Ankle Sprain Injuries and How to Quickly Recover

Oh no! You've rolled your ankle (again). While it may be a drag and while you may have to spend a week or two on the sidelines, there's no reason why this injury should affect you for months to come. Here to explain why and how is Beijing United Family Hospital (BJU) Chiropractor Dr. Steven Darden. 

According to renowned US academic medical center the Mayo Clinic, an ankle sprain is the most common sprain injury. A sprain is an injury to the fibers of a ligament. Ligaments are strong bands of tissue that connect and stabilize bony attachments. For most minor sprains, the RICE anagram is the recommended first line of treatment after an injury for the first 24-48 hours:

Rest the injured limb

Your doctor may recommend not putting any weight on the injured area for 48 to 72 hours, so you may need to use crutches. A splint or brace may also be helpful initially. But don't avoid all activity. 

Even with an ankle sprain, you can usually still exercise other muscles to minimize deconditioning. For example, you can use an exercise bicycle with arm exercise handles, working both your arms and the uninjured leg while resting the injured ankle on another part of the bike. That way, you still get three-limb exercise to keep up your cardiovascular conditioning.

Depending on the mechanism of your injury, your doctor might recommend an X-ray at this time as well.

Ice the area

Use a cold pack, a slush bath, or a compression sleeve filled with cold water to help limit swelling after an injury. Try to ice the area as soon as possible after the injury and continue to ice it for 15 to 20 minutes, four to eight times a day, for the first 48 hours or until swelling improves. If you use ice, be careful not to use it for too long, as this could cause tissue damage.

Compress the area with an elastic wrap or bandage

Compressive wraps or sleeves made from elastic or neoprene are best.

Elevate the injured limb above your heart

Do this whenever possible to help prevent or limit swelling.

Once a fracture has been ruled out, it is possible to start gentle range-of-motion (ROM) exercises to start the rehabilitation process. Ankle sprains can take months to heal to the point of being able to return fully to pain-free sports activities. It is possible to shorten the return to sport time by nutritional considerations and ROM exercises. 

Most ankle sprains are inversion ankle sprains, which means the patient rolls over the foot as the arch moves up. The fibula is moved forward as the ankle talus bone rolls out.

The classification of an ankle sprain ranges from grade I to grade IV based on the severity of functional criteria. There are also phases I-III for the rehabilitation of ankle sprains.

Phase I of rehab for a lateral ankle sprain focuses on decreasing swelling, pain, and inflammation; restoring range of motion; and normalizing gait or walking ability. This is where RICE starts – it kicks off the rehab process as soon as possible after the injury and should be performed three to four times a day for 20 minutes. Gentle range-of-motion movements can also help restore full ROM in a shorter time span depending on the severity or grade (I-IV) of the injury. 

During phase I of rehab, it is nutritionally beneficial to introduce anti-inflammatory supplements such as ginger, turmeric, and garlic (1). Dr. David Seaman, a US chiropractor and nutrition expert who has been a pioneer in the field of anti-inflammatory dieting for improved medical outcomes, also recommends proteolytic enzymes such as bromelain, trypsin, chymotrypsin, and papain. These enzymes come from natural sources such as pineapple and papaya fruits. Clinical studies have found that these proteolytic enzymes can reduce pain and inflammation associated with acute injuries (2).

During phase I of rehab for less-severe sprains (grades I and II), an ankle brace and crutches may be necessary for pain-free gait. For severe sprains (grades II and III), a walking boot may be required.

Some ROM exercises I have found helpful to speed up the healing time for ankle sprains are mobilization with movement (MWM) exercises along with gentle ROM and targeted isometric exercises. Joint taping can also help with initial joint stabilization.

Moving into phase II exercises, we can work on regaining full ROM. Here, we continue with joint mobilization exercises as well as various ankle joint adjustments to improve pain-free ROM. Here, flexibility exercises with the gastrocnemius/soleus (calf) muscle complex and the Achilles tendon are introduced. Strengthening and proprioception (balance) exercises are essential to progressing through phase II of rehab.

Phase III of rehab focuses on a safe return to the patient’s previous level of activity (3). 

From here, the main focus of rehab is prevention of re-injury, so taping and bracing might be necessary for return to sport activity.

So, an ankle sprain need not take several months to return to pain-free walking and sporting activities. We can take a proactive approach right away to decrease the ankle sprain injury time. The first step is RICE (rest, ice, compression, and elevation). Then, gentle ROM exercises can be implemented depending on the severity of the tearing of ligament fibers. We also need to consider a nutritional approach using natural anti-inflammatory supplements as well as other protective and healing vitamins and minerals. Dr. Seaman has many suggestions for further reading (see the references below). We can also implement mobilization with movement exercises, rehab, and chiropractic adjustments to further decrease rehabilitation time. 

As always, see a healthcare practitioner after an acute injury and you can take a proactive approach to speeding up the healing time associated with your injury.

Dr. Steve Darden has over two decades of clinical experience. He specializes in upper and lower-back pain, sciatica, fibromyalgia, arthritis, and sports injuries. He also uses chiropractic adjustments, ultrasound, medium-frequency electrical stimulation, and rehabilitation exercises as treatment modalities. 

Interested in learning more about how you can reduce inflammation and boost your immune system through chiropractic sessions that target the ICV? Make an appointment with Dr. Darden by calling the BJU Service Center at 4008-919191.

References

1. Seaman, DR. A sports nutrition: a biochemical view of injury care and prevention. In Hyde TE, Gengenbach MS. Eds. Conservative management of sports injuries. 2nd ed. Boston: Jones and Bartlett; 2007: p.1067-1092. 

2. Bucci, L. Nutrition Applied to Injury Rehabilitation and Sports Medicine. Boca Raton, Fla: CRC Press, 1995

3. Hammer WI. Functional soft-tissue examination and treatment by manual methods. Boston: Jones & Bartlett; 2007: p.755.

• Want to learn more about Dr. Darden? Read our Q&A with him here!

• Ready to start exercising as the days get warmer and longer? Read our guide to picking up a new outdoor sport without picking up a new injury. 

• Think you may need to see a physiotherapist? BJU Physio Ying Swee Ong explains how physiotherapy can help you.