The Trainer’s Room: Sprained Ankle Treatment, Rehab, and Recovery Time
(The Trainer’s Room is a regular column at Midwest Sports Fans by Denver chiropractors Dr. Niall McNally and Dr. Ihsan Erhuy, the pain and rehabilitation experts at the Mountain View Pain Center in Denver, CO.
All treatment options provided in this article should not be taken as specific advice, but rather as a general guide regarding what is typically done to treat the injury being described.
You should always consult your doctor before beginning any pain management or rehab program.)
______________________________
Ankle Sprains
For this article we will discuss one the most common sports related injuries, the ankle sprain. This type of injury can happen in all sports, to any player, and makes any activity nearly impossible until the pain is gone and the ankle heals.
Inversion injuries, or acute lateral ligament sprains, are the most common form of sporting injury, accounting for 40% of all injuries and up to 85% of ankle sprains, which in themselves are responsible for over 15% of all time lost from sport.
The injury occurs when the athlete lands with the foot plantar flexed and slightly inverted. This position unlocks the joint. What this means is simply rolling your ankle.
Plantar flexion inversion sprain
———-
Sprained Ankle: The Ligaments, Ankle Sprain Grades, and Recovery Time
The lateral (outside) ankle ligaments are: the anterior talofibular ligament (ATFL), the calcaneofibular ligament (CFL), and the posterior talofibular ligament (PTFL). The medial (inside) ankle ligaments are the deep and superficial portions of the deltoid ligament.
The most commonly sprained ankle ligament is the ATFL, followed by the CFL. An isolated CFL tear is rare, and is almost always preceded by a tear of the ATFL. These injuries are caused by running on uneven terrain, stepping in a hole, stepping on another athlete’s foot during play, or landing from a jump in an unbalanced position.
A syndesmotic ankle sprain, or high ankle sprain, occurs as a result of forced external rotation of the foot or during internal rotation of the tibia on a fixed, planted foot. A common mechanism is a direct blow to the back of the ankle while the foot is externally rotated.
Classification of lateral ligamentous injuries is variable. Injuries are described as primary, secondary, or tertiary, or grade 1, 2, or 3, in order of increasing severity, as illustrated in the ankle sprain grade chart below. The grading of ankle sprains helps to guide treatment, rehabilitation, and prognosis. The ankle sprain grade is based on the number of ligaments injured, degree of ligament tearing (partial vs. complete tear), and amount of swelling and ecchymosis (bruising).
West Point Ankle Spain Grading System
| Stage 1 | Stage 2 | Stage 3 | |
|---|---|---|---|
| Edems/Ecchymosis (Bruising) | Localized/Slight | Localized/Moderate | Diffuse/Significant |
| Weight Bearing Ability | Full or Partial Without Significant Pain | Difficult Without Crutches | Impossible Significant Pain |
| Ligament Pathology (ligament damage) | Ligament Stretch | Partial Tear | Complete Tear |
| Return to Sporting Activities (recovery time) | 11 days | 2-6 weeks | 4-26 weeks |
Please note this chart provides only a rough estimate of sprain ankle recovery time. Other factors must be weighed in such as previous injuries, age, weight, health status, and your sprained ankle treatment plan to give a more exact prognosis of recovery.
Two easy tests to determine when your previously sprained ankle is stable enough to get back in the game are to stand on the ankle in question for one minute with eyes closed, or jump up and down ten times in a row. If you can perform these without pain then you should be ready for action. However, even if you can perform these tests, your ankle may still be damaged, so take caution and protect yourself. Have the sprained ankle taped or wear some form of ankle support until it has healed.
Be aware there may also be an underlying fracture as well with an ankle sprain. This could contribute to the intense pain and swelling. It is possible to fracture the malleoli, cuboid, navicular, talus, or calcaneus. This is why it is important to see your doctor for an X-ray after an injury. An MRI might be needed because some fractures do not show up on conventional X-ray; MRI is also the best way to rule out underlying ligament damage.
While most ankle sprains will heal without complication, 20% of all sprains will lead to further chronic instability. Ligaments and tendons are stretched and damaged in an ankle sprain, but with the appropriate treatments we can heal and strengthen the area. If the ankle is left to heal on its own, you run the risk of developing an unstable joint. This can leading to multiple ankle injuries and even more complications down the road.
Sprained Ankle Treatment and Rehab
Before we get into treatment, we must first understand what is happening to the ligament. In the initial injury for example, the inversion sprain, the ATFL is stretched and torn. When this occurs the area will hemorrhage and will become inflamed. The body’s natural healing process will kick in and lay down more collagen to the affected area. If the appropriate steps are taken the collagen will lay down in the correct fashion reducing scar tissue and decrease the risk of future sprains.
