This may sound like a familiar scenario for some of you –
You are sliding across the tennis court, arms outstretched, racket glinting in the sun, every sinew in your body poised to unleash that perfect volley to clinch the game. And that’s when you feel it – your balance starts to give, your foot rolls inwards, and pain shoots up your leg and spine, exploding in your head like a firecracker. You collapse in a dusty heap, clutching your ankle and wondering why you hadn’t stayed in that day to do the laundry.
Ah, the dreaded ankle sprain. Who hasn’t had one? Maybe you’d tripped on an uneven pavement, or those lovely high heels that you just bought let you down…literally. Whatever the circumstance, we’ve all sprained our ankles at some point. In fact, ankle sprains are probably one of the most common musculoskeletal injuries. In the United States alone, there are about 23,000 ankle sprains everyday. (To put this number in perspective, that would be about 400 a day in Singapore.)
And yet, most of us don’t think of a sprained ankle as a potentially serious injury with possible long-lasting consequences. We’re unlikely to see a doctor about it. Most of the time it’s just a matter of putting our feet up (often literally) and taking a rest for a couple of days and applying an ice-pack on the sprain. And after a couple of days, when the pain and swelling subsides sufficiently, we limp back to work, often with an impressive, suitably augmented account of what happened.
What we don’t realize, is that the seemingly simple ankle sprain, if improperly treated, has the potential to cause long-term damage (and possibly recur), leading to a real reduction in our quality of life. One study has found that more than half of ankle sprains, when examined under the MRI, are in fact more serious than initially thought.
What should you be doing instead to rehab your sprained ankle effectively? The recovery of an ankle sprain goes through two distinct phases:
1. The restricted motion phase
This occurs in the first few days after the injury. Ideally, treatment during this phase should be guided by the acronym “PRICE” (or the shorter “RICE”):
P is for PROTECTION
You’ll be advised to use an external supportive device such as a semi-rigid or lace-up brace to protect the ankle from further injury. This will allow your ankle to heal faster and with less pain.
R is for REST
It’s best to gradually bear weight on the ankle as soon as comfortably possible.
I is for ICE
Applying ice in the first few days can significantly reduce pain and allow you to bear weight quicker. Don’t apply ice directly to the skin, instead use a thin cloth to cover your skin and don’t keep it on for longer than 20 minutes to avoid frostbite. You can repeat the ice applications every 2 hours.
C is for COMPRESSION
Again some form of compression e.g. using an elastic bandage can help reduce swelling and therefore pain.
E is for ELEVATION
Raising your ankle above the level of your heart will also help fluids to drain away and allow any swelling to subside.
Therapeutic exercises such as “writing the alphabet” with your toes are another important aspect of the early rehabilitation phase. In addition, the American Physical Therapy Association also now recommends manual therapy. This is a technique whereby the ankle is gently moved and massaged by a physiotherapist to reduce swelling and improve ankle and foot mobility.
2. The progressive loading phase
In this later recovery phase, the emphasis is on improving flexibility, increasing muscle strength, and enhancing balance and coordination. The aim is return the limb to its previous functional level and to minimize the chance of a recurrence. This can be achieved by:
Again, this involve gentle joint mobilization and manipulation to improve ankle flexibility especially dorsiflexion (your ability to raise your forefoot up, higher than your heel).
Therapeutic Exercises and Activities
There are a number of weight-bearing exercises that can help to improve muscle power, coordination and balance e.g. standing on one leg on a wobble board or ankle disk. These therapeutic exercises are crucial to avoid a second ankle sprain and chronic ankle instability. (The risk of a repeat ankle sprain is very real and has been estimated to range from 30% to 80%.)
Activities and training which are sport-specific
If you’re a pro athlete, then you would need special exercises tailored to your own sport, to help you reach optimum fitness.
To ensure the best possible result, your ankle rehabilitation program should be individually designed and supervised by a qualified health professional such as a doctor specializing in podiatric or sports medicine, or a physical therapist.
And finally, just because you’ve had a great ankle rehabilitation program and your ankle feels like it's brand new, it doesn’t mean you should be negligent about the “common sense” habits such as warming-up properly, wearing the right footwear, and avoiding wet or uneven surfaces. Wearing an ankle brace is another excellent way to avoid a recurrence of an ankle sprain.
WHEN TO SEE A DOCTOR
That said, it is also essential to know the red flags that indicate your “sprained” ankle may actually be fractured. If you have any of the following features, you must see a doctor immediately –
- If you experience severe unbearable pain
- If you heard a popping sound when you injured your ankle
- If the ankle looks distorted
- If you can’t bear weight on it at all
So there you have it, the fundamentals of the most effective ankle sprain rehab program. Following the above steps will have you back on your feet in no time!