So I was wondering what to post this week and was coming up blank, however every cloud has a silver lining as I am trying to remind myself today, whilst nursing my painful ankle. Yesterday I took my son to the local pitches near where I live in Edinburgh, to let him run around and let off some steam (8 hours solid of watching TV and playing video games isn’t really helping him get the 1 hour of aerobic activity a day that’s recommended by the NHS for children!).
Within about 5 minutes, after a slightly overly optimistic stretch for the ball I felt the outside of my foot hit ground and be forced inwards (inversion for those interested in details) significantly more than it should have been. I felt a wee ‘pop’ and then a few seconds later a lot of pain. After sitting on the ground, trying not to use any language I was going to have to explain away to his mum, I began wondering a) have I broken it? and b) how am I going to get home? The initial pain started to subside and I realised that at least I had something to write about!
At this point my son helpfully asked “dad why aren’t you playing with me”, which prompted me to start doing something about the situation.
The initial priority was to decide how bad the injury was, so I went through a quick checklist. I was able to move the ankle actively, there was no bony tenderness around the ankle and I could put weight through it. I was therefore happy that there hadn’t been any fracture or dislocation. Please remember I’m a physio with over 15 years of experience so I’m happy to make that decision myself! If you have any doubt about the degree of injury you or anyone else has sustained, its better to err on the side of caution and visit A&E or minor injuries.
Since I’d ruled out fracture or dislocation I was left with the thought that my injury was some kind of soft tissue injury. I knew that my ankle had been forced into inversion and planter flexion (i.e. it had been forced inwards with my foot pointed down), I have had a long history of ankle sprains on the same ankle in the past, I had felt a “pop” and the ankle was immediately swollen (i.e. I had damaged something with a blood supply). Therefore it seemed pretty likely that I had sprained one or more of the ligaments on the outside or lateral aspect of the ankle. So far so good. This is extremely common; 70-85% of ankle sprains are of the lateral ligaments and given that my foot was pointed down or planterflexed when it rolled in it seemed likely that it was my anterior talofibular ligament or ATFL that had been sprained. It’s estimated that around two thirds of all ankle sprains affect the ATFL. I was sure that while my ankle was extremely sore, I didn’t need to go to A&E, it was a self limiting problem that would improve with appropriate management and I would get good resolution of symptoms eventually (if I do my rehab!). My son was happy that we didn’t need to go to hospital, as by now his main concern was he wanted to get home as soon as possible so he could have lunch!
So what to do now, well I wasn’t going to be able to do anything helpful sitting down at the pitches, so the first priority was to walk home very slowly. Once there I took adequate pain relief which luckily I had in the house, put a compression bandage on the ankle to apply even compression, elevated my ankle and applied ice intermittently. I also got up and moved around every hour or so.
Today one of my colleagues applied a taping to it, I’ve continued to take adequate pain relief and I’m gradually increasing the amount of walking I am doing, as well as starting some early range of movement exercises. As the swelling and pain settles I’ll steadily progress the rehabilitation I am doing; to include strengthening, stretching, proprioceptive/balance exercise when appropriate in terms of soft tissue healing timescales. While loading appropriately optimises healing, excessive overloading or doing the wrong thing at the wrong time can cause problems.
And there you have it, what to do if you have an acute sprained ankle!!! Initially decide – do I need to go to A&E or minor injuries to rule out fracture or dislocation? If you decide that it is a soft tissue injury(STI) or you have been to A&E and you’ve been told that you have a STI, then the priority is to manage the pain appropriately, Rest and Elevate the injury, apply Compression and Ice. This is easily remembered as RICE (although I would add in appropriate pain relief as well).
Once the initial 48-72 hours is over, you then need to steadily and progressively recover range of movement, strength, balance and function; while respecting soft tissue healing timescales. This is something that physiotherapy can help with and certainly something I’ll be doing myself over the next 6-8 weeks. On a closing note, I mentioned earlier that I have a history of ankle sprains on that side in the past. There is good evidence that ankle sprains are often recurrent and that appropriate rehabilitation, especially proprioceptive or balance exercise, can be effective. Therefore, if you have a sprained ankle, it is not enough to just wait for the pain to settle and then return to sport or activity, you need to restore full range of movement, power and balance at the ankle to reduce the risk of reoccurrence when you return to normal activities.
If we can help you with your sprained ankle or indeed any injury sporting or otherwise, please contact us to book an appointment in our clinic in Eskbank near Edinburgh. We can normally see you within a few days and often on the same day. We are open from 8 am until 8 pm so we can see you at a time of your convenience.