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When To Return To Sport After Ankle Sprain?

• Elke
• 26.04.2023
• 0
• 13

Your Recovery Timeline – Before you can get back to your sport, you must give the injured ankle tissues time to heal at a cellular level. Only then can you start to strategically load the tissue to help it rebuild, strengthen and prepare you for a safe and successful return to sport. There are a number of factors that determine how much time you’ll need to fully recover, including:

The type and severity of your ankle injury (and the form of treatment you undergo) Your health and age Most importantly your adherence to your physician’s recommendations and physical therapist’s program

1) Type of Ankle Injury, Severity and Treatment Ankle sprains, bone fractures, Achilles ruptures, torn ligaments and chronic tendinopathy are among the most common forms of ankle injury, Dr. Smith says. And the recovery for each of these varies. For example, while someone might be able to return to sport one to two weeks after a very mild ankle sprain, it can take many athletes as many as six weeks to three months for ankle stability to significantly improve.

1. At the other end of the spectrum, severe Achilles tendon injuries or fractures often require surgery and can take upwards of a full year for the body to recover.
2. People with acute Achilles tendon ruptures should not expect to resume their normal walking patterns until 12 to 18 weeks post-injury.
3. These patients may be advised to avoid running and other non-contact sports for at least 16 to 20 weeks.2) Health and Age Your prior activity level, baseline muscle mass and bone density all play into your health, and all collectively help determine how long it will take you to recover post-injury.

The healthier and more active you were prior to injury, the less time you can expect your recovery to take. And, the healthier you are, the greater the array of treatment options available to you—which can potentially mean a speedier return to sport. While a person in poor health might not be a good candidate for beneficial surgery, someone in good health might be.

1. While you can’t change the past, everyone’s ankle injury recovery can benefit from integrating healthy lifestyle habits like eating nutrient-dense foods and getting seven to nine hours of sleep per night.3) Adherence to Your Recovery Plan Right now, your sport is recovery.
2. To progress at it, you need to show the same dedication you do to exciting interval and agility drills.

While the initial days and weeks of the recovery plan may seem boring, and it may be hard to see the relevance to your sport, it’s important to trust the process. Understand that by following the more “boring” instructions early on, you can get back on the field with your teammates even quicker.

Try to think about your physical therapy recovery plan as a visual pyramid: The base or bottom layer includes the lower-level, stationary exercises. The peak of the pyramid is live, competitive play on the field. To reach the peak of your pyramid, you must follow the recovery plan exactly as instructed by your physical therapist; otherwise you may not be granted the metaphorical key to move on to the middle tier of exercises, which is a stepping stone to return to sport.

Adhere to the basics early and it will pay off for you later on.

How long should you wait to play sports after a sprained ankle?

About Ankle Sprains – Ankle sprains are graded into various categories and each grade of ankle sprain will usually have a different time frame on how soon it is safe to return to activity. The type of activity is also a factor, as sports that involve twisting/turning will require greater strength and stability than, for example, jogging or hiking. Grades of ankle sprain:

Grade 1 sprains are light sprains that usually allow return to sport in 2-3 weeks. Grade 2 ankle sprains involve greater injury to the ligament and can take up 4-6 weeks to allow full return to sport. Grade 3 injuries are more severe in nature and often involve full tearing of the ligament and possible bone fracture. The length of time to recover from grade 3 ankle sprains could be 3 months or more.

All of these time frames are variable on case by case. Before returning to activity, whatever grade of sprain it is, it’s important that you have undergone some rehab to ensure safe transition to your activity and minimizing the risk of re-injury. With any ankle sprain, there are a number of core areas that need to be trained to a sufficient level that is appropriate to the demands of the sport/activity you engage in.

Can I do sports with a sprained ankle?

Can I Go Back to Sports? – If you have an ankle sprain, you’ll probably need to take some time off from sports and other strenuous physical activities. Make sure your sprained ankle is completely healed first. You can go back when:

The swelling goes down. The sport does not cause pain. The doctor says it’s OK. You can bear weight without a limp. You have your full range of motion. Your strength returns to normal.

How long should you stay off a sprained ankle?

Sprained Ankle | Orthopedics & Sports Medicine Every day, approximately 25,000 people sprain an ankle. Ankle sprains happen when the foot twists, rolls or turns beyond its normal motions. When a ligament is forced to stretch beyond its normal range, a sprain occurs.

Severity	Physical Examination Findings	Impairment	Pathophysiology	Common Treatment Protocol
Grade 1	Minimal tenderness and swelling	Minimal	Microscopic tearing of collagen fibers	Weight bearing as tolerated No splinting / castingIsometric exercisesFull range-of-motion and stretching / strengthening exercises
Grade 2	Moderate tenderness and swelling, along with a decreased range of motion and possible instability	Moderate	Complete tears of some but not all collagen fibers in the ligament	Immobilization with air splint Physical therapy with range-of-motion and stretching / strengthening exercises
Grade 3	Significant swelling, tenderness, and instability	Severe	Complete tear / rupture of ligament	Immobilization Physical therapy similar to grade 2 sprains, but over a longer period Possible surgical reconstruction

Reprinted with permission from Bernstein J (ed): Musculoskeletal Medicine, Rosemont, IL; American Academy of Orthopaedic Surgeons, 2003, p.242. The amount of pain and swelling you experience will depend on the amount of stretching and tearing of the ligament.

Instability occurs when there has been complete tearing of the ligament or a complete dislocation of the ankle joint. Swelling and pain typically last 2-3 days. Walking may be difficult and crutches may be needed. When an ankle sprain is suspected, your doctor will perform a physical exam which may be painful.

The doctor may need to move your ankle in various ways to determine which ligament has been damaged. Your doctor may be able to tell you the grade of your ankle sprain based upon the amount of swelling, pain, and bruising. If there is a complete tear of the ligaments, the ankle may become unstable after the initial injury phase passes.

If this occurs, it is possible that the injury may also have caused damage to the ankle joint surface itself. Your doctor may order X-rays to make sure you don’t have a broken bone in the ankle or foot. A broken bone can produce similar symptoms of pain and swelling. An MRI (magnetic resonance imaging) scan may be ordered if your doctor suspects a very severe injury to the ligaments, injury to the joint surface, a small bone chip, or other problem.

The MRI may be delayed in order to allow any swelling and bruising to resolve itself. Most ankle sprains need only a period of protection to heal. The healing process takes about four weeks to six weeks. The acronym R.I.C.E is a good way to remember what to do:

Rest your ankle by not walking on it. Ice should be immediately applied. It keeps the swelling down. It can be used for 20-30 minutes, 3-4 times per day. Compression dressings, bandages, or ace-wraps immobilize and support the injured ankle. Elevate your ankle above your heart level as much as possible for the first 48 hours.

Depending upon the grade of injury, your doctor may recommend a cast boot, air splint, and/or crutches. Even a complete ligament tear can heal without surgical repair if it is immobilized appropriately. Your doctor may tell you to incorporate motion early in the healing process to prevent stiffness.

