Ankle sprains are common in athletes, but that doesn’t mean they’re not serious. An ankle injury can take you out of the game for a week or more if not treated properly. Get back on your feet faster by following these treatment tips for healing a sprained ankle ASAP.
Sprained ankles make up about a quarter of the injuries seen in sports medicine. They may not be life-threatening, but if you’re an active person staying off your feet for a couple of days can be a lifestyle change. It’s important to administer first aid immediately and start rehab exercises as soon as possible. The way you treat your ankle sprain in the first 24-72 hours can make all the difference in a quicker recovery and lower risk of health complications in the future.
What Causes an Ankle Sprain?
According to the American Orthopaedic Foot and Ankle Association, people who play sports are at higher risk for sprains. But you don’t have to be an athlete to experience a rolled ankle. Anything that causes your ankle to roll, twist, or bend at an abnormal angle can cause a mild sprain or worse. The Mayo Clinic finds that other common causes– both in sports and otherwise- include walking on uneven surfaces, falling, landing awkwardly on your foot after jumping or pivoting, or having another person or object land on your foot.
These sports injuries are most often reported in tennis, basketball, football, soccer, volleyball, and cross country running.
Even if you’re not an athlete or weekend warrior, you might be at a higher risk of sustaining a sprained ankle if you:
- commonly walk on uneven surfaces
- are in poor physical health
- wear improper shoes
- or have suffered foot and ankle injuries in the past
Anatomy of the Ankle
The ankle is a complex joint, made up of bones, tendons, and ligaments, which are the tough bands of tissue that run along the inside and outside of your ankle that hold the bones together. They help to stabilize the joint. An ankle sprain occurs when you stretch or tear these ligaments by forcing them into a position that is beyond the normal range.
If foot and ankle health is not maintained properly it can cause secondary injuries higher up the chain. That’s why it’s so important to treat an ankle sprain seriously, even if it means staying off your feet for a few weeks.
Types of Ankle Sprains
Our feet tend to turn inward as we walk, so sprained ankles most commonly happen when the ankle rolls inward, resulting in lateral ankle sprains. These occur when you stretch or tear the ligaments on the outside of your ankle. Medial ankle sprains are less common. This is when you injure the ligaments on the inside of the ankle. A syndesmotic ankle sprain- or high ankle sprain- involves the tearing of the ligaments above the ankle. Though this type does not occur as often, it can be combined with lateral and medial sprains and often takes months to heal.
Grade 1 Sprains
Ankle sprains are classified by the severity of the ligament damage. With a grade 1 sprain, the ligaments are stretched but not torn. You may have mild pain and swelling but should not experience any loss of mobility or instability. You should not need to see a doctor unless you desire medical advice. With a minor sprain, you can begin physical therapy immediately and should be back in action in less than a week.
Grade 2 Sprains
A grade 2 sprain entails some tearing of the ligaments, but not a complete separation. You may experience swelling and pain that ranges from moderate to severe, as well as some joint instability. With this type of injury, you should start by keeping the ankle completely immobilized for several days. Sprained ankle recovery of this type usually takes four to six weeks. You probably don’t need to see a doctor unless the condition doesn’t improve.
Grade 3 Sprains
A grade 3 sprain occurs when the ligament is totally ruptured (or torn apart). Pain, swelling, and joint instability can be so severe that it is not possible to put any weight on the ankle. A doctor visit is often needed for this ankle sprain injury. An immobilization device like a hard cast is necessary for at least 10 days. Needless to say, this type of injury will take the longest to heal- three months or more. In some cases, a severe sprain will require surgery to repair the ligament.
When You Should Seek Medical Attention
Luckily, many acute sports- and exercise-related injuries can be treated at home following the treatment suggestions below. However, a severe sprain may require a health professional or even an immediate visit to one of your local urgent care clinics. If you fear that you might have a broken ankle, ankle fracture, or dislocated ankle, head for the hospital immediately for an X-ray. Other signs that you may need to see a doctor include:
- Inability to put weight on the ankle, even after a few days of rest.
