Ankle sprains occur at the most inopportune moments! A week before he was to compete at the California State high jump track meet, my son sprained his ankle in practice. The next 6 days were fraught with grief, anxiety, pain, grit, determination, and yet glimmers of hope. It was his senior year and he was the first athlete from his high school to qualify for the CIF Southern Section Masters Meet. He was cleared by the athletic trainer the day before the meet. So with ankle taped, he willed himself to show up for the day of the competition. He had to completely change his approach due to the ankle injury but was able to clear opening height and then called it a day. He showed up and that’s all that mattered.
An ankle sprain is a common, fairly straightforward soft tissue injury yet not without frustration and fear for the sidelined athlete. RICE is still the most common advice mentioned in the medical field, however it’s time for a more complete, holistic approach. In 2019 the British Journal of Sports Medicine reported that soft tissue injuries can be better managed beyond the traditional acronym, Rest Ice Compression Elevation (RICE).
Peace + Love comprises the best evidence applying to any soft tissue injuries as it takes into account the person with the injury not just the injury itself. Take note that there are 3 grades to ankle sprains varying in the amount of injury to the surrounding tissue. Ruling out red flags of fractures, full tears, and instability is always wise before returning to sport or activity. The level of tissue injury can’t be determined by the level of pain one is in. However an increase in swelling and discoloration, and decrease in function are signs to watch out for.
Day 1-3
P is for protect
Unload or restrict movement for 1–3 days to minimize bleeding and reduce the risk of further injury. Prolonged rest however delays healing compromising the quality of the tissue. Pain usually begins to die down in the first 3 days and protection ceases.
E is for elevate
Elevation is still valuable when swelling has occurred. Elevate the limb higher than the heart.
A is for avoiding anti-inflammatories
Inflammation is a valid part of the healing process and needs to take it’s course.
“Inhibiting inflammation using medications may negatively affect long-term tissue healing, especially when higher dosages are used.” Ice is typically used for controlling inflammation as well. It may help for an analgesic affect and considered a useful tool in minimizing secondary tissue damage in the first 12 hours post injury. Apply in 20-30 minute intervals in immediate aftermath of the injury, but it isn’t recommended for long term use to control swelling.
C is for compression
Compression after an ankle sprain may be an effective tool for injury management to reduce pain and improve confidence in feeling support for the structure. Compression can be in the form of an ace bandage wrap, taping, compression socks, and or compression devices.
E is for Education
There is no magic cure for hurrying up a soft tissue injury. Healing can take anywhere from 1-12 weeks depending on the severity of the tissue damage. It is vital to set realistic expectations around healing and not fall prey to the “quick fixes”. An active approach is more beneficial as it promotes the athlete’s self efficacy in recovery.
Days 4 +
L is for Load
Activity should be resumed early as symptoms allow. Long term rest isn’t always best. Optimal loading “promotes repair, remodeling and builds tissue tolerance and the capacity of tendons, muscles and ligaments.” Bearing weight on your foot/ankle in a progressive load is healthy. Take it step by step and stay at a low symptom threshold when starting out. Progress from load through both legs to load on a single leg. See exercises above for various options of single leg loading.
O is for Optimism
There is no shame in fear. It’s natural to worry if you will be able to return to what you love. However, your perception on the threat of injury matters. Beliefs and emotions are thought to explain more of the variation in symptoms than the degree of the tissue injury severity! Be a movement optimist, but if you are worried about progressing too soon or further injury, see a physical therapist for personalized help.
V is for vascularization
“Aerobic exercise ( with minimal pain) should be started a few days after injury to boost motivation and increase blood flow to the injured structures.” Blood flow promotes healing and improves swelling. This could be as gentle as drawing the alphabet with your ankle or as active as riding a stationary bike. Movement is medicine.
E is for Exercise
Gradually loading and exercising the injured body part will optimize tissue healing, recovery, and your confidence to use your body again. Exercise is also shown to reduce recurrent ankle sprains. Exercises should gradually progress to promote 3D motion, speed, power, balance, and change of direction for a healthy return to sport.