Ultrasound Electrical stimulation Active range of motion exercises or controlled movements of the ankle joint without resistance Water exercises if land-based strengthening exercises, such as toe-raising, are too painful. Lower extremity exercises and endurance activities as tolerated. Proprioception training

Non-steroidal anti-inflammatory drugs (NSAIDs) may be used to control pain and inflammation. Surgical treatment for ankle sprains is rare. Surgery is reserved for injuries that fail to respond to non-surgical treatment and for persistent instability after months of rehabilitation and non-surgical treatment. Surgical options include:

Arthroscopy – A surgeon looks inside the joint to see if there are any loose fragments of bone or cartilage, or part of the ligament caught in the joint. Reconstruction – A surgeon repairs the torn ligament with stitches or suture, or uses other ligaments and/or tendons found in the foot and around the ankle to repair the damaged ligaments.

All ankle sprains recover through three phases:

Phase 1 – 1 Week – Resting, protecting the ankle, and reducing swelling. Phase 2 – 1 to 2 Weeks – Restoring range of motion, strength, and flexibility. Phase 3 – Weeks to Months – Gradually returning to activities that do not require turning or twisting the ankle and doing maintenance exercises. Later followed by activities that require sharp, sudden turns (cutting activities) such as tennis, basketball or football.

If an ankle sprain is not recognized and treated, chronic problems of pain and instability may result. : Sprained Ankle | Orthopedics & Sports Medicine

Can I play sports a week after ankle sprain?

1) Type of Ankle Injury, Severity and Treatment For example, while someone might be able to return to sport one to two weeks after a very mild ankle sprain, it can take many athletes as many as six weeks to three months for ankle stability to significantly improve.

Can I run a week after spraining my ankle?

Our articles are not designed to replace medical advice. If you have an injury we recommend seeing a qualified health professional. To book an appointment with Tom Goom (AKA ‘The Running Physio’) visit our clinic page, We offer both in-person assessments and online consultations.

You’re running along, minding your own business, when out of nowhere a demonic child on a scooter hurtles towards you. You change direction, shifting to one side but sadly your ankle is planted firmly on the ground and you go over on it. There’s immediate pain and swearing. The kid whizzes off, unaware of the damage they’ve caused and you sit in a heap wondering whether you’ll be back running again any time soon.

Ankle sprains are common and can be a painful nuisance to a runner. In the worst-case scenario, the ankle can become weak and unstable, preventing any sporting activity, but with the right management you can soon be back on your feet (and chasing that annoying kid on the scooter) The British Journal of Sports Medicine recently published a clinical guideline on the management of acute ankle sprains – Kerhoffs et al.

2012), This will form the basis of our recommendations. Lateral ankle sprains (ones that involve the outside of the ankle) are more common than medial sprains and will be the main focus of the article. Ankle sprains are commonly caused by the inversion of the foot and ankle i.e. the foot and ankle turn in.

This, accompanied with our body weight, places great stress on the structures on the outside of the foot and ankle. Most commonly the Anterior TaloFibular Ligament (AFTL) is injured – it has been estimated this ligament is affected in as much as 90% of inversion sprains.

1. The AFTL is part of the capsule surrounding the ankle joint, as a result, when it is injured there is usually fairly immediate swelling.
2. I think ATFL may work like an airbag for the ankle joint – it tears and a huge amount of swelling is released which cushions and protects the ankle from further damage.

There are other, arguably more crucial ligaments surrounding the ankle, such as the calcaneofibular ligament. While AFTL is relatively small and weak, these are thicker and stronger and may play a more significant role in stability. It seems perhaps ATFL is designed to tear to help protect more important structures.

Rule out serious injury Respect the healing process Manage pain and swelling with POLICE +/- NSAIDS Restore range of movement, control and strength

Ruling out serious injury Acute sprains will often result in pain and swelling around the outside of the ankle, with discomfort moving or taking weight. An important initial question is ‘have I broken it?’. Kerhoffs et al.2012 estimate that only around 15% of ankle sprains result in a fracture but it is important to rule this out.

1. There are clinical signs you can use but I strongly recommend a medical opinion for an acute ankle injury.
2. We offer advice here but nothing can replace the assessment of a skilled medical professional.
3. If in doubt, get it checked out.
4. When you are examined they are likely to follow something known as the Ottawa Rules.

These are a series of signs and symptoms that are used to help rule out a fracture and are “strongly recommended” in the BJSM guideline; “X-ray diagnostics is only indicated in case of pain in the malleoli or middle foot, combined with one of the following findings: palpation pain on the dorsal side of one or both of the malleoli, palpation pain at the bases of the metatarsal bone V, palpation pain of the navicular bone and finally if the patient is unable to walk at least four steps.” What this means, in more simple terms, is pain if you feel along any of the bones susceptible to injury (the fibular, tibia, base of the fifth metatarsal and navicular) accompanied with being unable to walk at least four steps.

1. To those of us with no medical training, whether you can walk or not is the clearest, most simple guideline.
2. If you’re struggling to walk it’s an indication that you may have a fracture which really should be checked out.
3. The BJSM reported that if you are able to walk again within 48 hours after trauma it is an “auspicious sign and indicates good prognosis”.

Another good sign is a lack of swelling within the first 24-48 hours. Most serious injuries to the ankle will swell, either fairly immediately (within the first 2-3 hours) or within the first day or so afterwards. If you have no swelling and can comfortably weight bear then you may have a minor sprain.

• This is sometimes called a ‘distortion’ which means the ligament may have been stretched or partially torn but as a whole remains intact.
• Many people with these injuries will choose not to seek medical help.
• This is a reasonable choice but obviously, you do so at your own risk and if you are concerned it may be wise to ask your GP to examine the ankle.

Respecting the healing process The body has amazing abilities to heal and though we may try to speed up this process, perhaps in reality all we can really do is try to create the best environment for healing to happen. In the early stages of an ankle sprain, there is usually significant inflammation, football fans might remember Per Mertesacker’s ankle after his sprain; Ligament injuries are thought to take around 12 weeks to heal and during this period may be vulnerable to excessive load. This is especially true in the first few days leading up to 3-4 weeks after injury. Your body will be trying to repair the injured tissue by forming a scar, made up largely of collagen.

1. Up until 3-4 weeks post-injury this new tissue is fragile and will break down if too much stress is placed upon it.
2. Bear this in mind when considering exercise and activity.
3. A general guide is to stay active but be sensible – stick to things that don’t increase your pain or swelling.
4. Avoid activities that involve twisting the ankle or heavy resistance.

Also, even walking a long way can be painful in the early stages, don’t be tempted to do too much too soon – let the area heal! Manage pain and swelling RICE used to be the standard recommendation but recently this has changed to POLICE which stands for Protection Optimal Loading Ice Compression and Elevation (more details in the link above).

1. The BJSM gave a rather mixed message in the role of ice and compression in acute ankle sprains, they comment on the lack of research evidence but conclude, “The use of ice and compression, in combination with rest and elevation, is an important aspect of treatment in the acute phase of LAI”.
2. LAI = Lateral Ankle Injury).

The aim with ice, compression etc is to reduce ankle swelling and pain. Some believe this may be counterproductive as swelling is a natural part of the healing process. It surrounds and supports the area as it heals and helps deliver a host of chemicals and specialist cells which are essential to the healing process.

