Sprained ankles: medical information, treatments and how to stop getting them?

[The_Great_Philosopher]

English soccer player Wayne Rooney went over on his right ankle and sprained it in a game last night, which he has done 7 times in his career. He’ll be out for a few weeks. Here’s a video of how he did it. I’ve been having the same problem, and I always do it the same way he did: in the last 2 years I’ve sprained both ankles a few times, always by rolling onto the outside of my foot while landing from a jump or running. They range from very mild injuries that are OK again within a few hours, to the sprain I’m recovering from right now, which swelled up, bruised extensively and is still not recovered after 5 weeks (I really wrenched it, pretty painful).

1. Does anyone have any good sites that offer detailed medical information about ankle sprains? Anyone studying medicine or sports medicine? For the recent injury my ankle was swollen across the front, but I also had bruising from the heel up and swelling a third of the way up my calf. I think I sprained the calcaneo-fibular ligament and the anterior talofibular ligament, but I’m not sure.

2. Anyone have advice for treatment? I know there’s “Rest, Ice, Compression, Elevation” but anyone want to expand on those or offer other suggestions? Would physiotherapy make a difference in how quickly it heels, or reduce the likelihood of it happening again?

3. Any advice of how to stop it happening so often? I’m thinking of wearing ankle supports during sport from now on. But the fact it’s happening so much to a world-class, professional soccer player with a team of medics at his disposal sadly makes me think there’s not much anyone can do to stop it.

[Deeg]

@The_Great_Philosopher

3. Any advice of how to stop it happening so often? I’m thinking of wearing ankle supports during sport from now on. But the fact it’s happening so much to a world-class, professional soccer player with a team of medics at his disposal sadly makes me think there’s not much anyone can do to stop it.

There are different solutions for bracing your foot to prevent ankle sprains (like this). My understanding, however, is that immobilizing your ankle puts more strain on your knees which increases the chance of a knee injury. Since knee injuries are so much more debilitating than ankle injuries only soft ankle braces are used.

[dracoi]

I’m a lot like you when it comes to ankle sprains. It’s been almost three years since one really put me down and I’m way overdue for another major sprain that will keep me in bed for two weeks.

the only advice I have on top of the standard RICE is to do at least a little bit of movement with it as it heals. Move the foot in circles in both directions, and side to side, and up and down You don’t want to make movements that hurt, but movements that feel uncomfortable are good. The idea (according to doctors who have recommended it) is that you’re doing some mild stretching that will help to make sure you still have the full range of motion after you’re done healing.

As for avoiding it? I’ve stopped jumping, for one, and stick to exercises and sports that keep at least one foot on the ground all the time. I got a nice pair of hiking boots that provide some ankle support and so I use those when I’m out in nature or working in the yard.

[Iggins]

I play basketball, so my ankles have sprained many times. I went to a doctor for my worst sprain (I thought I may have fractured or ruptured something). He said that for severe sprains, besides RICE, keep the ankle moving, as mentioned above; I rode a stationary bike.

I wore an Aircast AirSport brace for a year after I was able to play again, which took 6-8 months itself.

In an unrelated issue, I have herniated discs that caused some nerve damage in my left leg, and I now have mild drop-foot. Whenever I play now, I wear an Aircast A60, which keeps me from rolling the ankle easily, but allows good range of motion.

(This is NOT a paid advert for Aircast!)

[The_Great_Philosopher]

No recommendations for physiotherapy then? What would a physiotherapist even do, massage it?

Speaking of that, I’ve heard that the things to avoid are “HARM” - heat, alcohol, running/exercise and massage. Is that just for the first 48 hours? I’m trying to get back to running now. I’m doing short jogs at a low speed on a treadmill (which has more ‘give’ than concrete). It doesn’t hurt but it’s a little uncomfortable on the ankle. That’s OK to start with right? I’m not crippling it more?

[Mama_Zappa]

@The_Great_Philosopher

No recommendations for physiotherapy then? What would a physiotherapist even do, massage it?

Speaking of that, I’ve heard that the things to avoid are “HARM” - heat, alcohol, running/exercise and massage. Is that just for the first 48 hours? I’m trying to get back to running now. I’m doing short jogs at a low speed on a treadmill (which has more ‘give’ than concrete). It doesn’t hurt but it’s a little uncomfortable on the ankle. That’s OK to start with right? I’m not crippling it more?

