Stand on, stretch, and move a sprained ankle?

[Bottle Rocket]

I just recently rolled my ankle... After getting in an argument the last time this happened with some family members that work in medical related fields about the reasons behind swelling, ice, heat, and all of that stuff, I figured I would come here for some more thoughts on the subject.

Now, the majority of you will recommend R.I.C.E. I am looking for some more reasons behind these recommendations, as well as some sort of research somewhere that shows that these methods actually speed up or help the healing process. I have not been able to find very much.

What I did come across was a very interesting article, I think from a skateboarding website. Obviously this guy is no doctor (might even be an absolute idiot, I don't know), but he makes a relatively convincing argument for those looking for more than the usual doctor prescribed "just lay around and do nothing" that you hear for many injuries of this type.

Here is the article (http://flipcatch.wordpress.com/2007/...ed-foot-fix/):

this is my take on ankles. specifically sprained ankles. I’m not talking little tweaks either. I’m talking fully rolled ones, that swell up pretty much instantly (verging on dislocation) and/or completely ripping all tissues and tendons, causing bruising that starts going up the back of your leg (as well as everywhere else) and feels like you’ve broken your foot. Yeah, those are the best aren’t they?

Y’see the thing with rolling ankles is once you’ve established there’s no bone damage, there’s nothing more you can do to wreck them. Everything from the point of ‘rolling’ is the bodies way of healing. Once you are aware of this, your mental approach to your injury will change from ‘I’m out of action, and can’t do anything’ to ‘this is annoying, I’ll just go and fix it’. Sadly, the thing that stops us doing anything other than resting and icing is professional advice…. grrrrrr …. and my Dr is useless so I rarely visit and listen to him.

Dr’s will tell you to ‘ice-up and rest’ and there’s nothing more they can do for it. Fine, however that is also the same words of advice they offer an 85yr old person as they do a 15yr old person. This is useless to active people. We need to get back in action asap. There’s a lot you can do to get that fully rolled ankle working in probably a quarter of the time, most Dr’s claim it will take.

first understand what’s happened to your foot;
The tissues, have torn, the ankle is trying to protect itself and start healing by swelling up, allowing zero movement, until the bruising can come out. The ankle is damaged, the tissue cools and starts locking up the foot. Once you’ve established there’s no bones broken, you can start to reverse the damage.

Here’s what you do;

Always stand on it.
Stop being a moaning lightweight and complaining that ‘it hurts’. Its just pain, ignore it. Training your brain to accept that this is ‘good healing pain’, is the way forward. If like me, you’re always active, then suddenly being reduced to a wobbly cripple, because one of your joints decided to give way, then you’ll know the importance of being able to walk properly, like there’s no injury at all. Therefore, dump the crutches, stop hopping, and start walking like a normal human being again. It’ll take a while, but start as early as possible… Unless my foot is pointing the wrong direction, or worse then i’m walking out. none of that ‘hopping’ rubbish.

(you’ll notice i’m not being very sympathetic here? well thats because sympathy never healed anything)

never stop moving it
If you’re sat at a desk all day, keep rotating the foot, ignore the swelling, there’s nothing you can do about that, just get yourself a super sloppy pair of comfy ‘mid-height’ shoes (iPaths are perfect btw) and get used to it. next!

hot and cold
ice the foot to bring out the bruising, and heat the foot to keep the tissue soft and supple. Get an ice-pack on it, then get it in a hot bath straight away. For one of my worst injuries, I spent 2 days doing this continually. By the third day I was back at work and walking pretty good.

Stretch
Standard movement isn’t enough, we’re athletes right? we need full movement in all our joints. Sure its going to hurt, but don’t be a wuss and wimp out on me. Take pain killers, smoke weed, do whatever you’ve gotta do to block out the pain, but push your ankle movements to the limit. Ignore the swelling, that’s just a pain in the ***, stretch the foot out in every direction as much as possible. Even if you get tears of pain, ignore that and keep pushing it. Tears are the bodies way of moaning. Ignore it.