Sprained Ankle Treatment
Initial treatment or the acute phase (0-24 hours) of the inversion injury/simple ankle sprain follows the usual regime of protection, rest, ice, compression, and elevation (PRICE). Although a very simple step, it is commonly overlooked, creating a longer recovery process.
Ice is most beneficial immediately after the injury, as it decreases swelling and helps with pain relief. Blood flow does not decrease significantly for about 10 minutes after the application of ice (but DO NOT ice longer than 20 minutes), by which time considerable bleeding may already have occurred, so the compressive element becomes equally important as an aid to restricting hemorrhage. The ankle should be taped in the opposite fashion of the injury. This will help to shorten the stretched ligaments and begin the healing process. If sports related, the athlete should be removed from the field of play without placing weight on the joint. The limb should be elevated as soon as possible and compression applied.
After you pick yourself up off the sidelines, go see your doctor. It is important to perform the appropriate orthopedics examination to determine the ankle’s stability and if there is any other underlying tendon ruptures or fractures. The majority of ankle sprains respond well to conservative care, and surgery is generally avoided in this type of injury. However it is recommended to see a doctor and let him/her make the call. You do not want to push an unstable ankle, or you can further damage the already weakened ankle.
Many think that because the ankle was injured the best course of action is to brace it and leave it alone. However, research shows that early mobilization of the joint will stimulate collagen bundle orientation and therefore stimulate healing. At Mountain View Pain Center we recognize the importance of adjusting and restore biomechanics to the joint while applying the other therapies. It is important to work with your doctor or trainer to properly rehab the area to strengthen and prevent from further sprains.
Early sprained ankle treatment will focus on moving out the edema (swelling) of the area, which will also promote healing. At Mountain View Pain Center we perform this process in several different ways. The first is an electrotherapy called hi-volt. Hi-volt is a direct current applied to the body through pads. In this type of injury the polarity should be set to positive (acts like ice). The hi-volt treatment has several benefits for an ankle sprain. The electric current will pump out the swelling and decrease pain.
The next step we take at Mountain View Pain Center is to apply kinesio-tape to the area. This allows the healing process to continue while the patient is at home. The tape also assists in the removal of inflammation and swelling. In the first 72 hours the kinesio-tape will be applied in a fan-like fashion across the foot with two strips, one facing towards the middle of the foot and one fanning out. This will open the lymphatic channels thus allowing the edema to move out of the area.
Another great way to move out swelling is a soft tissue technique aided with a specialized instrument. This specific technique is great for breaking spasms, removing adhesions (scar tissue), and in this case pushing out swelling. Your doctor should perform this to assist the lymphatic flow in the ankle. Adding this technique to our treatment has helped patients get back on their feet much quicker.
Sprained Ankle Rehab
After the removal of the pain and swelling, the next step is to begin rehab and work to prevent future ankle sprains. We do this by therapeutic exercises designed to strengthen the injured and weakened area. We also continue the use of kinesio-tape to help support the area, as well as allowing the patient the freedom to move the ankle, while still getting the therapeutic benefits. This is done with the same technique with tape to the outside of the foot, as well as stabilization tape up the calf muscle to aid the ankle in flexion of the foot.
Supplements
As mentioned in previous articles Omega fatty acids or fish oils help with inflammation in the body. Flavanoids, which give fruit their pigment, work exceptionally well with the reduction of inflammation, the increase of stabilizing collagen structures, and thus decrease pain. Collagen is a major protein in the tendons, so if you are trying to avoid future sprains, it is a good idea to take this supplement to help enforce the tendons.
Another important supplement to take for the prevention of future strains is vitamin C. Vitamin C deficiency is associated with defective formation of the tendons, making you more susceptible to an injury. (Side note: smokers are often deficient in vitamin C, so if you smoke you may be inhibiting your body’s ability to heal itself.)
Chronic Ankle Sprains
Without the appropriate care for an ankle sprain you may develop an unstable joint. When the joint becomes unstable the risk of further and more severe ankle sprains increases drastically. From here you must address the buildup of scar tissue as well as the instability. If you find yourself suffering from a chronic ankle sprain, let us know. We can help you develop a modified treatment plan.
These are the opinions and examples of treatment plans for sprained ankles from Mountain View Pain Center. If you have any further questions or concerns feel free to contact our office or leave a comment below. Additional home exercises can be prescribed by your physician to speed up the healing process.
——————–
The Trainer’s Room is written exclusively for Midwest Sports Fans by Denver chiropractors Dr. Niall McNally and Dr. Ihsan Erhuy of the Mountain View Pain Center in Denver, CO. You can contact them by leaving a comment below or sending an email to info@mountainviewpaincenter.com.