• Unfortunately, though excessive swelling can limit the range of movement, increase pain, reduce proprioception and inhibit muscle activity.
• Like many things, it’s about striking a balance.
• Intermittent use of ice etc is likely to be helpful to prevent excessive swelling without inhibiting the healing process.

Non-Steroidal Anti-inflammatory Drugs (NSAIDs) are frequently recommended after sprains but there is some debate over their effectiveness. There has been some suggestion that they may delay healing but if they allow early movement and reduce pain they can have a beneficial effect on recovery.

• You may choose a simple pain relief (such as paracetamol) instead of or as well as NSAIDs.
• More details here on NSAIDs in sport,
• For specific information on medications consult your GP or pharmacist.
• Protecting the ankle from excessive movement can help the pain, the BJSM recommended the use of a brace or supportive taping to prevent relapses.

They also found using a brace may speed return to work. However, they point out that these supports should be phased out over time. Restoring range, control and strength Swelling, pain and immobility can have dramatic effects on the foot and ankle. In many cases the ankle becomes stiff, surrounding muscles weaken and balance and control of movement is reduced.

1. This leaves the ankle vulnerable to re-injury if not addressed.
2. The challenge is maintaining ankle function while respecting the healing process – you may want to start exercising as early as possible but it needs to be done cautiously to allow the area to recover.
3. The BJSM recognised the importance of rehab; “Rehabilitation of athletes after LAI must be the result of a variety of exercises in which propriocepsis, strength, coordination and function of the extremity are maintained.” Minor ankle sprains Before we look into more serious ankle injuries we’ll briefly consider minor ankle sprains.

These might be described as a ‘distortion’ rather than an actual ligament tear. They tend to occur with a similar mechanism of injury but have less severe pain and swelling and rapidly resolve. It isn’t unusual for someone to return to running in as little as 1-2 weeks as there is little structural damage.

1. If you have a minor ankle sprain the advice would be to use POLICE in the first few days, gentle movement to restore range and then a gradual return to running when it feels comfortable to do so.
2. You may also benefit from balance and strength work to prevent recurrence (details below).
3. Moderate to severe ankle sprains Severity of ankle sprains and their prognosis varies a great deal.

The following is a general guideline, do consider that times will vary considerably between individuals. If you have specific advice from your health professional stick to it! Day 1-3 The first 3 days typically involve considerable bleeding and inflammation, use POLICE and combine it with gently moving the foot up and down, just as far as comfortable, little and often.

It may be sensible to avoid sideways movements which may place excessive stress on healing tissue and cause pain. Day 3-7 As you begin to enter the sub-acute phase pain may settle somewhat. In addition to up and down movements you may add gently moving the ankle side to side, just as far as comfortable.

A little stress to healing tissue can stimulate recovery but be careful not to overdo it. Again little and often is best. Day 7-14 If comfortable add seated ‘proprioception’ exercises – proprioception is your body’s ability to recognise its position in space and is closely linked to balance and movement control.

At this stage, something simple like placing a ball under your foot and moving it forwards and backwards and side to side with your eyes closed can stimulate proprioception. You can also start isometric strength work, again if comfortable. This means contracting the muscles around the ankle against something that won’t move.

This way the muscle works but the joint stays still. Push the foot down against the floor or a wall. Pull up against resistance from your other foot and push in and out against a wall or something sturdy that won’t move. Start to progress to a range of movement exercises in all directions – aim to restore flexibility when moving the ankle in, out, up and down.

• Don’t push through pain, just do what you can.
• Weeks 2-3 In many cases, pain may diminish significantly by 2 weeks after the injury.
• Much of the initial inflammation has settled and you may find you can progress your rehab.
• Despite this, tissue is still healing and it’s best to avoid impact or sudden twisting movements.

You can start to add single leg balance to your exercises if comfortable and progress to strength work through range rather than isometrically. You can do this with a resistance band or by starting calf raises (using both legs). Week 3-4 From roughly day 21 scar tissue is thought to be more capable of handling loads and stresses.

It is however far from ‘mature’ and re-injury and recurrent sprains are common so proceed with caution. Exercises may now be progressed with slightly more resistance, if comfortable you can try single leg calf raises and add a mini squat – this helps to restore dorsiflexion (the upward movement of the ankle).

The BJSM found that some will be able to return to ‘light work’ at between 3 and 4 weeks after partial or complete ligament rupture (or 2 weeks for ‘distortion’). This depends on how you are progressing and what guidance you have from your health professional but it gives an indication of the level of activity you might expect at this stage.

It may be that you feel ready to start cross-training, if you do so make it your priority to stay comfortable rather than improve fitness. Straight-line activities such as low resistance cycling or swimming front crawl are often best to start with but don’t work through the pain and monitor your swelling.

Week 4 onwards Obviously how you progress from week 4 onwards will depend a great deal on how things are going. To give you an idea of the variation we see in clinic, I have treated cases where people have been able to run, hop and kick a football just 2 weeks after an ankle sprain while others have still been on crutches at 6 weeks.

1. You can appreciate how hard it is to predict your progress at this stage.
2. Hopefully, your exercises so far will have kept the ankle flexible and strong but before starting more advanced impact and control work it is often best to ensure you have restored range of movement and muscle power.
3. Restoring ankle range All ankle movements are important but lack of dorsiflexion (the upward movement of the foot) is arguably the most vital.

The ankle dorsiflexion is essential for running and impact-based activity. Check your range using the knee to wall test, If it is limited you can work on it using lunges, single-leg dip, gastroc and soleus stretches. The in and out movements of the ankle (inversion and eversion) as also important, they allow the ankle to adapt its position to balance.

Turn the ankle in as far as comfortable and use your hands or a towel to stretch it a little. Do the same with turning the ankle out. Improving muscle power Strengthening around the ankle is sensible after a sprain. In particular, strengthening the peroneal muscles (on the outside of the ankle), Tibialis anterior (at the front) and the calf muscles will help to prevent re-injury.

This can be dome with theraband – this info sheet covers many of these exercises as well as the range of movement ones mentioned above. Single leg calf raises are excellent for building calf strength, your aim is to be able to do as many on the injured leg as you can on your good leg.

• To do it, stand on one leg with a little support if needed.
• Push up on your toes as far as comfortable, repeat until the calf fatigues.
• For our many American and Canadian readers, the AFX is also a great way to strengthen the foot and ankle (but is yet to be available in the UK).
• They have a video of how to use it following an ankle sprain.

Working basic balance Single leg balance and single knee dip are 2 excellent exercises for improving basic balance; Progressing control rehab Rather than adhering closely to specific timeframes, progressive control is about gradually challenging the ankle more, without increasing pain or swelling. So this might mean starting with single leg balance and single knee dip. Adding “100 up” then jogging on tiptoes. All of these are ‘straight line’. Next, I might add ‘lateral’ movements – side-stepping, then sideways jogging, if this was comfortable you could progress with ‘rotational’ movements – single leg balance while rotating the body or jogging a figure of 8 around cones.

