Healing sprained ankles
by Nathan Wei, MD, FACP, FACR
Nathan Wei is a nationally known board-certified rheumatologist and author of the Second Opinion Arthritis Treatment Kit. It's available exclusively at this website... not available in stores.
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A sprained ankle is a very common injury. It's estimated that more than 20,000 people a day sprain their ankle.
The bones that make up the ankle are held together with tough ligaments. They protect the ankle joint from abnormal movements-especially twisting, turning, and rolling of the foot.
A ligament is elastic. Ligaments usually stretch and then go back to their normal position. When a ligament is forced to stretch beyond its normal range, a sprain occurs. A severe sprain causes tearing of fibers.
Ankle sprains occur when the foot twists, rolls or turns beyond its normal range of motion.
If there is a severe in-turning or out-turning of the foot relative to the ankle, the ligaments stretch beyond their normal limits. If the force is too strong, the ligaments can tear. Pain and swelling result.
The amount of force determines the grade of the sprain. A mild sprain is a Grade 1. A moderate sprain is a Grade 2. A severe strain is a Grade 3.
Grade 1 sprain: Slight stretching and some damage to the fibers of the ligament.
Grade 2 sprain: Partial tearing of the ligament. If the ankle joint is examined and moved in certain ways, looseness of the ankle joint is noted.
Grade 3 sprain: Complete tear of the ligament. The examiner notes instability.
If there is a complete tear of the ligaments, the ankle may become unstable and cause damage to the ankle joint.
An MRI (magnetic resonance imaging) scan can determine the extent of injury.
Walking is difficult because of the swelling and pain. Crutches are indicated in the first two to three days following a sprain. Usually swelling and pain will last two days to three days. Air splints also are helpful.
Grade 3 injuries will require immobility with casting for 3-4 weeks to allow healing.
Even less severe injuries require about four weeks to six weeks. However, with less severe injuries, rRange of motion exercises early can help with healing if there isn't a complete ligament disruption. The motion aids in proprioception as well as reduction of stiffness. Even if an ankle has a chronic tear, it can still be functional because tendons help with stability and motion.
For a Grade 1 sprain, use R.I.C.E (rest, ice, compression and elevation):
•Rest your ankle by not walking on it.
•Ice should be immediately to reduce the swelling. It can be used for 20 minutes to 30 minutes, three or four times daily. Combine ice with wrapping to decrease swelling and pain.
•Compression dressings, bandages or ace-wraps immobilize and support the injured ankle.
•Elevate the ankle above the level of the heart for the first 48 hours after the sprain.
For a Grade 2 sprain, the RICE guidelines can also be used. Allow more time for healing to occur. The doctor may also use a device to immobilize or splint the ankle.
A Grade 3 sprain can be associated with permanent instability. Surgery is rarely needed. A short leg cast or a cast-brace may be used for two weeks to three weeks.
Rehabilitation is used to help to decrease pain and swelling and to prevent chronic ankle problems. Ultrasound and electrical stimulation may be used to help with pain and swelling.Rehabilitation exercises may involve active range of motion or controlled movements of the ankle joint without resistance. Water exercises may be used if land-based strengthening exercises, such as toe-raising, are too painful. Proprioception- position sensing- training is very important, as poor propriception is a major cause of repeat sprain and an unstable ankle joint.
All ankle sprains recover through three phases:
• Phase 1 includes resting, protecting the ankle and reducing the swelling (one week).
• Phase 2 includes restoring range of motion, strength and flexibility (one week to two weeks).
• Phase 3 includes gradually returning to activities that do not require turning or twisting the ankle and doing maintenance exercises. This will be followed later by being able to do activities that require sharp, sudden turns such as many sports.
Non-steroidal anti-inflammatory drugs (NSAIDs) may be used to control pain and inflammation.
The best way to prevent ankle sprains is to maintain good strength, muscle balance and flexibility.
• Warm-up before doing exercises and vigorous activities
• Pay attention to walking and running surfaces
• Wear good shoes
Prophylactic use of ankle braces when playiung sports are also helpful.
Chronic ankle sprains occur when initial ankle sprains are not treated appropriately. Activities that tend to make an already sprained ankle worse include stepping on uneven surfaces, cutting actions and sports that require rolling or twisting of the foot, such as trail running, basketball, tennis, football and soccer.
Possible complications of ankle sprains and treatment include abnormal proprioception that causes a re-injury. If this happens, chronic instability occurs.
Surgical treatment for ankle sprains is rarely required. Surgery is reserved for injuries that fail to respond to non-surgical treatment, and for persistent instability after months of rehabilitation and non-surgical treatment.
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