery faster in the long run.
Hubbard-Turner, T., Lavis, A., & Turner, M. J. (2021). Reduced fitness and body composition as consequences of chronic ankle instability. Athletic Training & Sports Health Care, 13(6), e419-e424.
Leicht, A. S., Sinclair, W. H., & Spinks, W. L. (2008). Effect of exercise mode on heart rate variability during steady state exercise. European journal of applied physiology, 102(2), 195-204.
Schiftan, G. S., Ross, L. A., & Hahne, A. J. (2015). The effectiveness of proprioceptive training in preventing ankle sprains in sporting populations: a systematic review and meta-analysis. Journal of science and medicine in sport, 18(3), 238-244.
The content here is designed for information & education purposes only and is not intended for medical advice.