How to Treat a Sprained Ankle

What should you do if you’ve sprained your ankle?  Ankle sprains are pretty common from the average person to the weekend warrior and even pro athletes.  Many athletes roll over on their ankle during their activity as a result of a ‘bad’ landing.  Meanwhile Jane Doe can easily sprain her ankle stepping into a pot hole in the street.

The most important thing in treating an ankle sprain is rehab.

Whether it be self-treatment or rehab done professionally by a chiropractor, physiotherapist or athletic trainer,  proper rehab is important in preventing future recurrent ankle sprains.

When you sprain your ankle, you actually stretch out the ligaments that keeps your ankle stablesometimes they are overstretched to the point of tearing ligament fibers.   When those ligaments heal, they are not as strong as they used to be and hence, do not provide the same level of support and stability as they once did.  Importantly, you will lose some ability to tell where your ankle is in space (this is called proprioception) which is not good because it increase your risk for another sprain.
The ankle is tender and swollen on the outside, below, and just in front of the ankle bone. Typically, the bone is not as tender at the area above and in front of it. A sprain may be mild, causing only modest pain, or severe enough to prevent weightbearing.

Initial care of ankle sprain is essentially the same as for all other acute injuries: RICE (Rest, Ice, Compression, and Elevation)

The RICE method helps to keep the swelling down and alleviate some pain.  Ice the ankle for 20 to 30 minutes each hour but do not put the ice directly on the skin because it can cause frostbite.  Instead, wrap the ice in a wet towel or cloth to protect the skin.   Elevate your foot above chest level to facilitate draining of the swelling.  If you are unable to bear weight or if the ankle fails to show any improvement within several days make sure you seek professional advice.  X-rays might be necessary to determine if a fracture occurred also.

Here are a few things I’d recommend for properly rehabbing your ankle:

1. ROM (range of motion) and Flexibility – Work on active ankle ROM, passive ROM and stretching the calves.  Once you’ve gotten back over 60% of your ankle ROM, you want to work on ankle strengthening exercises.  In particular you want to do theraband exercises that work on inversion and eversion.  Full range calf raises are also important.  Take it slow and work at your own pace.  Do not over push it.

2. Proprioception exercises – these are quite is simply single leg balancing exercises.  First start just by balancing on one foot on your injured ankle side with your arms by your side.  Try to progress to holding it for 1-2 mins.   Then you can progress to balancing with your eyes closed.   Next, try standing on something squishy and eventually standing on something squishy with your eyes closed.  Because you are on a less stable surface, it forces muscle and joint stability to be trained.   In more advanced work, you can try catching small balls thrown at you while trying to maintain your balance.

3. Heat and Ice – After about 2-3 days, it is usually safe to switch from ice to heat.  If the ankle is still quite swollen, you may have to wait about a week.  Heat stimulates more circulation through the injured area and will assist with recovery.  It’s also good to use heat to warm up the tissue before your rehab exercises.  After the workout, you can use ice to minimize any irritation to the tissue caused by the exercises.

4. Soft tissue work – After a 4-7 days, you can do some self treatment on the soft tissue around the ankle and also the calves.  With your thumb/fingers you can perform cross-friction massage across the fibers of the injured ankle ligaments.  Firm pressure is all that’s necessary.  It’s ok to feel a bit uncomfortable with the pressure.  Another good idea is to use either a foam roller and/or tennis ball to roll tight muscle areas in the calves.

5. Listen to your body! – Use common sense.  If something is painful, don’t do it.


The all-important question: When can I return to sports???

Return to sports only after you have met these goals:
1. You have full range of motion in all directions (up and down, side to side, and in and out).
2. You have near-normal strength in all muscles around the ankle.
3. You have good balance.
4. You have no pain or swelling with exercise or activity.

If you aren’t seeing a progressive improvement over the course of 2 weeks, you may need a professional assessment and additional therapy to get the healing going in the right direction. If you have any questions give us a call or come in for a free 15 min consultation with me.

Dr. Keith


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