Dr. Niall McNally is certified in chiropractic neurology and has a strong background in sports i
njuries and in the rehabilitation of common nagging athletic problems. Dr. McNally also is trained in pediatrics, orthopedics, and nutrition.
He graduated from the University of Central Oklahoma and successfully completed his Doctor of Chiropractic degree at the Parker College of Chiropractic in Dallas, TX. A very active athlete, Dr. McNally played hockey up into the junior level. In fact, it was his love for hockey, and the Colorado Avalanche, that originally gave him the idea to one day practice sports medicine and chiropractics in the area.
Dr. Ihsan Erhuy specializes in motor vehicle accident injures, back, neck, and extremity problems, as well as treating pregnant patients and children. He is certified in the Diversified, Gonstead, Thompson, Upper Cervical, Activator, Sacral Occipital, Applied Kinesiology, Soft Tissue techniques.
Originally from Adana, Turkey, Dr. Erhuy graduated from the University of Arizona and also susuccessfully completed his Doctor of Chiropractic degree, along with his bachelor of science in health and wellness, at the Parker College of Chiropractic in Dallas, TX.
Tags: sports injuries, sprained ankle
---------------
If you enjoyed this post, please consider sharing with your friends:
[...] Sprained Ankle Treatment Rehab Recovery Time Ankle Sprain Posted by root 25 minutes ago (http://www.midwestsportsfans.com) 22 april 2009 6312 views by mountain view pain center no comment email post print post care for an ankle sprain you may develop an unstable joint Discuss | Bury | News | Sprained Ankle Treatment Rehab Recovery Time Ankle Sprain [...]
HI IM A 35 YEAR OLD MALE,WHO WAS CROSSING THE STREET AND SPRAINED MY ANKLE .I WAS IN FRONT OF THE HOSPITAL WHEN THIS HAPPEN WENT TO THE E.R. HAD A SOFT CAST PUT ON, 4 DAYS LATER I HAD A FOLLOW UP AND AT THAT POINT I WAS TOLD THAT I HAD A GRADE 2 SPRAIN .. MY DOCTOR TOLD ME THAT I NEEDED A HARD CAST FOR AT LEAST 2 WEEKS ..MY QUESTION IS WHY IF IT`S NOT BROKE OR FRACTURE WHY SHOULD THEY PUT A HARD CAST INSTEAD OF A BOOT OR ACE BANDAGE
Reply
Dr. McNally, D.C. Reply:
July 2nd, 2009 at 11:58 am
@MICHAEL,
That is a pretty good question. In many cases doctor’s treatment plans very, and they do what they know gives them the best results or do what their training tells them to do. If you had seen a sports physcian I doubt this would have been the plan of action. It is hard to tell exactly why he would do this unless he suspected a underlying hairline fracture, or major instability of the ankle. It is not unlikley in a bad ankle sprain to have a small fracture, and in some instances it can take up to 10-14 days for a hairline fracture to show up on x-ray. Hopefully this gives you some insite on why he may have put you in a hard cast, in any case you should not be in it very long.
Dr. McNally
Reply
I’m 13 years old. I sprained my ankle skateboarding 7 days ago. By observing the chart above, I’m guessing I have a stage 1 sprain, because I am only experiancing minimal pain at this point. I went to the orthopediac and got x rays 3 days ago and they confirmed that i just had a sprain. The doctor gave me an air cast and I wore it for about 24 hours straight and have worn it for 0-10 hours a day since then as well as iceing the ankle 20 minutes on and off after activity. My ankle currently feels like it is almost 100% better when i walk and participate in other activities, but i just recently tried to skateboard again and it was extremely difficult. I performed absolutely terribly even though i felt very little pain attempting to maneuver the tricks. Why is this happening? Will i continue to suffer from this forever? Will I be able to return to my previous ability and even improve on that in a short amount of time? What can i do to get better? Thank you in advance for your time.
Reply
me Reply:
September 6th, 2009 at 10:13 pm
@Anthony, PUSSY!!!!!!
Reply
A few weeks ago, I sprained my ankle, a grade two sprain. I went to the doctor, where they they only wrapped it and told me to stay off of it for several weeks. And so I have, as much as possible, and the pain gone but for when I move it in one direction. I am not as worried about the sprain, but the healing. Should I have seen a rehab center for it, because I would really not like to lose the stability of my ankle. I am sixteen, and relatively active, if it matters. Thank you ahead.
Reply
I have a grade 3 sprain and have been in rehab for the last 3-4 weeks, so far so good but all of a sudden I get a shocking like twinge on the top of my foot near my big toe when I walk barefoot. I don’t have that pain when I wear shoes, any suggestions?? I intend to ask my orthopaedic Doctor on my next visit.