‘Rotation + lateral’ means combining these movements together – such as ‘Greek dancing’ (sideways jogging crossing one leg in front of the other) or adding cutting, or twisting movements to sideways activities. Make sure you are comfortable with one type of exercise before progressing to the next. Gradually increase speed and exercise intensity, add impact (such as running, skipping etc) only when comfortable.

Balance boards, BOSUs, ‘hedgehogs’, trampets, wobble cushions etc. can all be used as well to challenge control and improve proprioception. Returning to running Your health professional should help guide your return to running, follow their instruction as timeframes on when you can start running vary a great deal.

• As mentioned previously a mild sprain may see a return to running in 1-2 weeks, a very severe sprain may need 4-6 months.
• In order to return to running without risking re-injury, you need a full range of movement in the ankle, good muscle power (with equal calf strength) and good control of movement.

The ankle should feel stable and not give way, Impact should be pain-free and you should be able to run without pain. Ideally, all swelling should also have settled but some ankle sprains can remain slightly swollen for over a year after the injury so pain and function are better signs to use.

• For moderate to severe ankle sprains, you may be able to start some light treadmill jogging at around 4-6 weeks if comfortable, but it may take considerably longer in many cases.
• The treadmill is a good place to start as the surface is totally flat and predictable and unlikely to force the ankle into rapid sideways movements that may cause injury.

When comfortable this can be progressed to road running but trail running should be approached with caution – a rabbit hole or tree root could easily re-injure the ankle. Gradually increase distance and training intensity but remain sensible for at least 3-4 months after the injury and bear in mind that additional pain or swelling are signs that you’re overdoing it.

Is a sprained ankle still stiff after 3 months?

An error occurred. – Try watching this video on www.youtube.com, or enable JavaScript if it is disabled in your browser. Dr. Farber’s patient profiles include: Snowboard Injuries: “Snowboarder’s Fracture” Snowboarding-related ankle injuries are more common than skiing injuries due to the increased range of motion that the snowboarding boot allows compared to a downhill ski boot.

This patient suffered a less common ankle injury that is seen specifically in snowboarding and sometimes in soccer players called a “snowboarder’s fracture.” This is a discrete break in the talus bone at the subtalar joint of the foot. Best treatment often involves early surgery to avoid lasting pain and disability.

(For an alternative sprain originating in bone injury, also see patient profile #5.) Cartilage Fractures: Post-recovery pain with strenuous activity This patient, who recovered quickly from the initial injury, but who continued to feel deep pain with strenuous activity well after the normal healing period, is suffering from a virtually invisible impact or shear fracture of the osteochondral surface on the talus bone.

According to Dr. Farber, the best treatment is often arthroscopic debridement and cartilage stimulation procedures. Ankle Ligament Injuries: Transient pain and post-recovery instability With a history of ankle sprain, this patient presented with pain and ankle instability months after a precipitating injury as a result of tearing of the ligaments near the ankle bone at the outside aspect of the foot/ankle.

If the injury does not improve with bracing and therapy over time, the best treatment is surgical ligament repair. (For an alternative ankle sprain scenario, also see this patient, whose high ankle sprain was treated with long-term bracing). Scar Tissue: Persistent pain that responds to steroid therapy Since this patient’s persistent pain at the outside of the ankle responds to local anesthetic and steroid therapy with minimal diagnostic imaging studies, it is likely the result of scar tissue resulting from an injury and now causing impingent in the ankle with bone movement.

If the pain does not resolve with steroid therapy and time, the best treatment is surgical excision of the scar tissue via arthroscopy. Tendon Injury: The patient with post-inversion sprain pain This patient has nagging pain at the side and back of the ankle months after an inversion ankle sprain. This pain is caused by torn tendons.

If bracing and physical therapy does not resolve the ankle injury with time, the best treatment is surgery to repair the damaged tendons. (For an alternative ankle sprain originating in tendon injury, also see the this patient, whose damaged peroneal tendons at the rear of the foot were surgically repaired).

Peroneal Nerve Injury: The patient with pins and needle sensation months after ankle sprain This patient’s ankle sprain involved a stretch injury to the superficial peroneal nerve due to severe inversion and plantarflexion position of the ankle resulting in damage to the peroneal nerve at the front of the ankle.

Best treatment, involving medications, expectations, and time, is based on accurate diagnosis. Dr. Farber’s counsel to primary care physicians confronting protracted pain after an ankle sprain is to remember that an ankle sprain is still usually an ankle sprain “until it’s not”.

1. An ankle sprain that lingers beyond 3 months is often an injury to a bone, tendon or ligament that is unlikely to heal without intervention,” he says.
2. And the longer an ankle injury persists without proper treatment, the greater the likelihood that permanent disability will result.” In other words, Dr.

Farber concludes: Once it’s clear that ankle sprain is complicated and not resolving with the usual treatments, the best recourse is a referral to a qualified orthopaedic foot and ankle surgeon. My name is Daniel Farber. I’m assistant professor of clinical orthopedics at the University of Pennsylvania Perelman School of Medicine, director of the foot and ankle fellowship there, as well as the foot and ankle research.

• Today, however, we’ll be talking about a more clinical topic.
• We’ll be talking about the ankle sprain that doesn’t heal.
• First of all, we’re going to review some of the ankle anatomy and talk about ankle sprain mechanisms, grading and treatment of ankle sprains, and, finally, we’re going to really focus on going through some case scenarios on ankle sprains that don’t heal and what the pathology behind that is.

Then, we’ll briefly review what we’ve gone over. The way I put this together was to have a couple of different scenarios that go over some of these potential injuries. Scenario #1 is a 20-year-old female. She injured her ankle snowboarding about six weeks ago.

She was seen by the ski patrol on the hill, told that she just had a sprain. She used a lace-up ankle brace for a couple of weeks but really continues to have a lot of pain, especially along the anterolateral aspect of the ankle, and especially when the ankle is really everted and rolled out to the side.

Here’s a potential scenario where the snowboarder gets injured. You can see her coming down the hill in her best form, coming off a little jump, and, boom, she hits the ground. The foot tends to dorsiflex and evert and creates this injury that you see here.

• What you can see subtly on the X-ray is this little abnormality here along the lateral aspect of the talus.
• This is commonly referred to as a snowboarder’s fracture.
• On a CT scan, it becomes much more clear that, as the calcaneus comes up, it kind of hits against the fibula, it nutcrackers this little fragment here and breaks it off.

This is part of the joint, of the subtalar joint, so it’s an important fragment. It’s a dorsiflexion eversion mechanism. That nutcracker effect happens on the talus. This can be very easily missed because, on regular ankle films, it’s not always as clear as the X-ray that I showed you.

• A CT scan will show it but you have to have the suspicion and the knowledge that this might be an injury in order to even pursue a CT scan.
• The importance of this injury is that it’s much better to treat this early surgically.
• If it’s a really small fragment, you can sometimes treat this with nonoperative care, but a lot of times, especially with athletic patients who are very active, if this is a small fragment or it’s broken into a lot of little pieces, they do much better with early excision.