I’d be curious to see if a PT could do anything for it - my thinking is there must be ways of retraining your gait and improving balance. Of course, the angle I’m coming from is that I tend to trip over my own feet while walking, rolling the foot outward and spraining the ankle (my right ankle is currently taped from just such an escapade).

I’m already doing PT for other issues and chatted some with the therapist the other day. There are balancing / strengthening exercises they can work on, I just need to meet with my primary care doc to see about getting that ordered.

BTW - I gather “physiatry” is the specialty which deals with rehabbing such injuries. I may ask to be referred to a physiatrist to deal with this (in my case it’s a chronic and worsening syndrome of some sort).

[Swallowed_My_Cellphone]

@Mama_Zappa

I’d be curious to see if a PT could do anything for it - my thinking is there must be ways of retraining your gait and improving balance.

This is exactly what my treatment was after a bad ankle sprain. The story goes like this: I smashed my toe. To walk without my toe hurting, I walked funny. Result of walking funny was weird gait. Weird gait led to really bad ankle sprain while running. It was a horrible chain reaction, I tells ya!

Post-sprain physio helped strengthen the muscle groups that had gone wonky from walking funny, so I had a healthier gait that no longer put weird stress on my ankles and hip. The exercises also helped strengthen my then-wussy ankles and all sorts of muscles responsible for proper balance.

For awhile, I did have to learn how to properly tape my ankles. As Deeg mentioned if you immobilize stuff unncessarily, and or interefere with normal body mechanics too much, it can make a mess of other body parts (that’s why my hip was hurting after I hurt my ankle).

When taped properly, you can still use your ankle normally, but you have added support that helps to prevent over-pronation or over supination. I could run, rock climb, and play squash with my ankle taped and I still had pretty much my full range of motion, but it resisted going over too far.

Once my physio exercises really kicked in and made a difference, I was able to stop taping altogether.

[Enright3]

A PT can help you strengthen your ankle. One thing you’ll need to do is to get your balance back. Your brain makes millions of micro adjustments in balance every second, and when you sprain your ankle that has to be retaught.
I sprained my ankle severely last August. I still can’t run on it. It doesn’t hurt anymore except on rainy or cold days. How severe? Well, I was in a cast for two months. I had a history of spraining that ankle much like the examples above. In this case I was jogging and stepped on uneven asphalt and rolled my ankle. Not mention the damage to my opposite knee where I crashed and burned.
Check it out here! http://picasaweb.google.com/EnrightMcC/AnkleInjury#

[si_blakely]

I saw something recently that suggested that exercising joints on unstable surface (wobble pad or similar) helps recovery and can prevent further injuries. You may like to try using one - there are a few exercise options on the web.

Si

[Shot_From_Guns]

RICE is good. (Some smarmy assholes will tell you it’s PRICE, with the P standing for Prevention. Please feel free to smack 'em one.) If you’re taking painkillers, I generally go with ibuprofen, since it’s an anti-inflammatory as well as an analgesic.

When the ankle is healing, getting some resistance bands (not sure if this is the right word–the things I’m thinking of are broad, flat strips of stretchy material) and doing stretching exercises with them, flexing in various directions. Writing the alphabet with your big toe is a good way to get a lot of weird angles in. A physical therapist can probably suggest more ideas, including things to help strengthen the ankle and improve your balance (I vaguely recall something involving exercises while standing on a pillow, but I’m **not **recommending that 'cause even if I’m right, it sounds like the kind of thing that could result in another sprain if done wrong.)

The biggest problem with a sprained of any kind is that left to its own devices, without additional therapy, it will generally heal *weaker *than it was before. (Contrast this to a broken bone, which, once set, will heal to be stronger at the point it was broken.) When you stretch or tear the ligaments or tendons, you lose flexibility, strength, and sensation, which has to be rebuilt or compensated for, and that doesn’t generally happen on its own.

My cite: Not a doctor in any way, shape, or form, but I spent over a decade doing Irish dance and a had a lot of sprained ankles.

[Iggins]

@si_blakely

I saw something recently that suggested that exercising joints on unstable surface (wobble pad or similar) helps recovery and can prevent further injuries. You may like to try using one - there are a few exercise options on the web.

Si

This is a very good point. When I was doing physical therapy for my back injury, one of the exercises for my “numb” leg was a wobble pad, or one of those hemisphere platforms.

