Twisted ankle, use it or rest it?

Fell off the bike today on pitch hill and rolled over on my ankle badly – never right I’d yelp luke that! Had to ride home back to godalming and it’s very swollen now. Getting some ice on it and it hurts lots when flexing (and therefore walking). Should I keep walking on it or rest it by using crutches for a day or so?

Protect it, rest it, ice it, compress it and elevate it. Ice for 10 mins an hour. Tubigrip to compress it and put your feet up.

Ta. I expect a medicinal whiskey would be a good idea as well!

Remember that if you’re sprained your ankle, it’ll take weeks, or even months to heal, and using and abusing it before its ready could make you more susceptible to long term ankle problems (as I’ve found out to my cost.)

Although you need to rest your ankle, not moving it is a very bad idea. If you can, take lots of ibuprofen to help with the inflamation, apply ice, or a cold damp towel if the pressure of the ice is to much, every 30 minutes, for about 10 minutes. Personally I wouldn’t use a tubigrip bandage, as it offers very little support for the joint, and I’m not convinced that constricting the swelling is a good idea (but some medical bod will probably correct me on this…..)

Work on trying to write the alphabet in the air with your foot, but only by moving the ankle.

As soon as you can weight bare without it hurting to much start walking on your ankle. Move slower so that you don’t limp and maintain a natural stride, and start practising standing on just the damaged foot (You’ll probably need to support yourself initially) then whenever you can, do calf raises (i.e standing on tiptoes, and drop back down again in a slow controlled manner)

I can happily put weight on it standing still, just pushing off to walk that’s agony. Hopefully that means it isn’t too bad. Icing is feeling good!

In that case get a pillow or a cushion and practice standing on it with one leg. If it hurts too much stop. Don’t ice it too long or you’ll make it swell up more.

Just make shure it’s only a sprain though. 2 weeks hobbleing around on what I thought was a sprained ankle turned out to be a broken one.

Reckon I’ll give it until monday. If it’s still really hurting go and get it checked out.
Thanks all for the advice.

strongly advise you to get an xray pretty pronto, many ‘s’posed’ sprains have turned out to be broken as mentioned above.

Had it x-rayed in the end on Sunday (over a week ago now). Thanks to all the convinced me I should. They said it wasn’t broken. phew. Use crutches for a couple of days to help rest it a little.

Thought it felt a bit better yesterday an walked ~1.5 miles along the river yesterday and now it hurts more than ever and it’s still massively swollen! I’ve never had an ankle sprain like this before. Starting to wonder if there is something more serious up with it.

poor me…….. haven’t been able to exercise in any way, let alone use the bike, for over a week now.

Didn’t rest mine as much as I should and made it worse, REST REST REST

ibuprofen 3 times a day for 3-4 days will do you no harm and will hopefully ease the swelling

A week is nothing in terms of recovery time for a sprain, just be patient, use it when you can but don’t over do it.

Ankle sprains, the bane of and love of my working life…..

I love them because they are easy to diagnose and have an obvious and well researched path of treatment, and they only take me two minutes to sort out. I hate them because no-one is ever happy with a diagnosis of ‘just a sprain’, everyone seems to think that radiation is curative and no-one listens to the management plan and is then surprised when it doesn’t get better.

Most commonly injured bit of your ankle is the ATFL, the ligament that attaches your foot to your ankle on the outside just below and slightly in front of the boney knobbly bit. It’s usually injured by turning you ankle in (85% of ankle sprains).
In A&E we have rules (the Ottowa ankle rules) about which ankles do and don’t need x-raying and these should be applied strictly after a (hopefully) thorough examination. These rules indicate which ankles/feet need x-raying depending on which bits are sore and have been shown to be 98.5% sensitive, which means if applied properly they will pick up 98.5% of significant fractures. (This means we will still miss some breaks (1.5% of significant fractures and a number of insignificant fractures), so if it’s not starting to settle after a few days/a week then come back and see us.)

(Nearly) all of these injuries will get better with treatment….

