Ankle Sprain - When to return to sport?

[lihp8270]

Hi,

I feel awful signing up purely for advice. I would love to visit a physiotherapist face to face, but due to my work schedules, and the fact the injury does not prevent me from working means it's impractical for me.

Due to compound fracture of both radius and ulna back in January, I no longer play any contact sports, and switched over to "Touch" rugby.

Last Tuesday (28th July), I went over on my ankle (rolled ankle with sole facing in), hearing a pop as I went down. The pain was sharp at the time, but walked off for about 10 minutes, and went back into the game. I was entirely pain free during the game. After getting home and having a shower, it started to ache. No pain, I could still walk without a limp, but it ached, and looked swollen, so took myself to my local A&E department.

At A&E (I walked in), they checked it over, asked me to move the foot in all directions and were happy with the range of motion, the only pain was when they pressed onto the side of the ankle, because of this and the pop I was sent for X-Rays.

X-Rays came back clear, but now bruising had started to show on the side of the ankle (higher up near the lower leg). The Dr didn't seem too concerned with the pop, and likened it to cracking your knuckles. I was given a compression bandage to wear to help with the swelling.

The next day, Wednesday 29th July, it was quite sore in the morning, but as I moved around it became free and pain free. I was still able to walk without a limp.

It has gradually improved till Friday in which I watched a rugby game, so walked 2 miles, stood at a game for 2 hours, all pain free. So on Saturday I started to follow this advice

https://youtu.be/OD-p1mwqsH4?t=3m37s

So we're now up to today Monday 3rd August, 6 days after the accident. I have mild discomfort at maximum range of motion, but I can jump, stand on my toes (with some mild discomfort), jog, sprint at 100%, cut in while running at sharp angles pain free. But still experience mild discomfort/pain doing the exercises when near extreme motion. The most painful position being, foot rolled in, and pointing foot/toes up towards my shin.

Currently, bruising has pretty much gone, but there is some swelling still.

The advice by the Doctor was a little ambiguous in that he suggested, rest for 3 weeks or till I feel comfortable on the ankle.

I was looking at taping the ankle with the following method
https://www.youtube.com/watch?v=2sRtN-gngn0

And trying to play touch rugby again tomorrow, I obviously don't want to re-injure the ankle. But what risks are involved if I join in slowly, and sporadically? This is a social game run by a local club, rather than a competitive league.

Am I safe to try playing and stop if I feel any pain or discomfort? Are there any tests I can do, beyond trying jumps and standing on toes, that I can report back the results that would suggest whether my ankle is suitable to use again?

All advice is very much appreciated, and apologies for the long post, but hopefully I gave you all the details you need.

Thanks

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[AzzaRehab]

Hi,

Did you try playing rugby today? If so, how did it go?

Considering you were able to hop, run, sprint and cut at sharp angles only 6 days post-injury, I do not suspect there was a significant amount of damage to the ankle ligaments during the injury.

It will be important to manage any remaining swelling using the compression bandage, icing and mobility exercises (circles with foot, sitting wit foot up etc.).

From there, I would suggest some calf stretches / massage as these muscles tend to tighten significantly as a result of this type of injury and may be why you get pain at end of range. I would then progress to practice balancing on 1 leg (eyes open and eyes closed) to see how much that has been affected (ligaments have a big part to play in balance and co-ordination). If all is pain free then ease back into running and return sport in a week or so.

Hope this helps.

[lihp8270]

I actually went to a physiotherapist today, and wow, far better treatment than I have ever received at the NHS, listened to my concerns, and gave me answer to an exact question.

I went through the injury details with him, the pop, the bruising, and swelling. Explained that I could still walk on it and continued playing within 10 minutes. He had a look and a feel, found the sore spots, and suggested that 1 of the ligaments has a mild sprain, and another certainly has torn like A&E suggested.

So, I asked about returning to sports.

So, he had me first balancing on each leg to compare, 1 leg squats, jumping, hopping, hopping side to side. He was happy with all of that, and actually said I would be safe to continue all sports with care!

He commented that the ligament is going to be vulnerable for 6 weeks or so, and a bad sprain again in this time could cause a complete rupture, but just playing sport or cycling won't do continued damage.

He noticed an imbalance, when doing the 1 leg squats on my good ankle, my knee and ankle and thigh all go nicely in line. On the bad ankle, the knee tips in, but he thinks there's more going on. He explained that he thinks there's some weak muscles on that side, so gave me a list of exercises to do to improve it. He was actually more concerned about the knee than my ankle! When he explained where the strain goes and touched where it will cause an issue, is the exact same place where I have been getting knee pain while cycling!

So, to summarise,

I am fine to play sports so long as I tape the ankle, or use an aircast to help protect it from sprains. And, keep an eye on any pain and swelling. So pain, stop immediately, if swelling the day after, then rest it longer.

Today, I taped the ankle and went playing rugby, currently feel ok, will see how the swelling is in the morning, but hopefully I can get out on the bike tomorrow evening!

What I am most impressed with was that for just £30, I got a very understanding physio, who listened and answered my exact concerns, specific to my circumstances. A guy who found a condition I had, that I hadn't even mentioned! Massaged the ligaments, ultrasound therapy, and didn't pressure me into booking any more sessions. A vast difference to my experiences with the NHS, and will certainly be consulting a private physio for future issues!

[Sands of Chiro]

Honestly, it depends on the severity of the injury. Can you walk comfortably? Can you put all your weight on it without wincing in pain? These are the questions you have to ask yourself. My brother got really hurt in soccer and tried going back to early and ended up making it worse and had to take like a month off of work because he couldn't stand. Luckily he talked to a personal injury lawyer and was able to get compensation for he missed days, but not everyone can be so lucky.