[starryspice]

As far as treatments go, if you want to go beyond RICE to aid the healing process, you could try putting a comfrey salve onto the sprained area. Comfrey is a healing herb, and a double-blind study showed that it can reduce swelling and pain compared to placebo, as well as improve ankle mobility (http://www.ncbi.nlm.nih.gov/pubmed/15500257?dopt=Abstract).

(Note that comfrey is not particularly safe for internal use, though some might argue about this. If you do decide to use it, use externally only, as a lotion, oil or salve.)

I hope this is useful!

[si_blakely]

@starryspice

As far as treatments go, if you want to go beyond RICE to aid the healing process, you could try putting a comfrey salve onto the sprained area. Comfrey is a healing herb, and a double-blind study showed that it can reduce swelling and pain compared to placebo, as well as improve ankle mobility (http://www.ncbi.nlm.nih.gov/pubmed/15500257?dopt=Abstract).

I don’t know if it is available in the US, but the rub sold as Natures Kiss (in the UK) or AntiFlamme (in NZ) is brilliant - it contains Arnica and Peppermint, and is ideal for bruises, aching muscles, and sprains. I was put on to it by a physiotherapist in NZ years ago, and have been using it ever since - but only sparingly as it is quite pricey here in the UK. I have tried other Arnica based rubs over the years, but none have been even close to Antiflamme for effect.

Si

[Batsinma_Belfry]

I use a mini trampoline to strengthen my ankles. I don’t jump on it, just kind of bounce without lift off.

I think ankle weights would just strengthen your legs without giving the ankle muscles enough freedom of movement.

[Ionizer]

@Shot_From_Guns

The biggest problem with a sprained of any kind is that left to its own devices, without additional therapy, it will generally heal *weaker *than it was before. (Contrast this to a broken bone, which, once set, will heal to be stronger at the point it was broken.) When you stretch or tear the ligaments or tendons, you lose flexibility, strength, and sensation, which has to be rebuilt or compensated for, and that doesn’t generally happen on its own.

IANAD, but have been ‘imaging medically’ for several decades along with listening to/passing along ~Ortho advice and recommendations per the physician, etc…but this is just 'general info (to be clear, OK?) and circumstances vary for each injury (typical disclaimers apply)

Sprains do usually weaken a joint’s stability, especially when lig’s/tendons are torn even a little bit (even when non-visualized until stress-views obtained or whatnot), and repeated sprains often keep worsening the situation. Again, not always but usually, from those patients I have known through recovery and/or reinjury anyways. A weakened joint (by soft-tissue injury, per se) should be strengthened muscularly in most situations, and this is where PT is a 'positive, but not the only reason either. It depends. I’ve also seen plenty of injuries from favoring the uninjured foot/leg (or from hopping around on one leg and falling, etc), so be careful.

If RICE (as above) does not give improvement after a reasonable period (~coupla weeks+, or more sometimes), then get some professional advice and requisite imaging - not rare to have avulsion fractures with ‘bad sprains’, either. And often an assumed sprain is really a fracture (!) - seen LOTS of folks wearing tight boots and ACE wraps a week or more post-trauma saying “know it ain’t broken, but can I have some painkillers for the sprain 'til it heals a bit more?”. A couple X-rays later and I am applying the plaster/fiberglass with a smirk behind my smile. It can be very humbling for someone assuming too much (not saying this is the case here, of course!).

Most of all, respect the pain. It does mean something is wrong Repeated sprains (that are known to NOT be fractures) should probably be evaluated by ‘specialty physician’ for overall strength and future prevention along with recommended course of action (as everyone is a different situation, of course). Like how most old football players have bad knees from being injured repeatedly, right???

And now, after rereading the OP (still really bad after 5 weeks and extensive bruising)…sure it ain’t broken, Philo!!! If not already done, get some med attention (and probably required imaging, be it X-ray or MRI). I mean it, OK? That sounds out of bounds for a typical sprain, IME - but again, not a Doc (or physician). To each their own, always. Best of luck with future…hope it works out for ya!

[Eats_Crayons]

@Batsinma_Belfry

I use a mini trampoline to strengthen my ankles. I don’t jump on it, just kind of bounce without lift off.

Bosu balls are good for that too. Stand on one foot for balance and strengthening.

