All it takes is the smallest lapse in concentration or misstep and over you go. There’s immediate pain, often an audible crack or pop, swelling and sometimes a rather dramatic bruising that arises in the following days.
Like all injuries, ankle sprains can differ in severity depending on the amount of tissue damage that occurs. Minor strains may involve only one ligament with minimal ankle dysfunction while the more severe injuries can damage multiple ligaments, could include a fracture and result in much higher levels of dysfunction.
We use a grading system when we are assessing these injuries
Grade 1. Mild pain with no actual ligament tearing. No bruising and no ankle instability. Able to weight bear. Approx 1-3 week recovery*
Grade 2. Partial ligament tear. There will be swelling and possible bruising. Slight pain with walking and weight-bearing. Approx 2-6 weeks recovery*
Grade 3. Full tear. Severe pain, swelling and bruising. Considerable instability and loss of function of the ankle. Often unable to weight bear. Approx 10-12 weeks recovery*
* These are rough guidelines. Recovery time can vary between individuals and can be influenced by how your injury is managed.
Many people might be familiar with the acronym RICER - Rest, Ice, Compression, Elevation, Referral. I personally prefer the idea that soft tissue injuries need PEACE and LOVE.
In the first 24-48 hours, your ankle sprains need PEACE
P - Protection. Try to avoid further aggravation of damaged tissues by unloading or restricting movement initially. This will depend on the degree of the injury. Higher graded sprains will require a little more protection in the early stages. You can use pain as a guide as to when you can begin gentle loading.
E - Elevation of the ankle above the level of the heart to assist with swelling management
A - Avoid anti-inflammatories. In the acute period, such medications can be detrimental for longer-term tissue
C - Compression via taping or a compression bandage can be helpful with swelling management
E - Education regarding an active approach to recovery especially when it comes to the benefits of early loading for tissue healing. I think its really important to set realistic expectations for recovery time with clients suffering acute injuries such as an ankle sprain.
From 48 hours onwards add in a little LOVE
L - Load. This doesn’t mean resume all types of exercise straight away but gradual mechanical stress is important for tissue remodelling and strengthening. Your physio should guide you with appropriate exercises during this phase.
O - Optimism. Yes, the brain plays a role in the recovery of any injury. Factors such as fear avoidance, catastrophising or depression can potentially be barriers to optimal recovery.
V - Vascularisation. This refers to cardiovascular styles of exercise which should be commenced as soon as tolerated as this can assist with increasing blood flow to the injured tissues. I would encourage pain-free options such as an exercise bike.
E - Exercise. Targeted strengthening, mobility and proprioception exercises are all important to prevent reoccurrence. Exercises should be progressed as pain allows.
If you do suffer from an acute ankle sprain I’d encourage you to visit your Physio for a proper assessment. They should guide you through the initial stages of management before introducing a graded strengthening and rehab program. If all your Physio does is use machines, give you acupuncture and ices your ankle please (may I politely suggest) you find yourself a new Physio that will focus on an ACTIVE RECOVERY.