Most athletes at some point in their career have sprained their ankle playing sport. It is a very common injury in sports with lots of change of direction, such as football and netball as well as jumping sports where there is a risk of landing on someone else’s foot such as rebounding in basketball. They can really interrupt a sports season or even if you don’t play sport how long you need to be off work. Often there is a lot you can be doing to help your ankle recover in the first few days if you know what to do!
Here are some guidelines on the best management for acute ankle sprains in the first week which can help the ankle recover and get back to sport faster.
Acute Stage Best Management:
Rest – avoid walking long distances if you are limping.
Ice – 20 mins every 2 hours.
Compression – wear a compression sock or tubigrip over your ankle. Taping can also be a form of compression that your physiotherapist can show you.
Elevate: Keep your foot up above your heart height whenever possible in the first 2-3 days. At night elevate your foot on pillows. This helps to reduce the swelling from pooling in the ankle.
Referral: See a medical professional such as a physiotherapist or sports doctor to determine if an Xray is required and to diagnose the damage.
Extra tips on Icing:
Remove the shoe? You will hear debate sometimes over whether to remove the players shoe or keep it on for compression. My belief is that if you want to ice the ankle you can’t really access it well enough if the shoe is still on so take the shoe off and ice the areas that are sore and swollen.
No Anti-Inflammatories: Let the icing be the natural management of swelling as there is evidence that using anti-inflammatories can inhibit ligament healing if used in the first 72 hours. Analgesics such as panadol for pain are fine to use as needed.
Ice Vs Natural Healing = ICE
Some people are beginning to debate whether we should ice at all as swelling is the bodies natural way of healing. However, it is not the normal act of swelling that tends to cause complications with rehabbing an ankle back to sport it is an over reaction of the body and the excessive amount of swelling that increases stiffness and pain. Therefore, I still recommend icing straight away as it will never completely get rid of all the natural inflammatory cells anyway and helps to prevent hiccups in later stages of rehabilitation.
The biggest tip I give people when they have acutely sprained their ankle and it is either really swollen or there is an important match/deadline to be ready for is to ice there foot/ankle in a bucket. Add water and ice into a bucket and dunk the entire foot and ankle in. There are different ways from here as to how you do it depending on the threshold of the injured athlete and their tolerance of the cold. I generally suggest to keep it in for 5 minutes and to practice moving the foot up and down to keep the mobility and prevent stiffness. If they find it difficult to keep the foot in there due to the cold temperature you can do 30 seconds in the bucket and 30 seconds out and do it for 10 minutes. This works a treat as the whole ankle receives the ice including inside the joint and you can keep your foot moving whilst you do it to help prevent stiffness.
If you are serious about getting back quicker than the norm because you are in the middle of finals for example I would definitely suggest setting your alarm over night on the night that you injured your ankle and getting up perhaps 2-3 times to ice the ankle for 10-20 minutes. Otherwise, expect a fat and stiff ankle the next morning.
Lectric Soda Crystals:
These are another great adjunct to icing to help reduce the swelling. Make sure you follow the instructions as you can get ice burn from overuse.
Signs of an Ankle Fracture:
I would always recommend to see a professional to determine this as missing a fracture can be detrimental to short and long term rehabilitation.
However, my guide as to whether your risk is higher and should seek a professional’s opinion includes:
– Unable to weight bear at all initially or in the next 2 days – This means not even putting a tiny amount of pressure on that foot including to limp off the court.
– Deep ache at night that wakes you up
– Icing the ankle is painful
Importance of seeing a Physio:
I have given a specific guide for everything that you can do independently to give yourself the best chance but the importance of seeing a sports therapist such as a physio is crucial. This is important to confirm the exact damage that you have done, prognosis, X-ray referral to confirm no fracture and to begin some manual therapy to get the ankle moving again. Specific taping techniques can help remove swelling and pain as well as other manual techniques that help to reduce swelling, stiffness, and pain. Physiotherapy is also crucial for designing you a rehabilitation program to build back up the strength in your ankle to help get you back to walking pain-free, running and then back to sport/work as quickly as possible. These exercises are also important for preventing future injuries to the same ligaments.