Protection – Some bad ankle sprains require some form of protection for a few days, this may take the form of aircast devices or occasionally even a plaster

Relative rest – The ankle joint requires some rest but also some active rehabilitation; try to rest it up as much as possible for the first 48 hours and slowly get using it again – GENTLY AT FIRST. It should take 4-6 weeks to build back up to normal use of your ankle and even then it will not be at full strength. The alphabet exercises mentioned above are good for restoring full range of movement.

Ice – Ice packs will help control swelling and to some extent pain. Don’t apply directly to the skin and only use for 15 mins out of every hour.

Compression – with proper compression bandaging can help reduce the swelling (until the first time it is taken off when you get home and not put back on properly when it will do nowt so don’t expect to get one). Tubigrip bandages are shit and add nothing to the management of ankle sprains aside from you getting slightly more sympathy from your mates and costing the NHS a fortune so you won’t get one.

Elevation – Keep it up, it reduces swelling. (Has to be above waist height to be of any use.)

The last thing to get better in ankle sprains is proprioception or joint position sense. The ligaments around your ankle are full of tiny little sensors that tell your brain exactly where your foot/ankle joint is in space. This is the reason you can stand on one foot and close your eyes and not fall over (try it on your sprained ankle – I bet you fall over). I always liken these to small springs that get stretched when you move the joint and your brain interprets this stretch to tell you where your foot is. Imagine going over on your ankle over-stretches these springs and, as we all know from dismantling biros as a kid, when you overstretch a spring it never quite goes back to its original length. These proprioceptors can take ages to get better (a few months) and it is for this reason that your ankle feels a bit unstable for ages after you sprain it. The best way to retrain these stretch receptors is with a programme of active rehab, namely wobble boards or similar. Once your ankle is mostly better, and has most of its strength back (approx. 3-4 weeks) you need to started testing the proprioceptors to get them working again. As mentioned above standing a=on unstable surfaces (cushions) is pretty good and wobble boards can be had from Amazon for £15-20 (or you can play the balance games on your Wii Fit (the marble games is particularly good)).

Hope this helps…

(Can you tell I’m revising for exams?)

Protection – Some bad ankle sprains require some form of protection for a few days, this may take the form of aircast devices or occasionally even a plaster

How do they decide a sprain is severe enough to require a cast?

Is it possible to pass the Ottawa ankle rules test and still have a sprain severe enough to require immobilisation?

Bang on from dr_death. It may well be a long time before you get strength, confidence and proprioception. I’ve done mine 3 times fell running and it can really bugger your season. Don’t nurse it too much, you still need to use it.

I fell off and twisted my ankle on a solo ride on the Quantocks, turned out to be an open fracture, nothing 6 weeks in plaster and 12 weeks off work wouldn’t cure 😳

Ebygomm – Clinical judgment (ankle draw test and experience) and yes.

Cheers, just wondering. I passed the test but was told later (4 weeks ish) I should have been non-weight bearing on that foot (tore the ligaments that hold the tibia and fibia together, not the standard ones)

To be honest with you fella, when you wake up in the morning the decision will already have been made for you. If its hurting now, just wait til the first rays of sunshine awaken you from your dreamy torpor. There will another yelp when you try and stand up.

I thought I might be able to wing it after limping back home from a night ride. I was straight into A&E when I awoke the next morning. You don’t have to wait to long at 8.30am though.

It was months before I was back on the bike. I made the mistake of trying too early. I put some flats on and went out in the Peaks. A truly stupid thing to do. DON’T DO IT!!!!!

And for future reference, could I recommend one of these:

http://www.chainreactioncycles.com/Models.aspx?ModelID=1203

my other half twisted her ankle a few years back and ignored it, pain, swelling, etc, currently signed off work, 6 weeks and counting with Achilles Tendonitis, currently doing Physio and the threat of a cast if it doesn’t get much better soon.

I’ve had problems with my left ankle for years, its severely weakened from inverting several times and now is producing knock on problems in my knee. The last sprain happened about 3 months ago and I’ve been out of action (running) since

I did all the RICE stuff then biked for a bit. I’ve been rehabilitating it with a series of exercises I found on the net, raising on one leg, on both on tip toes etc, its working really well and I’ve been able to introduce some moderate running over the last couple of weeks.

both my ankles are well fecked – always had looseish joints and then did few yrs of playing footy and spraining every month or so (and strating to play before fixed properly)

Ended up playing with both taped up almost solid before giving up

they just have no resistance at all now to re-spraining (I guess maybe proprioception – I don’t feel them starting to go in time to do anything about it)

My advice – do what the doc said up there ^

Great stuf dr_death on those proprioceptors i wondered why my ankle stayed “wobbily” for a bit after injury. Very useful post! I have done quite a bit of “DIY” treatment of both ankles over the years as it is so hard getting to see a doc.

