Pre-season for winter sports will be starting shortly and with it, the good old ankle sprain will start filling up A&Es and physio waiting rooms. It’s not a fun injury, so having a few ideas on how to manage it to improve your outcomes will help get you back on the court / field / track / dance floor sooner.
Should I go to A&E?
If you suspect the ankle is broken or very seriously injured, yes. Some indications that the ankle may be broken include an inability to weight bear on the ankle for four or more steps immediately after the injury, or indeed an hour or so later. If it is really tender to touch over the bone on the inside or outside of your ankle, or on the inside or outside of your foot, it may pay to visit the A&E. If the ankle swells or bruises significantly and quite quickly, it may also pay to visit the A&E. Sometimes people think that if they hear a loud noise, this means that it is broken, but this is not necessarily the case. The above guidelines have a stronger relationship with fractures than a noise or sensation.
If I don’t need to go to A&E?
Now is the time to follow your RICE management:
Rest – stop walking on it! Reduce the load going through that side as quickly as possible.
Ice – 10-15 minutes minimum and make sure you don’t apply ice directly to your skin unless you want to add a nice ice burn to your injury.
Compression – bind it in a bandage or something tight to limit the swelling – this will help reduce your pain and recovery time.
Elevation – get that foot up, above heart level is better but off the ground is good as swelling responds to gravity and you can have a giant foot and ankle very quickly if you don’t elevate.
The use of anti-inflammatories with acute musculoskeletal injuries is sometimes a bit controversial. If there is a suspected fracture, it is suggested that inhibiting the inflammatory process can prevent healing. Not all doctors agree, so you may be prescribed some if you visit a doctor. If a fracture is unlikely or ruled out, anti-inflammatories can hasten the healing process and reduce the inflammatory phase.
Only if you absolutely need to! Physios hate unnecessary use of crutches. If you are limping heavily and your gait is so poor that we suspect you will risk other complications and pain from it, we will encourage the use of one or two crutches. Learning to use crutches well is important or you can have wrist or shoulder pain, or muscular contractures from them. I like my patients to put their heel down and simulate a proper step with little or no weight going through the leg (depending on any requests from a specialist). This stops the calf from getting tight and prevents hitching through the hip which can cause pain in the pelvis and lower back.
Yes! The degree to which you injure yourself will dictate which exercises you can start with but generally the first thing we get people doing is gentle active range of motion exercises to try and maintain some joint health without overloading the soft tissues. You can do this with some fractures as well, but talk to your physio first. Stretches and progressive strengthening exercises will make up part of your rehab. Balance and proprioception drills will also feature strongly. Your physio will do a full assessment to establish if this injury may have been influenced by any other factors (weak muscles, previous injury or poor biomechanics, to name a few) and your rehab programme will include exercises for that too.
Your injury will certainly involve exercise prescription from a physio, and depending on the type of injury, it may involve some hands-on treatment too. The objective of this is to manage pain and swelling, improve range of motion and regain or maintain mobility at and around the injury site. Sometimes an old ankle injury that was never well managed can prevent you from squatting fully or walking down stairs comfortably. Managing this early is much easier!
Strapping / brace?
We often use strapping to make you more comfortable throughout the healing process. I like to use it with the first period of returning to sport or activity to aid in your awareness of the joint, facilitate the recruitment of your muscles and prevent re-injury. However, investing in a brace for the long term is less common. The reason being is that most people, with the right help, make a good recovery. Bracing is a good idea for an athlete or very active person who has sustained multiple injuries or undergone surgery and has some degree of chronic instability. But generally, physios would like to see you use your own muscles and joint receptors if you can, rather than rely on external support for good function. Discuss this with your physio if you are not sure.
If you can’t get in to see your physio very quickly, this information should help you manage your condition until you can. The more ankle sprains you have had, the more likely you are to sustain another – so if you have rolled your ankle once or twice and don’t think you did a great job rehabilitating it, get in touch to get it sorted, even if it was a long time ago. Your future self will thank you for it!
Written by HeathZone Physiotherapist Rebecca Diana