To wrap up our section on ankle sprains, I was able to chat more with Kathleen about her clinical experience and treatment recommendations. Kathleen’s background working with the SF Ballet, not to mention her years as a dancer herself, have given her a high volume of foot and ankle injuries to draw from!
NS: For the past month, we’ve been sharing the latest research on lateral ankle sprains. As a recap, what are your top three take aways for anyone who just suffered an ankle sprain?
KM: Top three suggestions, ok!
First, the old RICE- idea that everyone knows, we really don’t do more than 24 hours post-injury. After that, we recommend relative rest; We don’t want you out running by any means, but don’t want complete immobilization like previously thought. Rest, ice it, compress it, elevate it, and don’t move!! We’ve all heard this, right? But that actually doesn’t help facilitate healing. Breaking down this old idea is a key part of our patient education. After 24 hours, we want you to start doing gentle activities, like ankle circles or ankle pumps based on what you can tolerate. Try short walks, if you can. It’s still ok to rest and elevate at the end of the day, or when you can throughout the day, but a combination is best.
Next, use something as appropriate to help, like an ankle brace or compression sleeve, one or two crutches. Use what you need, and don’t be so hesitant! The mentality of “No, I can just walk it off..” often prolongs recovery.
And third, see a provider! You don’t have to go to see a doctor, you’re able to go directly to a physical therapist, in California and in many other states. Ankle sprains are very easily treatable, without a doctor. We of course will do any screening and if we think that it is something more serious, we can help you navigate a referral to a physician.
NS: You read my mind- ankle sprains are one of the most down-played injuries, with people doing everything imaginable to simply “walk it off.” Can you share more about the importance of using crutches and braces during recovery?
KM: Yes! The attitude of “Oh, I can walk it off” ultimately leads to a lack of treatment. What happens is you interrupt the proprioception, or the ability to sense where the foot and ankle are in space. The nerves located in the joint need to be rehabilitated as well. So while you may see external progress, decreased swelling, the bruising will go away, less pain, the ability to be on your feet for longer, etc, you may still be lacking full range of motion and effective proprioception. This can set you up for reoccurring ankle sprains. Each time, it takes less to sprain the ankle, and may cause more severe damage. Giving the injury the attention it needs, the first time, can improve your outcomes for years down the road!
NS: What are the chances that someone would injury another part of their body while pushing through an ankle sprain?
KM: Definitely! In cases, what we often see is an altered gait, or limp. To avoid positions of pain, we develop new movement strategies. These may not be ideal, from a biomechanical perspective. We end up using the back, or hip, or knee, to make up for the injured ankle. We recommend crutches for this exact reason- allowing the tool to fill in the gaps, rather than place additional stress on the body in the early stages of recovery. As the ankle range of motion and tolerance returns, you can ditch the crutch and walk normally!
NS: Ankle sprains always seem to come out of nowhere- that one wrong step! What’s the most unusual injury story you’ve heard?
KM: How do I choose?! The most unique story I’ve heard, a patient was jumping over a wall while traveling in a foreign country. They landed poorly, and ended up severely injuring both ankles. They needed to be carried back to their hotel, and it put a bit of a damper on the trip! One of the most common injuries, that’s actually pretty funny, is that most ankle sprains happen with the help of a few drinks. They step off the curb on their way home, and boom! Ankle sprain!
NS: At Physical TheraPT, as many of our patients know, we love staying current on the latest innovations in exercise and rehab equipment. What’s your favorite product out there right now for ankle injuries?
KM: There has been a lot of recent innovation for ankle braces! Newer models offer athletes improved range of motion, while still giving them the right amount of support. These new braces also fit better into cleats than older lace-up models. My top picks right now are the Mueller XLP, designed with a shorter forefoot profile, the DonJoy Bionic Speed Wrap, with customizable support straps, and the McDavid Elite Engineered Wrap, which mimics a traditional ankle tape and contours to the foot.
NS: Given the current concerns around COVID-19, it’s understandable that some patients may want to avoid going to the doctor. Tell us more about how telehealth appointments can be instrumental in diagnosing something like an acute ankle sprain!
KM: Great question! We can assess through visual evaluation, having you move your ankle in specific patterns over the screen, allowing us to check out quality and range of motion. While we can’t complete a normal hands-on assessment virtually, we are able to triage the severity of the injury. We can help you determine the need for an in-person appointment, typically when there is concern for bony injury, like a fracture, or if the sprain is severe enough to need surgery or immobilization to heal appropriately. the majority of ankle sprains don’t require this level of care .
NS: Great points! Can you also share how someone can begin rehab for an ankle sprain remotely?
KM: Telehealth for physical therapy is great for home exercise programs and patient education! We’ll go over what the first steps are, what the expectations and goals are for the first week, and so on. We’re able to provide feedback on your form and technique, and coach you through helpful strategies, like self-massage to help with swelling. Telehealth is a great tool for both Grade 1 and Grade 2 injuries, and would save you a trip to the doctor’s office.
NS: Last question- what’s your go-to strategy for pain relief with this type of injury?
KM: I love that you asked this question! There is a lot of research on the efficacy of contrast therapy, or contrast baths, for ankle sprains. For the initial 48 hours, ice is still the best recommendation. But after that, we move to a contrast of warm and cold because this emulates the body’s natural pumping action, helping to move out swelling.
To do this, you can use a hot pack-cold pack combination, alternating between them. Even better, you can set up a home contrast bath system! Submerge the foot in a bucket of cold ice water, then warm bath-temperature water. We recommend using two trash cans, or one trash can next to a tub for this.
This creates vasoconstriction with the cold water, closing the blood vessels, and vasodilation with the warm water, opening the blood vessels. You create this open-closed-open-closed cycling, which facilitates flushing the swelling and edema out of the ankle, and back up into the body. Typically, our muscles do this naturally as we walk, but as we discussed, walking may be limited during this phase of recovery.
