Ankle Sprain 101 - What to do 1st
Hey, what's going on everyone! It is James Dulkerian, doctor of physical therapy and the owner of Pioneer PT, the first mobile physical therapy clinic.
Today, lets go ahead and discuss ankle sprains. We will discuss what they are, the different grades of sprains, the different types of ankle sprains, and then how to deal with it. That is the most important part.
What is an ankle sprain? An ankle sprain occurs when you stretch the foot a little bit too far, more than the normal range of motion. The most common, is when you land on your foot, your foot turns in and your ankle turns out. That is the most common, with between 70-85% being these lateral ankle sprains or it is called an inversion ankle sprain. The inside of the ankle is a little bit more rare so we are not going to spend much time with that.
In these sprains, what happens is that you stretch the ligaments (ligaments connect bone to bone) too far causing damage. You may also have some tissue damage to the muscle/tendon (tendon attaches muscle to bone).
Grades: Grade 1 is just a stretch of the ligaments. You stretched them a little bit more than their normal maximum range of motion, causing some irritation. Grade 2: that means that you overstretched the ligaments, and this time you have had some failing. Some of those fibers tore. Just some. Lastly, Grade 3. In this case, the ligament had gone beyond it length of support and it has failed causing it to tear completely. Grade 3, definitely takes the longest for recovery time.
With grades the recover time varies. You can be down 1-2 weeks with a minor Grade 1 sprain, but up to about 12 weeks or so with a Grade 3 sprain. Unfortunately, ligaments they due not have as good of a blood supply compared to other tissues in out bodies. Even bone can feel faster than ligaments. Be patient, and hang in there, it will get better.
Now, we covered grades, and approximate recovery times for return to sport. Again, about 2-12 weeks depending on the severity. Then, types, we talking about the inversion sprain being the most common, when the foot turns in and the ankle rolls out. This often occurs walking on uneven ground and your ankle rolls out, you are wearing high heels stepping on an uneven sidewalk and twist it (Think Fells Point in Baltimore). Then most commonly it occurs in sports when running and cutting or in basketball, this happened to me in high school. I sprained it once, and then sprained it again. (The doctor never sent me to physical therapy at that time to strengthen the ankle). I went up for a rebound and come down on another players foot, causing the ankle to twist.
Research shows that the most common cause of injury is a previous injury. Make sure you get it taken care of so it is not a reoccurring issue.
Most ankle sprains are low ankle sprains. High ankle sprains can also occur, but this is more rare. A high ankle sprain occurs with the tissue between the two lower leg bones, the Tibia and Fibula.
What do you want to do when you have an ankle sprain? When you have an ankle sprain the easiest acronym to remember is called P.R.I.C.E. What does P.R.I.C.E. stand for?
First, you want to protect it. You want to protect it from further damage. Depending on the severity the doctor may prescribe you crutches to unweight the ankle. You can also consider wearing a brace/tape so you do not twist it again. Something to protect that ankle. That is P.
R stands for rest. With a sprained ankle you want to rest it, meaning you want to get off of it early on to protect it from positions that irritate it or be angry. An angry sprained ankle is when it is Warm, Swollen, Red, and Painful. When it is angry you do not want to do things that aggravate it. Therefore, R stand for rest.
Next, one of the most common things that you want to do is Ice. Ice initially after an ankle sprain for at least the first 3 days. Ice helps to bring swelling down by constricting your blood vessels so it does not get more and more swollen, and more painful causing further tissue damage. Use an ice pack on there at least 20 minutes per hour. I would recommend ice at least 3-5x a day at a minimum for at least the first 3 days. Also, for the ankle, I really like an ice bath. Fill a bucket full of ice water, and dunk your foot for 30-60 seconds and then take out for 30-60 seconds, then dunk it back in. It is tough, but I would try to repeat the process for about 5 minutes. Get the ice on there to control your inflammation.
Next, we are talking about C. C stands for compression. Please wear an athletic sock as it tends to have a little bit more compression down in the foot, and (It is easiest to get on in the morning first thing) wrapping your ankle. You can use an Ace bandage. It does not have to be super tight, because you do not want your toes turning purple or red. That means it is too tight cutting off the blood flow return by creating a tourniquet. Back off if that is the case. In general wrap from the toes to above the ankle, and grade it, meaning have a little bit more compression down in the foot and less compression above the ankle. Wrap tighter at the bottom and as you go up decrease the tension. That helps to pull the fluid back up. We want to get that fluid back up towards our hip.
That leads to the last one, E. E stands for elevation. Ideally you want to elevate your foot above your heart. Use at least 2 pillows one under the thigh and one under the lower leg. Lying back on your back this will help elevate the leg. That way we have the assistance of gravity to help pull that fluid back up towards the hip and towards the abdomen so our lymph nodes can recycle that fluid and get rid of it.
P.R.I.C.E. the easiest acronym to remember. Protection, Rest, Ice, Compression, Elevation. That is the best method for treatment of the ankle early on.
Hey, what's going on everyone! It is James, Doctor of Physical Therapy and the owner of Pioneer PT.
A few people reached out after my last post and asked, "How do I know if I have enough mid back mobility?"
Well, here is a quick and easy test that you can do to find out!
You just need 2 things. You need some type of stick or dowel, and a chair without arm rests.
We are going to be sitting on the very, very corner of the chair looking at both straight lines of the chair for this test.
-Sit on that corner.
-We will go left first, so cross your left foot over your right ankle.
-Place the stick behind your neck
-& rotate left as far as you can comfortably
For adequate range of motion you should be going past the straight line on the chair for your mobility of your mid back.
Repeat on the other side, and if you do not have symmetry, or you cannot go past that straight line, then you know there is an issue and it should be addressed.
Without proper mid back mobility, you must move more elsewhere throughout the spine and this often leads to neck or lower back problems. Please reach out to Pioneer PT with any further questions.
Let's talk about the importance of Mid Back Mobility or Thoracic Spine Health:
We want good rotation and extension through the mid back, so we can take some pressure off both the neck and shoulders as well as the lumbar spine, or your lower back.
A couple quick exercises that you can do are the Cat-Cow. First, drop your head down, round your back, tuck your tail, take a big deep breath at end range....and as your blow out, bring your head up, drop your belly down towards the floor, and again big deep breath at end range. About 10-15 repetitions.
Then, you can drop back, butt to heels, and lead with your head, reach up towards the sky. Do this on both arms, again between 10-15 repetitions. It will help you to loosen up and feel good through your mid back.
Try it out and comment in the section below as to how it's helped.
James Dulkerian, DPT
Active outdoorsman with an honest soul and a passion for health.