All of you lot go away and grab a cushion and try standing on it with one leg come back and tell us how you get on. 😀

I have done quite a bit of “DIY” treatment of both ankles over the years as it is so hard getting to see a doc.

My GP sent me for an Xray, there was clearly no broken bone, perhaps some scar tissue on the tendon from the sprain, all I wanted was a referral to physio, but its too much hassle to keep going to the dr’s then the hospital and back again when a homemade programme is perfectly doable.

All of you lot go away and grab a cushion and try standing on it with one leg come back and tell us how you get on.

I like that, thats been added to my routine.

I was circuit training tonight, which involved a little bit of standing on 1 leg – I can’t do it without waving arms and occasional hops even on a solid wood floor in thin-soled trainers

🙁

Awesome info guys. Many thanks – especially to dr_death for taking the time to write such a comprehensive explanation.

I’ve got an appointment tomorrow to see my chiropractor who conveniently also specialises in sports injuries. So I’ll be getting some further professional opinion on the matter.

When i did mine (drunk, curb, slip, sprain..) was off the bike for around 3 weeks, used it as little as possible but kept it moving with gentle excercises at home, went back to work couriering and had to be very careful with it, had a few moments of searing pain when i slipped my pedal… moving it seemed to aid it’s recovery, although it was 6 months before it felt completely normal but is now fine…I sort no medical advice and just went on how it felt, perhaps not the best thing to do but all was well in the end.

Just be careful with it, don’t get stuck in to soon. 😕

Dr Death,

Um, that reads just like a ‘text’ book!

What about dynamic stability? There are some great points throughout this thread, however they are generalised. You must obtain a reliable diagnosis to the severity (alluded to) which in turn will dictate the treatment plan.

Go find a well seasoned sports physio as they will have clinically observed such presentations from start to ….well further down the line than other medical professionals and therefore would hold a broader treatment knowledge base.

Tubigrip is poor/next to useless for stability. However, who can tell me for which application (relative to situations such as this) it is good for?

You’re the physio student. You tell us.

Also, tubigrip bandages are not shit. It’s just that very few people know how to use them to provide adequate graded compression.

turned out to be an open fracture

How exactly did you not notice an open fracture? 😯

My GP sent me for an Xray, there was clearly no broken bone, perhaps some scar tissue on the tendon from the sprain, all I wanted was a referral to physio, but its too much hassle to keep going to the dr’s then the hospital and back again when a homemade programme is perfectly doable.

I find it quite straightforward to see a physio when I want. All I have to do is pay, rather than expect to get one on the NHS for something which will heal itself. Not only that, but the one time I did get NHS physio he did a very poor job of diagnosing the underlying problem – happy to pay for somebody who specialises more in sports injuries.

I’d agree about getting it looked at, and maybe paying, if you’re anxious to get back to full speed quickly. Depends how important your sport is to you.

There are some self taping regimes you can do if you get shown. Definitely a short term measure though. You need to wean yourself off them. Useful to give a helping hand to the lost proprioception being re-learnt – can give a tug on the skin when you’re about to go over and let you recover in time. I probably wouldn’t recommend it to someone more sensible, but I ran the British fell relays with a taped ankle before it was fully recovered. Good luck.

Love Tubs – The text book of Steve (sadly this is the kind of shit that floats about in my brain……)

Tubigrip is shit; due to the linear spring rate of the elastic it’s almost impossible to get graduated compression over something as knobbly as the human body. Also it will only last until the patient moves as this invariably moves their tubigrip.

Oh, and Sam_Underhill – it was all going so well up until this point….

I’ve got an appointment tomorrow to see my chiropractor who conveniently also specialises in sports injuries. So I’ll be getting some further professional opinion on the matter.