Ta-daa. that’s it. nothing more to do. It can takes aaages to sort out this injury, but it shouldn’t take forever. In a few days: walking, a week: walking properly and being able to jump up and down etc. Note; it’ll take a lot longer to for the swelling to go down. This advice is learned from 20+yrs of rolling ankles on a skateboard, and learning from other skaters about dealing with rolled ankles.

Personally I have gone from a fully rolled, instantly swollen, can’t walk properly, ankle to being back on my board and skating (casually) in a week. So if you’ve anything less than a fully rolled ankle then, you’ll be back in action in no time.

Most people reading this, will think ‘yeah, but you haven’t seen ‘my’ ankle’ … uh-huh… your muscular composition is different to everyone else is it? I don’t think so.

hope this helps

I would be very interested to hear comments from you all. After a while, I'll give some of my own ideas that will most likely be shot down by those that actually know what they are talking about.

[LuckyR]

Two missing pieces of info that are needed to answer your question correctly:

1- Your age

2- What is the actual injury to your ankle? The most common minor injury would be overstretched tendons, perhaps some ligament strain if it was really bad. However my wife had a hairline fracture of the inside of the ankle bone where the tendon attaches and she is 3-4 months into the injury and is nowhere near back to normal. You may not know the answer to this question, so you should see someone who can tell you the answer.

[Rickson]

That "athlete" gives extremely bad advice and I wouldn't take his advice. Go with the traditional ice method. Your body's natural reaction is to pool blood into the injury site and that would work great several days after the injury, but it only causes pain and swelling at the beginning of an injury. You need to fight your body's natural reaction by taking down the swelling which of course means ice. Do you heal faster from icing the injured area than from never icing the injury? Of course you do because if you let nature take its course, the ankle will swell up and after several days of pain, you'll be able to walk normally again, but with ice, you take away that painful swelling and you'll heal up in a fraction of the time. Ice and heat? Absolutely not! Heat increases the swelling which of course adds to your healing time. Heat can be beneficial after the healing process has taken place, but never during. That guy in the article doesn't know what he's saying. I can't believe he's saying you should take the pain and just call yourself an athlete.

[Bottle Rocket]

Here is a post from another forum by a user name Fire Horse. He explains a lot of the things I was curious about and a lot of what Rickson has claimed without presenting anything to back up those claims. I am sort of doing public research I guess - for the greater good of the community, of course.

One of the main reasons for using ice post-injury is to slow down the metabolic rate of the cells in the area (like a vet putting a lizard in the fridge before surgery, you know...). By doing that, you can temporarily decrease the cells' requirements for oxygen, and hopefully fewer cells in the area of your injury will suffer damage related to lack of oxygen, in the acute phase of your injury. (A complete aside, here - the rooms used for heart surgery and the like are also cooled, for the same reason as the lizard going into the fridge - to decrease the metabolic rate, and decrease cell damage as a result. Neat, huh - but VERY cold for the theatre staff)

The reason that your tissues in the injured area are at risk of damage from lack of oxygen, is due to THE SWELLING, because swelling increases the pressure surrounding the cells in the injured area. That makes it harder for the blood supply containing oxygen and nutrients to battle (or diffuse) their way into your cells. Like trying to pump up a bike tyre with a fat guy sitting on the bike - it's a pressure thing, you know? (and thank you to my spouse for that particular analogy).

The reason that the swelling is there in the first place, is because when you injured yourself (and damaged some of your tissues - you reckless maniac!), the damaged tissues called for their own ambulance - and a fleet of them arrived. This is the response we know as inflammation, and it involves an increase in blood flow to the area, an increase in the permeability of the walls of your capillaries, so lots of fluid leaks into the space in your tissues surrounding your cells, and often clots there (read - stacks of ambulances parked all over the place), and the cells themselves swell. The effect this inflammation is intended to have, is to put up a barrier around the injured area (read - police roadblocks), to slow the passage of any bacteria or toxic products that may be in the injured tissue, into the surrounding healthy tissue (read - quarantine).

So the swelling does have a purpose, but it also comes at a cost to the tissues in the "quarantined area" - with all those ambulances parked all over the place, it's hard to get on with things. Then, when the quarantine period (read - acute inflammatory phase of injury) is over, the tissues have to repair their damaged lives. This includes rebuilding and remodelling, and this is where your friendly physio will start raving on about collagen fibres in disarray, and scar tissue in abundance. To avoid this (both the scarring and the raving, I mean), most people set out to minimise the inflammatory response as far as possible, when they get injured.