If it’s a significant fragment, they’ll do better with fixing this. This is a patient of mine from a couple of years ago. You can see this is a pretty large articular surface fragment that’s fractured. Then, you’ll see in this image here, the peroneal tendons, running right in this area.

• This is the lateral ankle here, so this is the front of the ankle.
• You can see the two little screws here that we used to fix this into place.
• Scenario #2 is a 22-year-old male basketball player.
• Sprained his ankle about six months ago.
• He recovered fairly quickly but the ankle has never quite felt right, never 100%, and it bothers him a lot with strenuous activity.

The pain is sort of deep in the ankle. Doesn’t have any instability, doesn’t really have any pain day to day, but, when he’s trying to play sports, this is still limiting him. Here’s a potential injury of the ankle. You’ll get a little close-up. Look at #50 there as he comes down and rolls his ankle.

If you watch a little linger, you get this close-up view. As his foot comes down, you see that rolling mechanism of the ankle. That’s a classic eversion ankle sprain injury while playing basketball that we see quite commonly. His X-rays are pretty normal. You don’t see any fractures or any clear abnormalities but, because he’s now gone a number of weeks with persistent pain, he got an MRI scan.

Here, you see this edema within the bone along the medial talus. This is consistent with an osteochondral injury of the talus. What’s happened is basically a shear sort of fracture of the cartilage. Then, you get this fluid that gets pushed down into the bone.

This can be a significant source of pain. This is often a delayed presentation because, usually, we expect these to get better. I think a lot of minor osteochondral injuries do happen with these injuries but they get better on their own and don’t need any additional treatment other than the standard treatment for an ankle sprain.

Again, these patients, usually day to day living, this is not a big deal, but it’s when they try to ramp up to more strenuous activities that they can’t get back there. The pain is often poorly localized. They kind of just feel it deep in the ankle, and it doesn’t always correlate.

If they feel the pain on the inside part of the ankle, they can still have the lesion on the outside part of the ankle. It’s pretty classic that they’re very bad at localizing where the injury is. X-rays are often negative. Sometimes, you can see some lucency in the talus that suggests there’s an injury there but, in more acute injuries, it’s often very hard to see, so MRI or CT scan can be very helpful.

In younger patients, a period of casting can be helpful to get this to heal. In older patients, and I’m not talking that old, but really past adolescence, oftentimes surgery is necessary to clean out the area of cartilage injury. We’ll often drill into the bone in that area to try to stimulate the body to form some scar cartilage over that region.

1. This is an arthroscopy.
2. What you can see here is this is a flap of cartilage that’s coming up from the normal cartilage surface here.
3. That’s part of that cartilage injury.
4. What we’ve done now is we’ve basically cleaned out that loose cartilage.
5. Now, we have a stable edge of cartilage.
6. Here is exposed bone.

This is a significant injury, where you lose cartilage. We then drill into the bone and what we want to see is this little bit of bleeding here. That’s those good marrow elements that have a lot of stem cells and multi-potential healing cells that can form some scar cartilage over this whole area so that at least that joint has a better gliding surface.

1. That seems to help very well in most patients.
2. Scenario #3, a 32-year-old female with multiple prior ankle sprains.
3. Her last sprain was about eight months ago.
4. She has persistent pain and swelling, doesn’t trust her ankle.
5. She avoids sports.
6. She has several episodes of giving way over the past six months.

You examine her in the office, and this is just the textbook image that we saw earlier. Again, you see this sort of dimple sign. There’s clear anterior instability. A patient who continues to be unstable at this stage, with giving-way episodes, they will often benefit at first from a course of physical therapy if they haven’t had that already.

That’s really to focus on proprioception and strengthening of the surrounding musculature to see if that can be adequately, Sorry, to see if that can adequately restore their sense of stability and allow them to return to activity. These patients often need bracing for more strenuous sporting activity to give them the sense of stability that they need.

If those things fail, then surgery to repair the ligament is often very helpful. This is a diagram of the classic Brostrom-type repair. This is the fibula right here. This is the calcaneofibular ligament, which has been cut and shortened and repaired. You don’t always actually have to repair this.

The most important part is repairing what’s called the anterior talofibular ligament. That ligament is actually underneath here. This is the extensor retinaculum, which holds down the tendons on the front of the ankle. We incorporate that into the repair for some additional stability. Underneath that is the ligament repair.

That’s very successful surgery. People do very well with that and they’re able to return to most sporting activities, but it does take about six months before they can go back to real strenuous activity. Scenario #4 is an 18-year-old football player who twisted his ankle on the turf about a month ago.

• They did rest, ice, compression, elevation, and told him he’d be better in a couple weeks because it didn’t look like that bad a sprain but he continues to have significant pain, pointing to the anterolateral aspect of the ankle.
• The pain travels up the leg from that point.
• X-rays are negative, but an MRI shows this fluid right here in the recess of the syndesmosis.

This, as we talked about earlier, is a syndesmotic injury, or your classic high ankle sprain. This is the injury to the syndesmotic ligaments that connect the fibula to the tibia, and so, when the ankle externally rotates, that’s what puts stress on these ligaments.

1. You can diagnose this with what’s called a squeeze test where you squeeze the fibula against the tibia proximally in the leg, just below the knee.
2. That should recreate pain at the ankle.
3. People often complain of pain over the tibia where you put your hand or your thumb.
4. That’s not a positive test.
5. It has to be pain that they feel down in the ankle.

The X-rays will be negative unless there’s severe ligament disruption and instability. That’s a different sort of injury. These take a long time to heal. They need a good bit of bracing for a while and rehab, and mostly time, but they will almost always settle down.

Scenario #5 is a 38-year-old female. She sprained her ankle about nine months ago. She got better for a while but has pain in the anterolateral ankle. No instability. She did some therapy, which didn’t help, but she did get a cortisone injection in the ankle and that seemed to give her excellent relief for a period of time.

This scenario, this is really a diagnosis of exclusion until you get to this point. This is an arthroscopic image of the ankle. Patients can develop what’s called an anterolateral impingement lesion. What that is is essentially hypertrophic scarring of the lateral ankle ligaments or the capsule.

• That creates, essentially, an impingement lesion where, when the ankle dorsiflexes and comes up, this excess tissue that you see here in the ankle.
• Here is the talus and up here is the tibia.
• When these two bones come together during activities, or even just walking, it pinches all this tissue here and causes pain.

These patients respond very well to excision of this tissue, but oftentimes they’ll get better with time or with a local cortisone injection. MRIs are not very helpful. They often don’t show this lesion. We’re looking at some research to see if ultrasound may be more helpful in finding these lesions, but sometimes it’s simply a diagnosis of exclusion.

• You’ve ruled out all the other things, their pain is appropriate and clinically appropriate to this sort of diagnosis, and you offer them an arthroscopy.
• That will often solve the issue for them.
• Scenario #6 is a 42-year-old female.
• She turned her ankle stepping off a curb about six weeks ago.
• They placed her in an air stirrup in the ED but that didn’t really help.

Her bruising and swelling has resolved but she continues to have a lot of pain over the lateral foot and ankle. Here are her X-rays. What you’ll notice here is some abnormality at the base of the fifth metatarsal. The point here is you always need to check the foot when people have an ankle sprain and turn it because you can sometimes end up with a fracture of the fifth metatarsal.

