Ankle sprains are one of the most common musculoskeletal injuries clinically seen by physiotherapists. Although sometimes considered trivial, it is important to treat even the smallest sprains to reduce the risk of recurrence and more permanent damage. Here is a small guide explaining the healing steps of a sprained ankle from the time of the injury to the full return to normal activity.
When the injury occurs
Even if it doesn’t occur during a very animated soccer match, but rather by missing a step of a curb chain, an ankle sprain can be very painful and very limiting. The swelling associated with the injury is often what most limits movements of the foot and increases pain. So at the time of the injury, it is important to follow the RICES principle to decrease swelling and redness and thus reduce pain. What is the RICES principle ? The RICES principle is an acronym meaning:
I = Immobilization
C = Cold
E = Elevation
S = Stabilization
Let’s review each of the components and explain their meaning.
1. Rest (R)
Following a sprain, it is important to have a rest period to allow adequate tissue repair. For a few days (sometimes more), decrease activities requiring weight on the affected foot and/or rapid movement. If tolerated (depending on the severity of the sprain), it may be possible to walk on the injured foot, but carefully. Usually, following an ankle injury, a physiotherapy assessment would be preferable to determine the degree of sprain and if X-Rays are necessary. The physiotherapist will tell you if you need to use a walking aid, such as crutches, help you adjust and show you how to use the walking aid if necessary (you can also read our blog article on walking aids !)
2. Immobilization (I)
Similar to the rest principle, immobilization aims at helping long-term recovery of tissues. Following a sprain, place the ankle in a resting and supported position. This can be done for a few days.
Despite that, do not stop to move completely! Repeated movements in the permitted range will be beneficial and facilitate the return to normal activities.
3. Cold (C)
In the acute phase, it is important to apply ice regularly to limit swelling and redness. What do we mean by “regularly”? In fact, during the first 3 days or so, it is recommended to apply ice every two hours for 20 minutes.
4. Elevation (E)
For a few days , it is recommended to elevate the affected leg above the heart level on pillows during moments of rest to reduce swelling. With the help of gravity, excess liquid causing swelling will be more easily drained by the lymphatic system. While raising the injured ankle, move your toes and ankle in the allowable limit, which will also decrease swelling and pain.
5. Stabilization (S)
It may be beneficial to contain the injured ankle with an elastic bandage at the time of injury until a few days after. The bandage can limit movement, but also contain edema. So to prevent that the ankle swells disproportionately and to offer additional support, the bandage can be useful during the acute phase of the sprain. To increase the effectiveness of the anti-swelling effect, it may be optimal to apply the bandage with the ice application (bandage placed around the ice, but not too tight).
The rehabilitation phase
Depending on the severity of the sprain, it may happen that it is necessary to wait a few days to a few weeks (in severe cases) to start the rehabilitation phase. In this phase, the emphasis is on building ankle muscles strength, increase balance and restore the normal use of the foot for walking, running or any other activity.
Depending on the affected muscles, the physiotherapist will offer you a personalized exercise program to strengthen the ankle. These exercises may include strengthening resisted with elastic or with weights, or exercises that use body weight .
To prevent recurrence, it is important to increase balance and proprioception of the injured ankle. Proprioception refers to the way our body uses the data sent by the muscles and joints to determine their position in space. To improve the production and integration of these data, try to do balance exercises on the injured leg on surfaces ranging from firm to soft.
Return to normal activities
Again depending on the severity of the sprain, return to normal activities is encouraged, and this, rather quickly. The sooner usual activities (sports and other) are performed, the faster the ankle will receive a certain stress, and new tissue allowing healing can be tested for and maximize their endurance. According to the functional abilities and requests related to your activities, your therapist will suggest an specific plan that will allow tissue to adapt and avoid relapses.
For more information or to make an appointment, please contact our dynamic team!
Andrée-Anne Lorrain, M.Sc. pht