5 Steps to Recovery from Severe Ankle Sprain

It happens in a moment: you are running, then you side step and you fall to the ground with a cry and a poignant pain in your ankle. As you try to stand up, the pain shooting up through your leg from the ankle is unbearable and you notice the first signs of swelling. Within half an hour, your ankle is fully swollen, purplish in colour.

The diagnose? You suffered an ankle sprain, possibly a severe one. From the first moment when you are aware of the injury, it is important to take the right steps in order to encourage a fast recovery, and get back on the running track as soon as possible.

Today we will present you the first five steps you must take to recover from the sprain, protect your ankle, and make sure that when you start your first rehab exercises, it is safe to do so and there is no risk of a fresh injury. These 5 steps are known as the PRICE routine and they should become a second nature to you in case of any type of leg injury during running.

Step 1: Protect

Immediately after the injury, the tissue of your ankle is painful and tender. The tendons are overtaxed and are unable to support your joint in its normal position. Under no circumstances should you put your foot down and exert any kind of pressure or effort upon in.

During the first moments after the injury it is second nature to try to downplay its gravity and take a few steps to get your ankle back in shape. Resist this impulse, continue to sit down, and call an ambulance or a friend to take you to hospital. During the first days after the ankle sprain, you will be recommended to wear a removable plastic cast, or a plaster cast (which you will be wearing all the time until the doctor removes it).

Remember, protection is the key to correct alignment of your ankle joint and complete recovery.

Step 2: Rest

During the entire recovery procedure you must allow your ankle to heal. Absolutely no physical efforts are allowed, not even walking. You must use crutches, even if you have a solid plaster cast on your leg. No pressure should be put on the recovering tissues. You will also experience continuous pain, in most cases at tolerable levels. If you feel that the pain threshold exceeds your limits, you should consult with your doctor about prescribing painkillers.

Step 3: Ice

Ice packs should be applied for 20 minutes, with a break of 1-2 hours between applications. The ice pack should never be applied directly onto the skin. Wear thick socks and, preferably, also wrap the ice pack in a towel. The ice pack applications help a lot with pain relief for severe ankle sprains and also reduce the swelling and bleeding.

Step 4: Compression

Compression is very important to realign the twisted tendons and reset your injured ankle in the normal position. A plastic removable cast is very helpful in the early stages after the injury (up to

3 days). After this moment, according to your doctor’s recommendations, you can replace the plastic cast with an elastic ankle brace.

Step 5: Elevation

Throughout the initial healing period of your ankle sprain (up to 5 days) you should keep your ankle elevated compared to the rest of your body. This facilitates the blood flow, prevents the formation of blood clots, and also prevents the accumulation of liquid in the injured tissues. By elevating your injured foot on a pillow, you help reduce the swelling and the pain and speed up your recovery.

In the end, remember that whenever you feel that something is not right in the healing process of your sprained ankle, you should immediately contact your doctor.


Major Injuries in Female Athletes Part 2 – The Ankle Sprain

Continuing the theme of lower limb ligament injuries in female athletes next up is the ankle sprain.

Damage to the ATFL or CF ligaments of the ankle (ankle sprain) is the single most common injury in female sport and the most common cause of prolonged  absence in young athletes (< 15 yrs old). Most studies looking at injury prevalence in female team based sports report that ankle sprains account for nearly I in 5 of all injuries big or small. The ATFL and CF ligaments, on the outside of your ankle are some of the main stabilisers of the joint. Ankle injuries can be divided into three types depending on severity: grade one (small tear), grade two (partial tear) or grade three (complete rupture).

Initially management of the injury is to reduce pain, swelling and restore movement. The POLICE principal can be helpful here: Protect, Optimum loading, Rest, Ice, Compress and Elevate. 

Rehabilitation is necessary to prevent chronic ankle problems, especially in grade two and three injuries. At first, rehabilitation exercises may involve active range of motion or controlled movements of the ankle joint without resistance. Water exercises may be used if land-based strengthening exercises, such as toe-raising, are too painful. Lower extremity exercises and endurance activities are added as tolerated.

Proprioception training is very important, as poor proprioception is a major cause of repeat sprains and an unstable ankle joint. The goal is to increase strength and range of motion as balance improves over time. The key to returning to play and preventing further ankle injury is a dynamic and progressive rehab programme. Once you are pain-free, have sufficient strength, balance and full range of motion other exercises may be added, such as agility drills.

For a better look check out the rehab video. 

Catherine Simpson MISCP MSc. Sports Medicine


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