• This is indeed a Jones fracture, and it is an area of the bone that sometimes doesn’t heal very well, my point being here is that you just need to make sure you examine this as a possible source of their injury.
• Treatment is often casting or a CAM boot.
• Most avulsion-type fractures will heal very readily.

The Jones fracture, like we see in this image here, often gives us trouble healing, and so, especially in athletic patients, we’ll consider putting a screw down the pike here to get this to heal more quickly. Here is an example of that where you see the screw crossing the fracture line.

This, again, helps to get this to heal much more quickly. Scenario #7 is a 36-year-old female. She suffered an inversion ankle sprain about six months ago. She’s done well except she has this nagging posteriolateral ankle pain and swelling and sometimes popping. Worse with activity. She uses a lace-up brace, which makes her feel better for activity, but this is still a significant problem for her.

This is a scenario where we can have some injury to the peroneal tendons. This is an MRI image, axial image. This is the fibula here, tibia is here, and these are the peroneal tendons running behind there. You can see these tendons should be restricted back here.

They should be back behind the fibula. This one is subluxating out to the side. In that setting, that instability can cause pain. It can also cause a tear to that tendon. This is an injury to the superior peroneal retinaculum. It can be simply a shift of the tendons. It can also be a tear in the tendons. Exam is very helpful to look for subluxation.

If you have their foot in a plantar flex position and a little bit eversion and you ask them to push against the side of their foot, you’ll sometimes feel those tendons shift out of position. MRI or ultrasound can be very helpful for diagnosis. For a tear, sometimes therapy and bracing is adequate to take care of this.

• If it doesn’t resolve, then surgery to clean out and repair the tendon is helpful.
• If it’s subluxation of the tendons and they really pop out next to the fibula, therapies are often not successful because it doesn’t help to restrain the tendon where it needs to be, and surgery to repair that retinaculum is quite helpful.

Scenario #8 is a 46-year-old male who sprained his ankle falling on the stairs and has a hyper-plantar flexion injury, as well as inversion. He now complains of pins and needles sensation in the dorsum in the foot, hypersensitivity over the top of the foot, and sometimes the pain will radiate up the anterolateral leg.

In this setting, this is what we often see, is an injury to the superficial peroneal nerve. You can see the branches of the superficial peroneal nerve. They cover the sensation over the entire top of the foot. You can see in this diagram, this whole area is covered by this single nerve. When you turn the ankle, this nerve gets put on tension and you can have a traction injury.

If you look closely at a lot of ankle sprains that you see, in the first few days, and sometimes even a few weeks, they’ll have irritation of this nerve, but it often quiets down. It’s a little bit more rare that this pain persists for a longer period of time.

You can see this on a regular patient just by surface anatomy. You can see the course of that superficial peroneal nerve right in this area. It’s a very superficial nerve, very susceptible to injury. This will get better with time. The most important thing that you can do is to diagnose this properly so you can let patients know that they will get better, it’s just going to take time.

Most of the time, the nerve recovers, but it can take a number of months. If they’re really having a tough time, using some neuroactive-type medications, whether that be Nortriptyline or Gabapentin or Cymbalta or similar things like that to help attenuate the nerve pain, can be helpful.

In summary, an ankle sprain is usually an ankle sprain, but sometimes it’s not. If it doesn’t get better, you want to further investigate this, both by physical exam, as well as diagnostic tests. It can be any of these diagnoses that we’ve talked about today, and there’s even more, but I won’t torture you with all the additional information there.

I want to thank you very much for your attention. It’s been an honor to have the opportunity to speak with you. Thank you.

How bad is a Grade 1 ankle sprain?

Varying Degrees of Ankle Sprains A sprained ankle is a very common injury. A sprained ankle can happen to athletes and non-athletes, children and adults. It can happen when you take part in sports or even by stepping on an uneven surface. Ankle sprains occur when the foot twists, turns or rolls beyond its normal motions.

• A sprain can also occur if the foot is planted unevenly on a surface, beyond the normal force of stepping.
• This causes the ligaments to stretch beyond their normal range in an abnormal position.
• A ligament is an elastic structure.
• Ligaments usually stretch within their limits, and then go back to their normal positions.

When a ligament is forced to stretch beyond its normal range, a sprain occurs. A severe sprain causes actual tearing of the elastic fibers. There are three grades for ankle sprains determined by the amount of force.

Grade 1: Stretching or slight tearing of the ligament with mild tenderness, swelling and stiffness. The ankle feels stable and it is usually possible to walk with minimal pain. Grade 2: A more severe sprain, but incomplete tear with moderate pain, swelling and bruising. Although it feels somewhat stable, the damaged areas are tender to the touch and walking is painful. Grade 3: This is a complete tear of the affected ligament(s) with severe swelling and bruising. The ankle is unstable and walking is likely not possible because the ankle gives out and there is intense pain.

A physician can diagnose a sprained ankle. X-rays are sometimes needed to rule out a broken bone in the ankle or foot. Broken bones can have similar symptoms of pain and swelling. If there is no broken bone, your physician will be able to tell you the grade of the ankle sprain based upon the amount of swelling, pain and bruising.

Grade 1: Use R.I.C.E. (rest, ice, compression and elevation). Ice should be applied immediately to help keep swelling down for 20-30 minutes up to four times daily. The ankle should be elevated above the chest for 48 hours. Rest your ankle and try not to walk on it. Use compression dressings and wraps to immobilize and support the ankle. Grade 2: Utilize the R.I.C.E. guidelines and allow more time for healing to occur. An immobilization device or splint is also recommended. Grade 3: Permanent instability can occur with a grade three sprain. A cast or a brace may be required for a couple weeks. Anti-inflammatory drugs like ibuprofen can be used to control pain and inflammation with a sprain. Surgery may be considered in younger, athletically active patients.

If an ankle sprain isn’t treated with the necessary attention and care, chronic problems of pain and instability can result. The best way to prevent ankle sprains is to maintain good strength, muscle balance and flexibility. Here are some additional prevention steps:

Wear good shoes Warm up before doing exercises and vigorous activities Pay attention to surfaces on which you run and walk Reinforce the foot and ankle’s stability with a brace if needed Pay attention to the body’s warning signs to slow down when you feel fatigue or pain.

: Varying Degrees of Ankle Sprains

Can you speed up sprained ankle recovery?

RICE – The acronym RICE stands for: rest, ice, compression, and elevation. Doctors often recommend these tactics to reduce swelling and inflammation in the days after an injury. Rest Resting the ankle is key for healing, and wearing a brace can help stabilize the injured area.

Attempting to return to sports or other activities too quickly increases the risk of another injury. Ice Using an ice pack may reduce blood flow to the injury and help ease pain and swelling. The American Academy of Family Physicians suggest applying an ice pack to the sprain for 10–20 minutes at a time.

Wrap the pack in a towel before laying it against the skin. However, the National Athletic Trainers’ Association reviewed the evidence for the use of ice on injuries in 2013. They found that, while doctors commonly recommend applying ice, there is limited evidence to support its effectiveness.