Reply
Dr. McNally, D.C. Reply:
July 13th, 2009 at 10:59 am
@loni,
Thanks for the response and I apologize about my late response. It is hard to determine exactly what is going on without seeing you and performing some orthopedic tests to determine what is going on. When you say twinge do you just mean you feel some pain in the joint by the big toe, or is it more of a radiating lighting like shock that runs across the foot towards the big toe? Also did you have an x-rays when you sprained the ankle. In some occasions a hairline fracture can take up to two weeks to show on x-ray, however it would be unlikely that you would have a fracture up by the toe from an ankle sprain.
Reply
Most athletes will sprain an ankle at one time or another in their playing days. In general, sprains have traditionally taken 4-6 weeks to rehabilitate. In our office it is not uncommon to return an athlete to competition in 7-10 days. This all depends of course on many factors including the conditioning and level of commitment of the patient. First our office determines if the injury is indeed a sprain by radiographs or other methods and then follow up requires therapy if indicated. Work comp is focused on active and passive motion with support. Ultrasound or muscle stimulation is used along with ice and tape to support correct motion and inhibite unwanted motion. It is important at this time to walk on the injury as motion is part of the healing process. This rehabilitaion process takes 7-10 days of everyday care and moves into the prehibilitation phase where as care is emphasized to prevent future injury. Body balancing techniques are initialized during this phase using joint propicoception or balance board techniques to “get to know” the joint again as well as streghthen the surrounding area.
Reply
Thank you,
I injured my ankle at work, I am self employed and was worried. Thank you for the gift of knowledge that put my mind at ease. Now I believe I can deal with the minor injury.
Reply
hello, my 4yr old neice fell was sitting on a trampoline- not jumping
an older child jump up onto to it.. bounced and off she flew.
landed on her right ankle
the ankle knob area is very black and blue and swollen.
at the ER we were told a hairline fracture and were advised to see an orthopedic specialist.
he said bad sprain. and it was wrapped
yesterday- an una? booth was placed on it.
however, it is still swollen, still very black and blue and she screams every time she attempts to stand on it.
how do we know if she is just reacting from fear or if it is still that painful.
this has been a full 7 days since the injury?
thank you for any suggestions or opinions.
Reply
Dr. McNally, D.C. Reply:
August 10th, 2009 at 10:31 am
@bernadette,
It sounds like she landed on it pretty hard to cause a fracture. Remember even just a sprained ankle can be very painful to stand on, so she will still have some difficulty walking for a least another week or so. Sorry it took so long to respond, how has she progressed since then?
Dr. McNally
Reply
Hi, I sprained my ankle while hiking 3 months ago, went to the doctor and got x rays said there was no broken bones I got a brace, I wore a brace and after 3 weeks I started biking but the swelling wasn’t getting any better so I went to Physical Therapy for ine visit since I’m uninsured. I was told I had to rest it, ice it and elevated it, and then start strenghtening exercises which I did. I felt I got much better after a month of rest, so I went back to biking again and was feeling fairly good but 2 weeks ago I hyper-extended my foot while biking with the pedal and felt like evething got stretched so I have not been biking since then, and then 5 days ago I was walking fast and my foot gave up on me and it rolled towards the outside of my foot and made my ankle swell up again and have been having some pain again. I ‘ve been icing everyday and elevating; but after 3 months I’m feeling frustated and worried this will become a chronic issue… I been going to the chiropractor and have gotten some laser treatments on my foot but I want to heal completely and be ready for the snowboard season coming up. Please help me out. Thank you.
Reply
Dr. McNally, D.C. Reply:
August 10th, 2009 at 10:39 am
@Candy,
Thanks for the comment and I apologize about the late response. It sounds like initially you let the injury go to long without treatment. What can happen in this case is the ligaments that were stretched an torn did not have time to heal, which will give you an unstable ankle. This will make the risk of re-injury more likely as you have experienced. I think you are taking the right steps now with the laser treatment and chiropractic, it is important to restore the proper biomechanics to the joint, which your chiropractor will be doing. Something you may ask your chiropractor to add is some kinesio-tape to help support the area without the restrictions of athletic tape.
Dr. McNally
Reply
Hello, I need your advice.
3 months ago I sprained my ankle really bad while hiking, went to the doctor, got x rays; I didn’t have any broken bones, so I got a brace which I wore. After 3 weeks or so I started biking but the pain and swelling weren’t getting any better so I went to Physical Therapy one time (since I’m uninsured) and was told to rest it, ice it and elevated until the swelling would go down and then I could start strenghtening exercises… I did all that and after a month of rest and feeling much better I went back into biking.. I was feeling pretty good but 2 weeks ago I hyper-extended my foot while biking with the pedal, I felt my foot got stretched too fast and made me swell a little bit again on my ankle and on top of my foot; and then 5 days ago I was walking fast and my foot gave up on me and made my foot roll towards the outside, almost spraining it again but not quite; making it swell and hurt again (not as bad though), so I’ve been icing it, elevating it and resting but I’m worried and frustrated I don’t want this to become a chronic issue. I also have been going to my chiropractor and have had 2 laser treatments. What should I do?
