Please help me with my sprained ankle

[nirish]

I sprained my ankle playing football three weeks ago, as the swelling was remaining I had it checked for fracture and was told I didn't need an xray as there is no pain indicating a fracture.

The medical specialist I saw and everything I read suggests I should be working on flexibility so I have been stretching my foot forward and back, left and right and there isn't much pain in doing this although it is stiff compared to my other ankle.

My issue is I wake up in the morning the swelling isn't too bad but by the end of the day and after the stretching it is really swollen up again and this cycle doesn't seem to improve.

Should I be continuing with the stretching despite the swelling ?? I am trying not to walk too much and elevating my foot for an hour or two every night.

I am a triathlete and am finding the downtime difficult although I know I have to be patient . . . .

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[StatesPT]

Hi - in my opinion the swelling is ok as long as the pain is low. At three weeks post injury i would have my patients do whatever does not hurt beyond a 3/10 level of pain and is very low risk for re-injury (cycling, rowing machine, elliptical, some water exercise). In general it is better to keep moving (stretch, walk) than sit with leg up on ice for hours. This is all pain dependent of course. What you should notice over a period of weeks is that you can do more activity before hitting that 3/10 pain level. Your local physio can assist with this. If you are not able to progress activity in the next few weeks then a return to your GP may be in order. Good luck!

[nirish]

Ok it's over a month now, I'm really not sure whether the swelling has improved at all in the last fortnight. I feel I am experiencing less pain now but each morning I have a small amount of swelling and a lot more in the evening. The swelling makes the ankle less flexible and it's hard to tell whether that ankle being less flexible is due to the swelling or ligament damage.

I'm also struggling to know how much to do, I'm desperate to get back into training but am worried about a setback.

Will the swelling eventually settle by itself or is it something I need to actively tackle somehow ??

[ALS388]

Make sure you are putting a cold compress on it after being on it. What would work best is if your compress also worked as a brace. Taping is always a very good thing to be doing. Helps with support and with preventative measures.

[nirish]

A few weeks ago I went to A&E/ER to check there wasn't a fracture and was informed there that there is no point in using ice after the initial week or two ???

Also when you say to use a brace, is this all the time or during activity and for what period do I use a brace before relying on my own strength ???

I am still shocked to have soreness and swelling 5 weeks after what felt like an innocuous sprain !!

[ALS388]

Hi Nirish,

Cold is not recommended for long term, consistent use because cold constricts the blood flow. However, if it is still swollen, the blood flow is constricted. The swelling has to come down in order to progress with the healing. Once the swelling comes down, then you want to focus on treatments that increase the blood flow to the area. But...with that being said, if you are active on it during the recovery period, inflammation is still going to develop from daily use. At this point, you want to only be doing usually one good cold treatment a day, after activity on the injured area. This will get down any inflammation and in turn, allow the blood flow to circulate in and through better. A brace is important at this point as you need compression to help bring down the swelling. Once the swelling is down, you want to use it (or tape) during activity to simply help preventing further injury during your recovery.

5 weeks....hmmmm. Are you putting a lot of strain on it daily? Are you quite active on it? If so, you really need to try and rest it. Rest, elevate and keep a cold compress on it.

I hope you start seeing some improvements soon. Please keep us up to date.
All the best.

[nirish]

Thanks great reply, I wouldn't say I am overly active on it in normal life, I've been doing stretches and some limited exercises like standing on one leg. I was informed online to progress with these even if there was still swelling there. I'm still getting some pain if I forget and turn around too quickly and there is some swelling between the ankle and the foot and across the bridge of the foot where it pivots. This tends to increase as the day goes on. I have been elevating it a lot in the evenings, sleeping with it on a couple of pillows and using a compression bandage in the mornings usually although I don't own a brace.

Could you send me a link as to what you mean by a brace as there as so many varying types and expense ranges. Everything I read suggests I should be progressing to light exercise such as cycling by now but I haven't done anything other than light walking to get around as it's still swollen and sore.

Can't decide if it warrants seeing a physio at this stage or if they will just tell me what I already know. Can they actually do much for it ??

[ALS388]

I sent you some info to your inbox. Tried posting but they won't allow links.

[nirish]

Thanks again for the information, I have been taking a pretty inactive approach for the last week or so and I think I am seeing a reduction in swelling although only marginally.

I have been using a stretching bandage tied tightly for a few hours every morning to help reduce it as well.

There is a lot of information in the link you sent me which is great but the wrap information appears to be for something that costs well over $100 dollars, this is definitely way beyond what I have to spend on a one off recovery.