Now Macattack may get hot and bothered when I type this, and demand to see references (sorry, Macca) - but when I was a student, there was more evidence to suggest that the best way to prevent swelling, was to elevate the affected part, and put a pressure wrap on it. The wrap increases the pressure from outside the body, and makes it harder for the extra fluid to leak into the tissues etc., as part of the inflammatory response, while the elevation serves to make it an uphill drive all the way for those darned inflammatory ambulances to get into the tissues. Meanwhile, the rest and ice part of the RICE equation, are meant to decrease the metabolic rate of the cells in the injured area, to hopefully minimise the damage to those cells, and therefore lessen the rebuilding and remodelling that will be required.

So, there you have it, in 5 paragraphs, no less. Yeah, a bit of a rave, I know. Hopefully more on-topic than some of my posts...
...and about the ankle - don't do what hurts, until it doesn't hurt to do it. All the best.

[Rickson]

You want backup? How's this? Before I became a certified trainer, I experienced a few ankle sprains from playing basketball and in those days, I used to let "nature run its course". Average healing time, 1 week. After I became a certified trainer, I'd ice any ankle injury. Average healing time, 2 days. You do the math.

[Bottle Rocket]

Originally Posted by Rickson

You want backup? How's this? Before I became a certified trainer, I experienced a few ankle sprains from playing basketball and in those days, I used to let "nature run its course". Average healing time, 1 week. After I became a certified trainer, I'd ice any ankle injury. Average healing time, 2 days. You do the math.

Yeah... I understand and appreciate your post. I also have found similar claims from people (such as those who replied to the original article I posted) that claimed the opposite results by doing none of the things you mentioned. This is the internet, after all.

Another great link:

http://orthopedics.about.com/cs/spra...nklesprain.htm

[Rickson]

So what is your take on the matter, rocket? Do you believe in icing or do you believe in tough love like that skater dude?

I used to do this all of the time. I believe in icing. Also in ASO ankle braces. The other thing you can do is strengthen the sides of your legs which will help stablize you if you start to go down again. Stand on one leg, get a Bosu etc. But the first thing you should do is get an ASO.

[Punisha]

RICE for me ... im gonna trust the combined knowledge of our medical professionals... also i concur with the basketball injuries... rice lowers the healing time by alot!

[Kevo]

I can only offer my personal experience. I've only had one major ankle roll in my life, but it was painful, and it was from a skateboard accident. Go figure...

Anyway, it was one of those popping sound type rolls and it was the first time ever I've had the kind of pain that prevents use of any kind. I ended up hobbling around for a few minutes and manipulating the ankle by hand to try and determine how bad it was. After I decided that it wasn't broken or totally borked I decided to test it out. Within about 10 minutes I was riding my board home very gingerly. As soon as I got home I iced it for a good while and then I walked on it around the house and stretched it out as best I could.

The worst part of the whole thing was waking up after my first night of sleep. It was much worse in the morning. I stretched it out as best I could, iced it a bit more and made sure I walked on it several times an hour. The next day it was much improved, and I continued to stretch it and walk on it. I played tennis on it, lightly, after 4 days, and it was probably 95% after a week. It wasn't 100% for a couple of weeks maybe, but I think if I would have kept up with the stretches it wouldn't have taken so long.

I definitely think the don't use it advice is totally bogus. My mom just finished her second knee replacement, and they had her up standing on it the first day and walking on it the next. She does exercises for several hours a day to make sure it stays mobile.

I think the main thing is to make certain that the damage isn't so extensive that you might need special care from a doctor. Other than that, use it but don't overdo it. Definitely don't totally ignore the pain.

[Rickson]

Kev, you would have healed much faster if you didn't stretch the injured ankle. Ice is to prevent swelling and rest is for recovery. Stretching an injury prolongs healing time although it's a good thing after you've completely healed. That means you can stretch after a week, not during the healing phase.