I want to heal completely and be ready for snowboarding season.
Thank you. Ms Zapata
Reply
Dr. McNally, D.C. Reply:
August 10th, 2009 at 10:41 am
@Zapata,
Thanks for the comment and I apologize about the late response. It sounds like initially you let the injury go to long without treatment. What can happen in this case is the ligaments that were stretched an torn did not have time to heal, which will give you an unstable ankle. This will make the risk of re-injury more likely as you have experienced. I think you are taking the right steps now with the laser treatment and chiropractic, it is important to restore the proper biomechanics to the joint, which your chiropractor will be doing. Something you may ask your chiropractor to add is some kinesio-tape to help support the area without the restrictions of athletic tape.
Dr. McNally
Reply
About 4 months ago i steped of a porch step and rolled my right ankle. Done this many times before. But this injury will not heal. like the others, ive done some research and its the Anterior Talofibular Ligament. Most days it doesnt hurt at all, i can jog and etc. Im a golfer which is why this is a concern to me. Then some days i cant walk at all i literally have to crawl, im in so much pain. I dont have the money to go too a docter right now, so what can i do at home to help keep the pain from just showing up.
Reply
Dr. McNally, D.C. Reply:
August 10th, 2009 at 10:50 am
@mark,
Try to start to slowly strengthen the ankle without pushing it too hard. When starting the rehab process you need to take it slow, so as not to re-injure the area. Things that you can begin with is toe raises, this mean have your foot flat on the ground, and lift the toes of the ground this will help strengthen the tibialis muscle on the front of the shin, and help to stabilize the ankle. Also start with rolling the ankle to restore movement. Begin with the nutrition as well.
Dr. McNally
Reply
I sprained my ankle six weeks ago while playing tennis. Unlike the drawing above, I sprained my ankle inward. I went to an urgent care facility initially and was told to allow the ankle to heal for four weeks by wearing a brace. After a couple weeks the pain got worse as I walked on it, so I went to an orthopaedic doctor. He told me what kind of sprain it was and gave me a more comfortable air cast. However, my ankle still feels the same. After calling the orthopaedic doctor’s office back, they told me that sometimes these sprains take 10 to 12 weeks to heal. For some reason, I don’t believe that since I still feel the pain. Is this true? Should I be concerned? I’m doing the rehabilitation exercises, but can’t seem to get any relief.
Reply
Dr. McNally, D.C. Reply:
August 11th, 2009 at 3:43 pm
@Alvin,
It is possible for the ankle to take several weeks to heal. I would suggest getting some treatment done as suggested above, this will help with the pain, swelling, and increase healing time. Having to deal with the ankle for 12 weeks is too long, so if you need a good recommendation let me know what area you are in and I will find someone for you.
Dr. McNally
Reply
Thanks for the advice doc. I have been icing my ankle every night and then soaking it in hot water in the tube. Can you over ice your ankle, because today it started hurting again, i iced it for about 1hr and soaked it for 10mins.
Reply
Dr. McNally, D.C. Reply:
August 11th, 2009 at 3:41 pm
@mark,
Yes you can over ice the ankle. You do not want to use ice any longer than 20 minutes, ice baths are usually colder so even less. Once you over ice the body will think the area is under hypothermia, and will send more blood to the area, acting like heat. Try not to ice over 20 minutes, a good rule with ice is once you feel the area starting to numb take the ice off. Also if you are still in the acute phase avoid heat for now, even though it feels good the area will actually get more swollen and hurt worse later.
Reply
mark Reply:
August 11th, 2009 at 3:51 pm
@mark, also the moving the foot around just makes my ankle sore for days, i have tried doing it often but had to stop because of the next day i cant walk. its my right ankle and i play golf everyday, when i swing the golf club it doesnt hurt even though im putting all my weight on it. Is that a good way to make it stronger or is that doing the opposite.
Reply
and its never swollen, unless i twist my foot the wrong way. But there is a little not on top of my Peroneus Longus, could this mean that i teared my ligament. thanks for all ur help
Reply
also this injury happened over half a year ago, it took about a month to stop hurting everyday, but since then it comes and goes. I walk bearfooted alot and were flip flops, should i not be doing this even when my ankle isnt hurting at the time.
