In the second part of this series, Chartered Physiotherapist Rebecca Wyatt advises on managing your ankle sprain.
So far we have identified the anatomy which could be injured during an ankle sprain and have outlined the importance of seeking appropriate initial medical and physiotherapy intervention.
In the early stages of an ankle sprain it is vital that the acute inflammation and swelling is managed. For this you need to remember to RICE:
Rest– from usual activities and prolonged walking. Your ankle needs chance to heal and rest provides the environment for this. Without rest further injury, inflammation and pain can occur.
Ice– to reduce the inflammatory response, swelling and pain generated by the injury. We advise a maximum of 20minutes each 1-2hours for the first 48 hours after injury. If it is too cold you will be less inclined to keep it there so wrap it up in a tea towel (or two!) This also prevents any ice burns being sustained.
Compression– this aims to help reduce swelling and provide a sense of comfort and security to the ankle. Swelling will always occur but managing it with a light, elastic bandage can help prevent excessive swelling which can lead to reduced blood flow to the area.
Elevation– the ankle needs to be elevated when resting, preferably with the ankle above the level of the hip. This aims to help reduce the swelling.
After an assessment with a Chartered Physiotherapist, you will be given plenty of advice as well as exercises to do at home. These are important to do as they function to further help with controlling swelling, increase range of movement and to strengthen the ankle.
In the initial stages it is likely that the exercises will mainly be non-weight bearing, and they may be sore to do. An example may be scrunching a piece of paper under your toes to work the arch of your foot or turning the big toe inwards so you can see the sole of your foot. Exercises are progressive and your Physiotherapist will advise how many and how often you should be doing.
On occasions a semi-rigid ankle brace or lace up brace or even taping may be advised by a Physiotherapist; however this is specific to each individual and any hobbies or sports they may do. Once you are able to walk without a limp physiotherapy treatment works towards mobilising any stiffness within the ankle or foot, addressing any soft tissue restrictions and beginning either sport-specific or work-specific exercises to enable a return to your previous activities.
According to Dutch clinical guidelines in 2012 (reference below) symptoms can continue to differing degrees depending on the severity of injury and the individual for up to 18 months. Their advice supports the work of a physiotherapist in rehabilitating ankle sprains, with exercises focussing on: strength, balance, range of movement, proprioception* and prevention of recurrence.
Physiotherapy treatment for ankle sprains can occur at any time after the injury. Obviously it’s more preferable in the early stages for thoroughness and to identify any possible complications, but even a patient who is prone to recurrence or near misses will benefit.
The Chartered Physiotherapists Lilliput Health are able to provide thorough assessment and rehabilitation of all ankle sprains and injuries. If you would like further information or to book an appointment, call the team on 01202 725090 or via email at email@example.com
Cryotherapy for acute ankle sprains: a randomised controlled study of two different icing protocols, Br.J.Sports.Med. August1,2006 40 700-705.
Kerkhoffs et al (2012) Diagnosis, treatment and prevention of ankle sprains: an evidence based clinical guideline. Br.J.Sports.Med. 46, 854-860.
Sunitha, J (2010) Cryotherapy-A review, Journal of Clinical and Diagnostic Research [serialonline] 4, 2325-2329.
*proprioception is the awareness of the body or a joint in space when either static or in motion.