• If ice does not help relieve symptoms, use other treatments instead.
• Compression Compression helps stabilize the injured joint and may reduce swelling.
• Try wrapping a bandage around the injured ankle.
• The bandage should be snug, but not so tight that it digs into the skin, hurts, or causes numbness.
• Elevation Elevating a sprained ankle reduces the accumulation of fluid in the joint.

This can ease swelling, which may also help reduce pain. Try sleeping with the foot and ankle propped up on pillows at a level higher than the heart. When sitting or resting, use pillows or a footrest to keep the foot and ankle elevated.

Is it OK to play soccer with a sprained ankle?

Why You Shouldn’t Play Through a Sprained Ankle Did you know that about of sports injuries are ? That makes this painful injury the most common musculoskeletal sports injury out there. And that only includes sprained ankles treated by medical professionals, meaning thousands more sprained ankles occur every year.

Ankle sprains can range from severe to mild, and sometimes when the pain isn’t too great it can be tempting to keep using a sprained ankle. But playing through a sprained ankle can lead it to heal incorrectly, causing chronic ankle issues to arise. At, our board-certified podiatrist, provides a comprehensive line of podiatric services to address many types of ankle and foot issues for patients in Lodi, New Jersey — including treating ankle sprains.

Dr. Rosenblum also believes patient education can go a long way in preventing unnecessary injury. That’s why our expert team put together this informative guide about why playing through a sprained ankle is never a good idea, as well as how you can prevent this injury from turning into a chronic problem.

What do pro athletes do for sprained ankle?

By Krizha Adona, SPT – American football athletes tend to get injured fairly often because it is a high contact sport and it requires great physical demands. High ankle sprains are one of the most common injuries that athletes may acquire during their careers. Sam Darnold of the New York Jets, Saquon Barkley of the New York Giants and Quandre Diggs of Seattle Seahawks are just some of the long list of people from the NFL that recently had high ankle sprain. What exactly is a high ankle sprain? A high ankle sprain can be acquired by excessively rotating the foot in an outward direction (external rotation) while the foot is positioned in dorsiflexion. It can also be acquired if the foot is planted on the ground and the athlete turns his lower leg (tibia and fibula) in an inward direction, or by getting a direct blow on the lateral (outer) aspect of the leg while the foot is planted on the ground. This causes causes injury to the syndesmotic ligaments just above the ankle joint,1 The syndesmotic ligaments act as stabilizers and shock absorbers of the ankle joint 2, and if damaged, can cause instability. It is important to differentiate this injury to a more common sprain called the lateral ankle sprain as they have some differences in treatment approach and length of recovery time. A lateral ankle sprain is acquired when you excessively plantarflex and invert your foot (roll your ankle) causing injury to the lateral ligaments of the ankle. How is this injury diagnosed? A physical therapist will take a thorough history to determine the mechanism of how the injury was acquired. During the physical examination, the therapist will palpate for tenderness around the ankle, and inspect it for swelling. The tenderness and/or pain is often diffuse but is typically located anterolaterally and/or posteromedially at the level of the ankle joint.1 Special provocative tests can also be utilized to confirm the diagnosis, as well as imaging such as X-ray or MRI.2 High ankle sprains are classified using 3 different grades, which depend on severity. Grade I is clinically mild, the ankle is stable, and radiographic findings appear normal. Grade II is typically associated with partial damage to the syndesmotic ligaments, and radiographic findings appear normal. It can present as a stable or unstable joint, and it should be assessed for confirmation. Lastly, a Grade III high ankle sprain include complete injury to the syndesmotic ligaments, plain radiography shows clear widening of the space between the tibia and fibula, and it commonly occurs with fractures or other injuries.1 The higher the grade of the ankle sprain is, the longer it will take for an athlete to return to sports.3 High ankle sprains are usually treated conservatively with physical therapy. However, if imaging shows that there is significant damage to the supporting ligaments causing instability of the ankle joint, and if there is syndesmotic widening >2mm, surgery is often necessary. Screws, suture buttons or a combination of both can be used as fixation devices to provide and re-establish stability to the ankle joint. Fixation is also indicated if conservative management was utilized but has failed.1 If an athlete’s injury requires a surgical approach, postoperative care includes: (1) immobilization with no weight bearing permitted for 4 to 6 weeks, (2) introduction of range of motion exercises and resistance training a few days after surgery, (3) progressive weight bearing in a boot and strengthening exercises under close supervision, (4) and lastly, depending on severity of injury, an athlete can return to sport at 10 to 12 weeks.1 If an athlete’s injury does not require a surgical approach, a 3-phase rehabilitation program can be utilized. Phase 1 (acute phase) focuses on protecting the joint while minimizing pain, inflammation, weakness and loss of motion. Phase 2 (subacute phase) focuses on normalizing joint mobility, strength, neuromuscular control, and return to basic function in activities of daily living. Phase 3 (advanced training) concentrates on preparing the athlete to return to sports. References

Hunt K, Phisitkul P, Pirolo J, Amendola A. High Ankle Sprains and Syndesmotic Injuries in Athletes. Journal of the American Academy of Orthopaedic Surgeons,2015;23(11):661-673. doi:10.5435/jaaos-d-13-00135Williams GN, Allen EJ. Rehabilitation of syndesmotic (high) ankle sprains. Sports Health,2010;2(6):460–470. doi:10.1177/1941738110384573Sikka R, Fetzer G, Sugarman E et al. Correlating MRI Findings with Disability in Syndesmotic Sprains of NFL Players. Foot Ankle Int,2012;33(5):371-378. doi:10.3113/fai.2012.0371a

Can I walk on my sprained ankle after 3 days?

Getting Active – The pain and swelling of an ankle sprain most often gets better within 48 hours. After that, you can begin to put weight back on your injured foot.

Put only as much weight on your foot as is comfortable at first. Slowly work your way up to your full weight.If your ankle begins to hurt, stop and rest.

Your provider will give you exercises to strengthen your foot and ankle. Doing these exercises can help prevent future sprains and chronic ankle pain. For less severe sprains, you may be able to go back to your normal activities after a few days. For more severe sprains, it may take several weeks. Talk to your provider before returning to more intense sports or work activities.

Can a sprained ankle heal in 5 days?

How Long Does It Take to Recover from a Sprained Ankle? – Recovery time from a sprained ankle will depend on the severity of the sprain. Most ankle sprains are mild and only need ice and elevation. Mild sprains typically begin to feel better in a few days to a week and heal by six weeks.

Can you recover from a sprained ankle in 4 days?

How long does a sprained ankle take to heal? – The recovery time for a sprained ankle varies depending on the severity of your injury. It may take anywhere from two weeks to heal a minor sprain and anywhere from six to 12 weeks to heal a severe sprain.

When can I return to soccer after ankle sprain?

Prognosis and return to sport – Recovery is usually very quick following a sprained ankle where the injury is on the outside of the foot. Most athletes can go back to full training after 1-3 weeks. It can take longer if there is considerable damage to the ligaments, and some people suffer from stiffness and pain for several months.

What grade ankle sprain do I have?