[The_Great_Philosopher]

@Ionizer

And now, after rereading the OP (still really bad after 5 weeks and extensive bruising)…sure it ain’t broken, Philo!!! If not already done, get some med attention (and probably required imaging, be it X-ray or MRI). I mean it, OK? That sounds out of bounds for a typical sprain, IME - but again, not a Doc (or physician).

I wouldn’t say it’s “really bad” any more. The bruising’s completely gone and the swelling’s mostly gone down. I can walk normally and I’ve just stated jogging again on the treadmill. I don’t think I’m tough enough for that to be broken. I probably should have got it checked initially though, it could have been a minor fracture.

I’ll look into the wobble pad/ankle weight exercises to help the recovery and I’ll get some of those compresses in case it happens again. Thanks for the advice.

[Ionizer]

Good to hear its not as bad as what I assumed. I’ve seen too many assumptions of sprains leading to longer-term problems over my years. But honestly, if you are easily and somewhat regularly reinjuring the same joint/structure, it likely has been damaged/weakened ‘permanently’ and can/will lead to much worse injury the next time (like pro athletes have happen regularly)… If such happens again to the joint/area, I highly recommend further investigation by good physician, especially if you wish to be active/weight-bearing upon said area later in life Your description of symptoms is very similar to what I heard from similarly injured folks I dealt with when I was in Ortho environs, and more often than not there was an issue to be dealt with professionally. YMMV, of course…but always remember that ‘feces occur’, so to speak.

In no way am I trying to sound lecturing…but if swelling is *still *present…and still painful after what you feel is long-enough-for-healing…get it looked at sooner rather than later. Injuries to other structures from compensating for a prior injury are not unusual (as said in other posts) and can really affect the future activity of a person. 'Nuff said - you ain’t an idiot, obviously. Take care of what ya still got… If I did not have so many memories of self-diagnosed ankle issues being wrong, I would not be typing this out, for sure. I realize I am likely stretching the ‘medical advice’ window, but there it is for you. (ignorance fought??)

An ounce of prevention and all that, right? Good luck!

[Enright3]

@si_blakely

I saw something recently that suggested that exercising joints on unstable surface (wobble pad or similar) helps recovery and can prevent further injuries. You may like to try using one - there are a few exercise options on the web.

Si

I’ll jump in and agree on this one too. After I hurt my ankle several of the various therapies was related to gently putting it on non-flat or non-stable surface. Either a wobble board, or a simple 2 x 6 board that I put on carpet and tried to balance on. First with eyes open, then with eyes closed. I was amazed at how your balance changes with your eyes closed. I was instructed to stand on one foot. When I could do that for a minute; I had to try it with my eyes closed. Couldn’t do it for more than about 5 seconds. So weird.

MBT shoes, and now Sketcher Shape-Ups (rocker shoes) try to mimic walking in the sand to strengthen your legs, improve your posture and everything else. I’m thinking about buying a pair.

[Mama_Zappa]

@Enright3

I’ll jump in and agree on this one too. After I hurt my ankle several of the various therapies was related to gently putting it on non-flat or non-stable surface. Either a wobble board, or a simple 2 x 6 board that I put on carpet and tried to balance on. First with eyes open, then with eyes closed. I was amazed at how your balance changes with your eyes closed. I was instructed to stand on one foot. When I could do that for a minute; I had to try it with my eyes closed. Couldn’t do it for more than about 5 seconds. So weird.

MBT shoes, and now Sketcher Shape-Ups (rocker shoes) try to mimic walking in the sand to strengthen your legs, improve your posture and everything else. I’m thinking about buying a pair.

I walked past a store that sold the Skechers just yesterday and was briefly tempted to try on a pair… then I reminded myself that with my knee issues and gait issues, adding something that routinely changed my gait (as opposed to wobble-board training which is under controlled circumstances) would most likely lead to unpleasant results for me.

Re eyes closed: yep. The eyes really do support the balance system - if your ears are messed up you’ll be getting confused signals and your brain “won’t believe your eyes” and you’ll wind up falling / hurling… but if your ears are working reasonably well, the eyes seem to complement the ear signals and fill in the gaps. Even a tactile feedback can help. I remember years ago working with a PT on my knee issues, they did some balance work also and I had to do the standing on one leg. Even gently placing a fingertip on a nearby surface helped the balance quite a bit. I guess because I’d start to tilt a bit, not enough for the ears to yell at me to STAND UP STRAIGHT, but the finger would sense the change in positioning.