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ESSENTIAL SKILLS HEEL RAISES. Stand holding on to something for balance. Keeping your feet parallel, rise up onto the balls of your feet without bending your knees. Stay there for a moment and come down again. Begin with five repetitions and then repeat this same exercise with the knees slightly bent. Build up slowly to eight repetitions of five. OUTER-ANKLE LIFT. For this exercise, you'll need the same props you used for the inner-ankle lift. Lie on your side on a couch or bed with your knees bent and the injured ankle on top, then extend the top leg off the edge of the couch or bed. Now, with the weight or the shopping bag across the front part of your foot, lift the outside of the foot toward the ceiling, keeping the foot pointed. Repeat this exercise ten times and then do it again, this time keeping the foot flexed. Build up slowly to three sets of ten repetitions. When an ankle sprain does not heal properly, it can become a chronic problem. After reading this article, you're in a INNER-ANKLE LIFT. To do this exercise, you'll need some props. You can use weights that attach to the foot in some way or use a small plastic shopping bag containing either a two- to five-pound weight or cans that total five pounds. Sitting in a chair, cross the injured leg over the uninjured leg with the weights or loaded shopping bag across the front part of your foot, just behind your toes. Now raise the foot toward the ceiling five times. Repeat after a brief rest. Gradually build up to three sets of ten repetitions. SURGERY When a ligament is totally ruptured, surgery is required to sew the torn ends of the ligament together. This type of surgery tends to be very successful. However, the more time that passes after the injury, the less likely it is that the surgery will succeed. A ruptured ligament will tend to shrivel up and adhere to whatever structure it is nearest to, making it difficult or impossible to perform the repair. A FREQUENT CHALLENGE Lateral ankle sprains are one of the most common types of injury, affecting almost all of us at some point in life. Because they happen so frequently, it's easy to regard them as merely a minor, temporary annoyance. However, without proper care, even a relatively mild sprain can develop into a chronic problem. I've seen clients who have suffered from a poorly healed ankle sprain for fifteen to twenty years before receiving effective treatment. better position to help any client with a lateral ankle sprain, no matter how old or recent the injury is. You've learned how to perform assessment tests to determine which structure or structures have been injured; use friction therapy and massage to stimulate healing while removing adhesive scar tissue; and teach the client exercises to promote stability and prevent any more damaging scar tissue from forming. You've also learned about other treatment options that may be appropriate in certain cases, including self-care and surgery. Armed with this knowledge, you can help ensure that an ankle sprain remains a temporary problem, allowing your clients to return as quickly as possible to a pain-free, active life. in education and sports medicine. He is founder of the Muscular Therapy Institute. Benjamin has been in private practice for more than forty years and has taught communication skills as a trainer and coach for more than twenty-five years. He teaches extensively across the country on topics including SAVI communications, ethics, and orthopedic massage, and is the author of Listen to Your Pain, Are You Tense? and Exercise Without Injury and coauthor of The Ethics of Touch. He can be contacted at bbby@mtti.com. Ben E. Benjamin, PhD, holds a doctorate 116 massage & bodywork january/february 2008