Reply
Dr. McNally, D.C. Reply:
August 12th, 2009 at 6:35 pm
@mark,
Even though the ankle may not be swollen in appearance there may still be inflammation under tissue causing pain. As for the knot on the muscle it is possible there is some scar tissue in there from the initial injury. This can be worked out as in the technique described in the article. As for flip flops the jury is out on whether or not they actually cause a problem. In my opinion flip flops are more unstable than shoes so they could cause a problem.
Dr. McNally
Reply
I took a tumble on my bicycle on Sat-June 20th and waited until Monday to get treatment. I went to the ER and they xrayed and said I have a fractured fibula and a severe #3 sprained ankle. I still can’t put any wt on it, The problem is I was born w/ severe club feet and had corrective surgeries, as a child (I am 59yrs old now) I have no insurance because I was laid off in April. I cant afford ort5ho Dr so they sent me to a PA who said just start putting wt on it and should be fine before Sept. Any suggestions? It still swells foot and calf if I dont keep it elevated and looks discolored, but I dont have any numbness.
Reply
Dr. McNally, D.C. Reply:
August 20th, 2009 at 7:05 pm
@Sherry,
Did you get a cast for the broken fibula? If you do not get some form of treatment the ankle will remain unstable and could be at risk of further injury. I would recommend either seeing a chiropractor or physical therapist, there treatment is usually significantly cheaper and they are more familiar with soft tissue treatment, such as a sprained ankle, however you will need an ortho for the broken bone. For example if you have an x-ray of a bone at an ortho’s office or hospital you could pay up to $500, at my office we charge 40 for an x-ray of the ankle. There are places you can be treated without insurance, you just need to find the right place.
Dr. McNally
Reply
also the moving the foot around just makes my ankle sore for days, i have tried doing it often but had to stop because of the next day i cant walk. its my right ankle and i play golf everyday, when i swing the golf club it doesnt hurt even though im putting all my weight on it. Is that a good way to make it stronger or is that doing the opposite
Reply
Dr. McNally, D.C. Reply:
August 20th, 2009 at 7:09 pm
@mark,
If anything causes pain to do then it is not the right move at all. Start with small ankle movements and see how far you can go before the pain starts. That is where you know you can do your exercises and can try to go further each week and that will help strengthen the area. Also wobble boards are a good way to increase stability, but be careful if your balance is not good try holding on to something first, if you fall you will hurt yourself worse.
Dr. McNally
Reply
i twisted my right ankle during football practice, and now it hurts a little to walk, run, and jump. however our team trainer tapes it up and says it should be alright, but it still hurts. should i practice .??
Reply
Dr. McNally, D.C. Reply:
August 20th, 2009 at 7:15 pm
@jered wood,
How is the ankle now? The more you practice on it, while it is sore the longer it will take to recover. While you are out of practice try some of the things above to start to rehab the area. I in no way intend to offend your trainer however they are not really trained with the knowledge of how to actually treat these types of injuries to the extent you could get at a doctors or a therapists office. They do however tape better than anyone, and see a ton of ankle injuries so keep a close eye on the ankle. If it is not improving see someone else. If you feel the tape is helping, then follow your trainers instructions.
Dr. McNally
Reply
Hi,
I rolled over my right ankle in basketball. I am wondering what your impression might be from the following description. It hurts and looks swollen from the “ball” (tibia?) on the outside of the ankle towards the very front of it (about a line of a couple of inches) but it is also swollen on the posterior side of the inside “ball” (tibia?) of the ankle maybe about an inch or two long around that “ball” towards the foot. So the areas are diagonally opposed – for lack of correct vocabulary – if the front of the ankle is north then these areas are northeast (outside) and southwest (inside). It happened a couple of hours ago and these areas are very sensitive to weight bearing (especially the area on the inside) although I can walk limping with discomfort. Moving my toes feels moderately painful in the inside posterior area. When the injury occurred it was very very painful for about 5 minutes or so. I have rolled over ankles before but this has certainly been a whole different level of pain and subsequent discomfort.
Thank you very much for any feedback and for the general information.
Reply
Dr. McNally, D.C. Reply:
August 20th, 2009 at 7:22 pm
@Carlos,
I am assuming when you say the “ball” you are referring the lateral mallelous of the tibia, which is the outside bump of the ankle joint. This is the most common area for a lateral ankle sprain, and the ligaments pass around this point. The swelling is normal and it is common to get swelling around the entire ankle even on the inside. However without knowing the severity of the sprain or actually seeing you I cannot say for sure. If the ankle is still swollen and starts bruise and walking becomes difficult it may be a good idea to get an x-ray. Sometimes it is possible to fracture that part of the tibia we where referring to.