- Increased swelling, discoloration, or deformity at the site.
- Experience extreme pain that cannot be controlled.
- Paralysis, tingling, or other health issues.
Treating an Ankle Sprain with RICE
For moderate and mild sprains, most family physicians will recommend RICE as the quickest and most effective sprained ankle treatment. This is an acronym for the tried-and-true treatment protocol of rest, ice, compression, and elevation.
Whether your sprained ankle is mild or severe, it’s best to let it rest for roughly 72 hours. This means putting little to no weight on it so that the tissues have a chance to begin healing without becoming re-injured. You may use crutches to keep weight off of the joint.
After this period, you can gradually resume activity. Since exercise is an important part of recovery, many sports medicine doctors will prescribe “relative rest” for a twisted ankle. This means that some movement can be beneficial- like ROM exercises- but you should avoid activities that put extra stress on the joint or cause undue pain.
Cold treatments- also called cryotherapy- are often applied to the injured area as first aid and continuing treatment. Ice can minimize the pain and swelling caused by a sprained ankle. Try to treat initial swelling immediately after the injury by applying ice to your ankle. This can be a slush bath, a store-bought ice pack, or a simple plastic bag filled with ice.
Limit the time you apply ice to 15-20 minutes at a time. Wait two to three hours before reapplying to reduce overexposure and promote faster healing. Avoid direct application of ice by placing a towel between the ice pack and your skin. Slight redness of the skin is common, but you should not experience a mottled or raised reaction.
Compression is important to reduce swelling and promote healing. This can be done with an elastic compression bandage or tape directly after injuring your ankle. Make sure that the wrap offers support while not being so tight that it causes numbness, tingling, or color change. The wrap should be loosened at night and rewrapped in the morning.
Since physical therapy is the best path to a speedy recovery, many doctors will recommend functional support over an immobilizing cast during the rehab process. Studies have shown that people experience a quicker return to activity, a better range of motion, and less swelling.
Functional ankle support is one that allows your sprained ankle some mobility while offering support to the ankle joint. Functional supports include braces, elastic bandages, and tape or sports wrap. You can find a list of my ankle brace recommendations here.
Elevation is another way to control swelling when you have a sprained ankle. Doing this will prevent the pooling of fluid around the joint, which in turn can reduce discomfort, aid in regaining movement, and may help speed up your recovery time.
To be properly elevated your injured ankle must be positioned above the level of your heart. For the first 24-48 hours try to lie back with your foot elevated for faster recovery. If it’s not feasible to lie down all day, try to keep your leg propped up as high as you comfortably can when seated. At night place a pillow or two under your foot to keep it raised.
The RICE treatment method has more recently been modified to PRICE to include the word protection. To prevent further injury, the sprained ankle should be immobilized immediately after injury and weight-bearing avoided. You may need to use crutches for more serious sprains. As you begin rehabilitation, partially immobilizing the joint with a splint, brace, or tape can prevent you from over-exerting the ligaments while they heal.
A popular question among active people with ankle sprains is whether it’s better to exercise or to keep the ankle completely immobilized until recovery. When it comes to a speedier recovery, many physicians agree that it’s more beneficial for people to begin rehabilitation exercises as soon as possible after a sprain. Exercise increases blood flow to the area which helps in healing the damaged ligaments.
For the ideal at-home PRICE treatment: for one to two days following your injury use an elastic bandage to secure an ice pack around your sprained ankle while sitting back with your leg elevated. Next, it’s time to start with physical therapy rehabilitation.
At-Home Physical Therapy for a Sprained Ankle
Studies have shown that physical therapy and strengthening exercises are the most effective for a quick recovery from ankle sprains and other soft tissue injuries. If you want to help your ankle heal faster, it’s imperative that you start post-injury physiotherapy within 48-72 hours, or as soon as you are physically able.