[BullDogTennis]

whatever you do just start SLOW. you dont want to take a chance of hurting in more in the long run. its better to stay off it as much as possible for a week or so, then be off it for months.

[Bottle Rocket]

Originally Posted by Rickson

Kev, you would have healed much faster if you didn't stretch the injured ankle. Ice is to prevent swelling and rest is for recovery. Stretching an injury prolongs healing time although it's a good thing after you've completely healed. That means you can stretch after a week, not during the healing phase.

Yeah, I'll agree with that.

Stretching an injury as soon as it happens doesn't sound real smart to me... Especially when it is a tearing of muscles and/or ligaments. Sort of counterproductive, isn't it?

[Kevo]

I tried the rest and don't use it thing on a more minor ankle injury before. It was over a month before I could fully flex the ankle in all directions without mild pain. I got that injury playing tennis. It was what I would consider a minor sprain. I had some trouble walking on it after it happened, but nothing like the skateboard accident. This injury had only minor swelling.

With the major sprain I literally couldn't put my foot on the ground immediately after it happened. It was quite scary. When I say stretch it, I didn't stretch it like I would normally. I just didn't want it too stiffen up and be painful for such a long period of time. I would just move it until it hurt and then back off. I was walking on it regularly the next day and played some light tennis on it within a week. This was a huge improvement over my previous experience with an ankle injury.

The day it happened my wife was talking about getting me crutches. I thought I would be off the courts for weeks. The fact that I was able to walk on it and that it was less painful to keep walking on it gave me hope for a quick recovery.

Maybe I am totally off base, but I think resting it completely would have kept me off it for a much longer time.

And, I want to stress that I am only speaking from personal experience and nothing more. I have only basic first aid training and I am not a doctor. If I had medical insurance, the first thing I would have done would have been a trip to the doctor.

[Rickson]

You mentioned that it swelled up more in the morning. That's why you ice and rest because you keep the swelling down. If it happens again, and I hope it doesn't, ice constantly without stretching. I guarantee you'll be back on your feet faster. The last ankle injury I had took me just over a day to heal. I was icing the whole time. I walked fine the next day and without any pain at all in 2 days.

[Fee]

I studied sports medicine for two years. Ankle injuries and shin splints were probably the most common problems we dealt with (community college football team, and every other sport). Of course we had modalities to help heal injuries, but the one thing that we stuck to with or without the modalities was ICE ICE ICE. For at least the first 48 hours, longer if there was still swelling. When the swelling went down significantly, we moved to ice/heat, but never in the extremes described in the first post. It was usualy ice or ice bucket for about 20 minutes, 5 minutes at room temperature, then 20 minutes of heat (whirlpool or heating pad).

Mobility was also part of the healing, but again usually not for the first 48 hours. The tendons, ligaments, and muscles involved in sprains and strains need time to recover and rest (and release a spasm) before they can be asked to do their old job again. No, you don't want to wait too long, but you don't want to push it either. We would usually check mobility with simple point/flex/make a circle movements, with the leg extended out in a sitting position, or up in a prone position. The athletes would be encouraged to do those same movements on their own as often as possible, but never to the point of pushing it.

There are other ankle exercises you can do during the healing process that help without hindering (sit in a chair with your foot flat and bunch a towel with your toes, then push the towel back out unbunched, pick a pencil up with your toes, foot circles, stuff like that). Weight bearing should be the last step after all of the non-weight bearing activities become easier, the pain is mostly gone, and the swelling is reduced.

Sorry I cannot give you any links to this info, and it might be completely outdated by now, but it was what I was taught when I studied to be an athletic trainer (but that was a while ago, I gave up and got a degree in Poli Sci instead).

[Kevo]

Fee, you make a lot of sense. I would be curious to see any kind of clinical studies of injuries that compare healing with no movement of the joint during initial recovery versus movement and limited exercise of the joint during initial recovery.

Like I mentioned earlier, after a knee replacement they try to get you walking shortly after surgery, and they do push you a little. Without the use of pain killers getting out of bed after the first day would probably not happen. Also there is significant swelling during this as well. I know it's not apples to apples, but I think the movement and exercise limited as it is really makes a big difference.