After I sprained my ankle

So what should I do right after I sprained my ankle? The first 24-48 hours are marked with intense pain and tissue swelling. In those first 2 days the swelling increases. Swelling should be avoided as much as possible because it gives extra pressure (is more pain) and slows down the healing process.

Back to the general explanation about the sprained ankle.

We have to intervene immediately. Remember the word: RICE. That stands for:

  • R = Rest, or a lot of rest. Move, but if possible unloaded, e.g. with walking aides.
  • I = Ice. So cooling. Cold water, or ice cubes wrapped in towel. Beware; ice could give blisters. We start immediately after spraining with ice. No cold water or ice? Then in a pool or a stream.
  • C = Cambric. That is a bandage. Elastic stockings are not suited for this purpose, they hurt getting them on or off. A bandage gives compression on the tissue that wants to swell. The bandage can be kept wet or removed when the ankle is cooled again.
  • E = Elevation. Try to keep the leg high for the first 2 days. Take a bench and use a comfortable pillow to support knee and lower leg.

When should I see a physician or go to first aid?

I already pointed out: I am Dutch, I follow Dutch protocols and regulations. When in doubt, please see a doctor!

In the Netherlands the guidelines are:

  1. If after cooling the ankle you still can not bear weight on the affected ankle, you should visit a doctor or first aid. There may be a complete tear of the ankle ligaments or a fracture. The doctor can assess whether it is necessary to take an X-ray. Often walking after a sprain is very painful but if you can stand and bear weight on the affected foot that means usually there is no fracture or no tears (a strained ankle) that need casts of operations.
  2. If you do not trust things, you are strongly advised to see a general practitioner or first aid.

What do I do to rehabilitate my sprained ankle after the first 48 hours?

So the first 48 hours we use RICE, see above. But even in this period you start gentle exercises. There are advantages of starting to exercise soon. Muscle activity reduces swelling faster, stiffness disappears faster and there is less chance of complications.

Every hour you are awake you turn the ankle 5 times to the left and 5 times to the right.

After the first 24 to 48 hours, cooling is no longer necessary, but it is often very pleasant. Cooling the ankle reduces pain.

After 2 days the first recovery phase begins. You will now see how seriously you sprained your ankle. If the swelling and pain quickly decrease and you can walk with a reasonably normal gait after a few days, you had a minor sprain and you can (normally) expect a successful recovery soon. A moderate sprain takes a bit more time.

You can overload the ankle during this period. The ankle then swells and gets painful again and again, especially after activities. Under-loading or just taking too much rest is also risky. The ankle will not recover properly if you do not do the right exercises. So you have to ajust the intensity of your exercises according to the reaction of the ankle. Too much pain or swelling right after the exercises means you have been too rigourous. No pain or swelling after the exercises means you could try to do a bit more.

An exercise scheme on the next page. Please consult your doctot before using the scheme on your own account.

During rehabilitation you will notice the ankle is more painfull at the end of the night. Pain and stiffness will reduce during the day because you use it and exercise it. Complete rest is never a good way to mend a sprained ankle.

How long will it take to heal?

Depending on how severely you sprained your ankle and a few other factors, generally spoken the following rules apply. You can expect to walk normal in 1 or 2 weeks after spraining. After 6 to 8 weeks you can do all day living things like you were used to. After 8 to 12 weeks you could take up sports again, at first maybe with support (brace, tape), later without.

Work resuming is of course almost entirely up to the kind of work you do; deskwork can be done very quickly, while a job that involves standing, walking or driving could take a little longer. You have your own responsibilities in this, but you can consult with your therapist, your doctor or the health and safety department at your work.

Complications after a sprained ankel

These signs could mean something is not well and you should see a doctor:

  • After a certain time you still suffer from severe pain
  • The pain increases in stead of decreases
  • There is great stiffness , not getting any better
  • Serious instability arises or remains
  • You feel that the joint is blocking, it isn’t just stiff

To evaluate the origin of these problems you should see your physician or therapist.

The ankle swells sometimes weeks after the original sprain

Sometimes the ankle swells at the end of the day even after a long time, even after almost all other symptoms have disappeared. Do not worry about that. Exercises help to restore the circulation. Remember that some bloodvessels have been damaged, repair takes time.

What can the physical therapist do for you?

The aim of physiotherapy after a sprained ankle is: helping with full rehabilitation, that is being able to resume all tasks and functions like before. A physiotherapist helps you to bring back strenght and stability and will encourage normal souplesse in the ankle joint necessary to return to your normal life, work and sports as soon and as safe as possible. The physiotherapist notes impaired healing and knows how to deal with that. The physiotherapist can give advise on bandage, tape and braces.

If you have no important complications, no enormous damage and no special needs (like performing top-level sport) you can do a lot at home all by yourself.

Love to hear your comments!