Dr. McNally
Reply
Carlos Reply:
September 12th, 2009 at 8:33 pm
Thanks for your reply Dr. McNelly. It turns out I didn’t have a fracture, but actually quite a sprain. The MRI report (done 3.5 days after the injury) states the following impression: 1 – complete tear of anterior talofibular ligament with high grade tear of calcaneofibular ligament; 2 – low grade sprains of inferior band of posterior tibiofibular and talofibular ligaments; 3- focal split tear of peroneus brevis tendon in fibular and subfibular location; 4 – small marrow contusion of inferolateral aspect of talar head associated with small talonavicular joint effusion; 5 – moderate tibiotalar joint effusion with fluid communicating with flexor hallucis longus tendon sheath. It makes note of other ligaments, tendons, and bone cartilage that appear normal. The doctor’s note (6 days after injury) makes mentions of a “negative squeeze test as well as talar tilt test”, “moderate pain with plantarflexion”, “notable pain against resistance with inversion and abduction”. “2+ dorsalis pedis pulse and cap refill in less than 2 seconds”. At therapy we have worked on exercises with elastic bands to prevent too much weakness of the ankle, but after a couple of sessions had to stop the balancing exercises (moving the good leg in back/forth and sideways motion while standing on injured leg) because the ankle way getting swollen and there was noticeable pain along the ATFL area as well as on the posterior/medial aspect of the ankle.
With that said. I am wondering what might be your approach to something like this. Particularly regarding protection and rest. How long should I use the aircast boot and crutches? What would you recommend in terms of exercise plan? They are trying to push me to walk again but it just doesn’t feel like I can do it without crutches without getting into a cycle of pain and swelling. I am also not using the boot since therapy started 2 weeks after injury. I saw there is a reference to a recent Lancet article on the immobilization of severe ankle sprains ( Lamb SE, Marsh JL, Hutton JL, Nakash R, Cooke MW (February 2009). “Mechanical supports for acute, severe ankle sprain: a pragmatic, multicentre, randomised controlled trial”),which I can’t read but seems to advocate for the use of boot or similar below the knee immobilization leading to faster recovery at 3 months. Lastly, I would be interested in specific nutritional advice for a good recovery (i.e. how much collage supplements should be taken, diet etc).
I know this is a lot to ask, but any help you can provide is immensely appreciated as I haven’t been able to get much in terms of information about all these concepts.
Thanks very much!
Reply
I was playing rugby and whilst i was chasing someone it felt as if i trapped my right foot in a hole or simply went over on it , im still quite unsure. Immediately my ankle started to swell up and the pain was excruciating. I went straight to the hospital where i was given x-rays , it showed nothing was broken and i had suffered a 4th degree/grade ankle sprain and i was simply told to rest and ice it. The next few days were agony , my leg , foot , ankle and toes were unbelievably swollen and covered in dark bruising.
I have continued to rest it and it has now been 6 weeks since the injury. I have had more x rays and reassured there was no evident breaks. Yet i still cannot walk , it is still swollen and my foot is a worrying colour.
Reply
Dr.Erhuy, D.C. Reply:
August 21st, 2009 at 10:34 am
@Ross, It sounds like you’re going through a lot of pain and I am sorry to hear that. But as the article says grade 3 takes 4-28 weeks to recover. A grade 4 on the other hand will take even longer because of the damage done to the ligaments. Try some of the advice in the article such as Hi-volt to push the swelling out of the area. As for the discoloration this is a normal step of the healing process, it doesn’t look every nice but it’s normal. Please feel free to keep us up dated on your ankle.
Thanks,
Dr. Erhuy, DC
Reply
Mark Korda Reply:
October 8th, 2009 at 8:00 pm
Hi Ross,I am a rugby fan,but only played football.I saw a lot of my buddies get injured.I walked home from my favorite pub 3 weeks ago and stepped in a pot hole.I went down like I got shot with an elephant gun.I'm 52 but until the ankle injury worked out every day.Some freinds gave me an air cast and almost every brase you could think of.I paint interiors for a living and was working for a female doctor who really did not take a close look.I'm hobbling around without crutches,and the right side of my right foot seems like where the injury presides.I don't have worring color yet,and I have no insurance,and I don't think I'm getting any improvement.The doctor I was working for said she did the same thing and it took 4 months to get better.I think I needed some one to vent to,and your injury sounded like mine.I'm going crazy…..lost my cable tv and am doomed to listen to AM talk radio.If you got the time,I got the time to listen…..thanks..Mark Korda Portland Maine.
Reply
I was playing rugby and whilst i was chasing someone it felt as if i trapped my right foot in a hole or simply went over on it , im still quite unsure. Immediately my ankle started to swell up and the pain was excruciating. I went straight to the hospital where i was given x-rays , it showed nothing was broken and i had suffered a 4th degree/grade ankle sprain and i was simply told to rest and ice it. The next few days were agony , my leg , foot , ankle and toes were unbelievably swollen and covered in dark bruising.
