I Think I Sprained My Ankle. What Should I Do?
It’s common to sprain an ankle. In fact, most of us have sprained an ankle at some point in our lives or know someone who has. Ankle sprains come in many levels of severity from an injury you can get through quickly, to something more serious that requires weeks utilizing a walking boot.
Ankle injuries often occur in sports with quick changes of direction or jumping in connection with landing awkwardly. They can also occur with missteps in everyday life or activities. What you do and how you recover after an ankle sprain is very important.
“What you do and how you recover after an ankle sprain is very important.”
All too often, ankle sprains are brushed off and “heal on their own”, but almost all sprains should be evaluated to decide if formal treatment is needed or not. While ankle sprains may be one of the most common injuries amongst all age groups, it may also be the most undertreated orthopedic injury.
Treatment with the help of a physical therapist can be beneficial not only for reducing pain and restoring function in more severe cases, but making sure that there are no deficits or changes in biomechanics after the ankle injury.
Individuals who have had an ankle sprain months or years ago can benefit from a thorough examination to ensure that their ankle is not affecting other body parts or movement patterns.
What should I do first after an ankle sprain occurs?
The first step after any new injury is to get assessed by a medical professional. WebMD is a common resource individuals refer to but it is no substitute for the accuracy of an orthopedic examination. Walking it off or toughing it out are common mistakes, but frequently lead to finding yourself behind in your potential rehab timeline. Having a proper diagnosis and plan set as early as possible is really the best and only approach in our opinion.
Common Problems Caused by Undiagnosed Ankle Sprains
Ankle sprains seem like a relatively straight forward injury, but there are a few other diagnoses that can either accompany an ankle sprain or masquerade as one.
High ankle sprains can accompany an ankle sprain
Avulsion fractures (ligament tearing off the bone) can present as an ankle sprain
Nerve injuries may look very similar to an ankle sprain
Foot or ankle fractures can accompany an ankle sprain
Other injuries such as back pain caused by limping or compensations
While the fractures mentioned above are not as common as a simple sprain, they should be assessed for by a professional to not slow the healing process. A surefire way to lengthen your rehabilitation back to normal is to have an improper diagnosis.
An x-ray is not always necessary!
Make sure to read our full article on when you need an x-ray for knee or ankle pain [link]. One sign you should immediately get an x-ray is if you cannot bear weight for more than four steps. There are other factors that a physical therapist or doctor can look at to rule out serious pathology, but if you cannot bear weight on your injured ankle, imaging is a must.
What Does an Ankle Sprain Evaluation Consist of?
For most patients who suffer an ankle sprain, a thorough evaluation will be necessary to determine:
exactly which ligaments were sprained
how much swelling is present, if the injury is new
what range of motion is limited
what daily or athletic activities are limited
Standing on tiptoes
Standing on one leg
Going up or down stairs
Squatting
The evaluation process of an ankle sprain will look slightly different for a brand new injury versus one that happened a few weeks to months ago. Examination of an older injury will place a large focus on your capacity and capability to perform specific movements to get an idea of strength and quality of movement. A physical therapist is trained to use specific tests to determine the extent of the injury. We base our examination on specific stress tests that look at the stability of the joint. These tests will give good indication about how long it may take for your ankle to return to normal with rehab.
How Can You Rehabilitate from an Ankle Sprain?
Once a formal and accurate diagnosis of your ankle sprain is made, a proper plan can be set forth for rehabilitation and recovery.
The most important part of rehabilitation is keeping our patient informed about where they are in relation to their goals, as well as outlining a specific plan to accomplish each goal. For an ankle sprain, there are specific criteria-based goals that can tell you exactly where you are on progression to your return to full activity. Each of the criteria listed below are listed in order of which they need to be achieved so that the next goal can be taken on without risk for further injury or setback.
Control Pain and Swelling
The first step in managing a new ankle injury is doing your best to reduce any swelling. Swelling by itself can cause increased pain, decreased range of motion, and decreased strength. If these factors can be improved by reducing swelling as early as possibly, more aggressive rehab can usually begin sooner. If pain is not due to swelling, this will be very individualized for each patient and a physical therapist examination will be necessary to determine what rehabilitation process will work best for you. Hands-on or manual therapy, repeated range of motion, rest, or ice may be necessary for pain control.
Restore Full Range of Motion
In some cases, range of motion is restored when swelling is normalized. But in most cases, more hands-on mobilization of the ankle joints followed by specific stretches will be very effective in normalizing ankle range of motion. In some cases, mobilization of the knee or hip can be beneficial in helping larger movements like a step down, squat, or lunge get back to normal.
Control the Range of Motion That You Have
It is one thing to passively stretch a joint as far as you can move it. It is much more applicable to daily life to be able to move that joint without the use of a stretching aid or your hands. During this control phase, making sure that there are no compensations from other body parts from limited movements or pain is crucial in restoring normal movements. Lastly, you can imagine how poorly strengthening might go if the control of an exercise is poor or not under the supervision of a trained physical therapist. This is where control and strength start to blend.
Improve Strength
Strength is crucial in all injuries, including ankle sprains. In some cases, this is solely returning strength to their prior levels. In other cases, a lack of strength can be the cause of injury in the first place. In either scenario, strengthening specific to each patient and each injury is crucial.
Isolated Strength- It is easy to see how specific strength at the ankle joint will be important. To be more specific, your calf muscles will be the most important for returning to athletic activity. The muscles that are responsible for the side to side stability of your ankle are also in charge of the stability of your arch. These cannot be neglected and are common areas of focus when we help our patients with ankle sprains and injuries.
Strength of Functional Movements- Squats, lunges, step-ups, and step-downs are a few examples that are the basis of daily movement. Assessment of the quality of these motions is important, followed by strengthening quality movement to improve each patient’s capacity.
Movement in Multiple planes- Forward, backward, and side to side are the cardinal planes. All too often practice of different movements gets limited to these three directions at best, sometimes only forward and backward. Twisting, pivoting, and angular movements happen more often than a strict lunge. All rehabs need to be progressed to include some level of these movements.
Balance and Body Awareness
Balance is important in a variety of activities and each patient’s balance requirements are different. Although fast movements seem to require less balance than more controlled movements, it is the balance and body awareness that allows us to avoid unsteady and unsafe fast movements.
Plyometrics
Plyometrics are jumping and bouncing and progression of these tasks will be specific to each patient, case, and athletic demands. Patients who do not play sports should at least work on being able to absorb force with their lower body. An example of this would be stepping off of a large step and being able to avoid landing hard. The control of this landing will reduce the chance of uncontrolled movement at the ankle.
Endurance
Once you can jump, bounce, squat, lunge etc., let’s do it over and over! All of the prior steps are the precursor to endurance. Once you can do it once and do it well, we can work on training your body specifically to do the things you like to do.
Let’s Get You Back to Normal
Crossing all of these criteria off the list will ensure a thorough and effective rehabilitation. Notice how there are no time guidelines listed. When each criteria is met, the next criteria can be assessed and then progressed. This allows for a customized experience for every patient to get back to what they love as efficiently and effectively as possible.
If ankle sprains are an issue for you, don’t hesitate to request an appointment with us to see where you fit into this process. You can also call our office at 908-589-9009 and our team will help schedule your appointment.