The National Athletic Trainers Association suggests range-of-motion (ROM), flexibility, and strengthening for the optimal rehab exercise program. The goals of rehabilitation include regaining a full range of motion, strengthening the joint, and improving neuromuscular coordination.
Rehabilitation in the Early Stages
It is okay to walk on a sprained ankle as long as it is stable enough to support your weight and without excessive pain. However, if you are not yet able to put weight on the joint there are gentle exercises you can do to keep your ankle limber in the first 48 hours. These include isometric and ROM exercises which cause contractions of the muscles around the joint. Whether passive (with the aid of your physical therapist) or active (on your own), these should be done as much as tolerated for a few minutes at a time. Examples of ROM exercises are:
- Dorsiflexion and plantar flexion. This means moving your foot up and down.
- Tracing the alphabet with your toe.
- Toe curls- done by picking up a towel with your toes repeatedly.
Once you can tolerate some weight on the ankle, it’s time to focus on stretching, balance, and stability training. These exercises may help you to regain coordination in your ankle muscles, thus preventing recurrent sprains in the future. Some exercises you can do include:
- Towel stretches
- Calf stretches
- Wobble board
- Stationary biking
Middle-Stage Rehab for Ankle Sprains
Once you can tolerably put weight on your injured leg and swelling and pain are manageable, you can begin middle-stage rehab. At this stage, you can continue with your balance and coordination exercises and start including some strengthening exercises. You can also begin to incorporate inversion and eversion stretches into your routine. This means moving your foot from side to side. Some beneficial exercises are:
- One-leg balance and reaching exercises
- Calf raises
- Single leg jumps
Continuing with Ankle Rehab
Continuing with your physical therapy routine, even after your ankle feels better, can reduce your risk of a recurring sprain. Try to do strengthening exercises in reps of 8-12 twice daily, and balance exercises at least once a day for two to four weeks after your injury. And don’t forget to stretch daily, especially before activity.
Medications for Ankle Pain Relief
Anti-inflammatory painkillers can be a helpful aid when you’re recovering from an injury. They can offer relief if your sprain is aching, even when you’re at rest, and also help with pain during and after intense therapy sessions.
Non-steroidal anti-inflammatory drugs (or NSAIDs) you don’t need a doctor to prescribe include ibuprofen or naproxen sodium. These can temporarily reduce swelling and inflammation as they reduce pain. If you have problems taking oral medications you can opt for topical NSAIDs like ointments or gels. These reduce pain and inflammation at the source, and you don’t have to risk them passing through your digestive tract.
Choosing Orthopedic Treatment Over Surgery for Torn Ligaments
I usually recommend holistic treatments over surgery when it comes to health and sports-related injuries, especially if the injury is a minor one. A torn ligament can take weeks to heal, but with the proper RICE treatment and sports therapy, you will be back in action again.
Torn ligaments in the ankle can be sewn back together by an orthopedic surgeon. For a severe ankle sprain that is not responding to treatment or has not improved in six months, this may be an option. Surgery to shorten the ligament may help with ankle stability in the long term. See a doctor for medical advice if you’re considering surgery.
Competitive athletes sometimes opt for surgery to correct torn ligaments in hopes that it will help them to heal faster. However, there is no evidence to support this. Engaging in therapeutic and strengthening exercises as early as possible is the best way to get you back in the game soon.
Future Care of Ankle Injuries
In the sports world, athletes are considered clear to return to gameplay once they’ve regained full mobility, can walk normally, and have regained about 80% of their pre-injury strength. Whether you are revisiting your doctor for a post-injury exam or assessing yourself look for these indicators before resuming normal activities.
If a sprained ankle is not treated properly people can experience complications in the future. To help prevent future ankle sprains, continue to work on building ankle strength and flexibility, wear properly fitted shoes, and consider wearing an ankle brace. If you’re worried about possible diseases, conditions, sprained ankle abnormalities, or long term health information, seek medical advice from your doctor.
I hope this advice can help to heal your ankle at home faster and get you back up and running!