Should I be concerned ?
I have continued to rest it and it has now been 6 weeks since the injury. I have had more x rays and reassured there was no evident breaks. Yet i still cannot walk , it is still swollen and my foot is a worrying colour.
Reply
Scott Reply:
September 25th, 2009 at 8:16 am
@Ross, you should absolutely have it x-rayed.
Reply
22 years old, grade 2/3 sprain.
Hi,
4 weeks ago at rugby ground I rolled my ankle on an uneven surface sidestepping at full pace.
I knew straight away that it was a bad sprain, I did not think that a break occured.
I did the right thing and got it xrayed – their was however two breaks. One on either side of the ankle (the one on the inside of the ankle was probably an old injury!).
After three weeks in a cast I went back to the hospital for further prognosis and (without another xray) the doctor feels that it is just ligament damage now and stuck me in another fiberglass cast this one weight bareing.
I am roughly four weeks into my recovery, how long do you feel I will be out for and are there any tips and comments you could offer to help speed up this recovery?
Thanks in advance
Adam
Reply
Hi,
About 6 weeks ago I sprained my ankle on an obstacle course training with my Reserve unit. The obstacle required me to jump off of a platform that was 12 feet high onto some soft rubber. Unfortunately when I landed I rolled my ankle and immediately heard and felt a pop in my ankle and absolutely could not put any weight on it from that exact moment. I had to be carried into the car and rushed to the ER. They took X-rays then, and the doctor said it was not broken, but just a bad sprain. He gave me crutches and an aircast which I used for about three weeks. When I got home I made an appointment with a sports orthopedic and he thoroughly examined my ankle and took more X-rays. He diagnosed me with a grade 2 sprain, gave me a compression ankle brace and advised me to do therapy. Also advised me to come back in 3-4 weeks, if not better, to do an MRI.
It has now been six weeks. I’ve been putting it in the cold pool for at least 15 min a day, putting a hot pack at night before I go to sleep and doing the rehab. My ankle still feels like something is terribly wrong with it. I know these things take time to heal but I’m afraid that its just not healing quick enough. I am a personal trainer and have to be on my feet all day. I know this has a lot to do with the healing process, but what other option do I have? I am an avid runner and have not been able to do anything for 6 weeks and counting. And I still cannot run! Should I make another appointment with my doctor and get the MRI?
Thanks,
Jackie
Reply
Here is a tricky one:
Water ski accident. Binding did not release feet in high speed fall resulting in axial loading of talus. Examination suspects neck of talus fracture and damaged deltoid ligmanets, however no fracture appears on xray, even after 4 weeks. First two weeks were on crutches with no weight bearing. Second 2 weeks were walking with boot. Ankle is still swolen and painful when twisted or loaded at any angle. Planning to visit doctor again in 1 week.
Thoughts????? Going on week 6 and the ankle is still swolen.
Reply
About 4 months ago I was running down the stairs and jumped off of the 3 to last step and landed on the side of my foot spraining my ankle. I put ice on it for awhile and used ibuprofen. even after 3 months there was mild pain to turn my foot to the left and right. About a month ago I was running on the sidewalk with my son and I stepped off onto the grass and turned my ankle again. This time it hurt so bad I became nauseous. I used ice and heat as well as ibuprofen. It doesn't hurt to turn it right or left anymore, however it hurts when I move it up and down. I haven't gone to the doctor simply because it was a sprain. What can I do to strengthen it up. I am a very physically active person and this has kept me from many of the exercises I usually do at the gym. Thank you.
Reply
Three weeks ago I rolled my ankle when I stepped down off the stairs, and I believed I dislocated it. I felt what I think was the bone dislocating out of the joint, and it felt almost as if the leg bone hit the floor because I got a jarring sensation further up my leg. The whole incident was the most excrutiating pain I've ever felt. My foot looked as though it was twisted to the side, and it hurt immensely to try to straighten it. I went to the ER immediately and they said there was no fracture and it just a sprain. They didn't tell me much more than that, just gave me an air splint and crutches and told me to follow up with my doctor in 10 days. When I went to the doctor (at 11 days post injury) I was still experiencing significant pain and swelling. He mentioned a concern of the smaller fractures you mentioned and told me to return in a week or two if I was still experiencing pain. It's now been three weeks since I injured it, and I have more mobility and am able to stand and (sort of) walk on it, but it's still swollen and still painful at times. I cannot flex it towards me without significant pain. Is this part of the normal healing process or should I return to the doctor for further checkup?
Reply