Mechanism of Injury – If there is a severe in-turning or out-turning of the foot relative to the ankle, the forces cause the ligaments to stretch beyond their normal length. If the force is too strong, the ligaments can tear. You may lose your balance when your foot is placed unevenly on the ground.

• You may fall and be unable to stand on that foot.
• When excessive force is applied to the ankle’s soft tissue structures, you may even hear a “pop.” Pain and swelling result.
• The amount of force determines the grade of the sprain.
• A mild sprain is a Grade 1.
• A moderate sprain is a Grade 2.
• A severe strain is a Grade 3.

( See Table 1 ) Grade 1 Sprain: Slight stretching and some damage to the fibers (fibrils) of the ligament. Grade 2 Sprain: Partial tearing of the ligament. If the ankle joint is examined and moved in certain ways, abnormal looseness (laxity) of the ankle joint occurs.

Should you walk on a sprained ankle after 2 weeks? Is it OK to walk on a sprained ankle? – February 1st, 2023 If you’ve just sprained your ankle, you might be wondering if it’s OK to walk on it. The answer that most medical professionals may give you is no. In fact, most experts suggest that immobilizing the foot and limiting weight-bearing activities for up to two weeks is the best course of action for a newly sprained ankle. A sprained ankle occurs when one or more of the ligaments in your ankle are overstretched or torn. A medical study reports that more than 23,000 U.S. adults per day require treatment for an ankle sprain. With so many ankle sprains happening on a daily basis, it can be important to learn the dos and don’ts behind them. Physical therapists can be a major resource for those with ankle sprains, These specialists can help you build you an effective recovery plan for your sprained ankle. Will ankle sprain not be better after 4 weeks? Swelling – It’s normal for a sprained ankle to swell, sometimes for four to six weeks, or longer. But swelling that persists for more than three months may be a sign of trouble. The lining of the capsule surrounding a joint is called the synovium, and anything inside the joint that irritates the synovium will cause it to secrete fluid. Swelling inside of a joint is often a sign that something is causing irritation. (The swelling that is seen from the outside is a combination of soft tissue swelling around the joint and fluid within the joint itself.) In the ankle there are several reasons for this condition. While these may seem alarming, treatment is possible. But first, let’s take a look at the culprits. Chronic synovitis Sometimes there is damage to the surface of the joint that does not show up on any tests, such as an X-ray or MRI, even though it continues to cause irritation and excess fluid. A bone chip At the time of injury, a bone chip may have been knocked loose, leaving a “loose body” floating around inside to cause trouble. An OCD lesion “OCD” in sports medicine stands for osteochondritis dissecans (not obsessive compulsive disorder). The easiest way to think of this is like a cavity in a tooth. It is something that leaves a small hole in the surface on the ankle bone (the talus ) with a dead piece of bone in it. An MRI study will usually pick this up. A bone bruise This is not black and blue. Instead, it feels like an achy pain that is difficult to explain and lasts for months. There is edema, or fluid, within the bones themselves that we can only see on an MRI study. Fortunately, it is rarely serious and gradually fades away. What can you do? Treatment for chronic swelling, no matter what the cause, usually requires sleeping with the leg elevated on a pillow at night and putting on an elastic ankle support in the morning when you get out of bed. If the swelling is minimal and is slowly going away with no other symptoms, it is OK to dance, but go easy on the jumps and grand plies till all the swelling is gone. However, if it doesn’t feel so good then don’t do it! An ankle support (no need for metal hinges, etc.) usually feels good at this stage. It also helps to avoid the saltshaker, which leads to water retention. With diligence, the swelling should go away. Can you run on a Grade 1 ankle sprain? – The triangle icon that indicates to play Dear Laura, Great set of questions! A sprain is a stretch or tear in a ligament that holds two bones together. In your ankle there are three smaller ligaments on the outside (where most sprains occur as the foot rolls in) and one big ligament on the inside (where only about five percent of sprains occur). A mild sprain usually involves a stretch or partial tear of the anterior talofibular ligament in the front and outside of the ankle. Letting the tendon heal is your best strategy for a rapid return to activity while minimizing your risk of future sprains. Most sprains heal 100 percent, but you can expect it to take 12 or more weeks. To answer your questions: The rule of thumb is to return to running when you are pain-free, have full range of motion, and the strength in the injured ankle is equal to that in your uninjured side. With a mild sprain and a functionally protective brace, you can often return to running in a couple of weeks. That said, the clock to full healing resets to 12 weeks every time you tweak the ligament—so caution is key.The best exercises I’d recommend for stabilizing the ankle are toe and heel walking. Try to build up to doing three to five minutes of each.Any cardio work that does not put your ankle ligaments at risk for re-injury and does not cause pain is fair game. Biking, rowing, elliptical, swimming, deep-water running, or kayaking should be safe.Preventing future sprains is difficult to address as ligaments are basically like tough rubber bands that will deform or tear if the “wrong” stress is placed on them. However, maintaining good core and leg strength may reduce your risk if it keeps you from fatiguing early and losing your footing while running. I hope this helps.Cheers,Bill : Bouncing Back from an Ankle Sprain Can you play sports on a Grade 1 ankle sprain? Grades of ankle sprain – Grade 1: These are light sprains that will allow you to return to sport in almost three weeks. Grade 2: It involves injury to the ligament and it can take up to 6 weeks before you return to sport. Grade 3: Is severe with full tearing of the ligament and may include a bone fracture. The length of recovery can take three months or more to recover. How bad is a Grade 1 ankle sprain? Varying Degrees of Ankle Sprains A sprained ankle is a very common injury. A sprained ankle can happen to athletes and non-athletes, children and adults. It can happen when you take part in sports or even by stepping on an uneven surface. Ankle sprains occur when the foot twists, turns or rolls beyond its normal motions. A sprain can also occur if the foot is planted unevenly on a surface, beyond the normal force of stepping. This causes the ligaments to stretch beyond their normal range in an abnormal position. A ligament is an elastic structure. Ligaments usually stretch within their limits, and then go back to their normal positions. When a ligament is forced to stretch beyond its normal range, a sprain occurs. A severe sprain causes actual tearing of the elastic fibers. There are three grades for ankle sprains determined by the amount of force. Grade 1: Stretching or slight tearing of the ligament with mild tenderness, swelling and stiffness. The ankle feels stable and it is usually possible to walk with minimal pain. Grade 2: A more severe sprain, but incomplete tear with moderate pain, swelling and bruising. Although it feels somewhat stable, the damaged areas are tender to the touch and walking is painful. Grade 3: This is a complete tear of the affected ligament(s) with severe swelling and bruising. The ankle is unstable and walking is likely not possible because the ankle gives out and there is intense pain. A physician can diagnose a sprained ankle. X-rays are sometimes needed to rule out a broken bone in the ankle or foot. Broken bones can have similar symptoms of pain and swelling. If there is no broken bone, your physician will be able to tell you the grade of the ankle sprain based upon the amount of swelling, pain and bruising. Grade 1: Use R.I.C.E. (rest, ice, compression and elevation). Ice should be applied immediately to help keep swelling down for 20-30 minutes up to four times daily. The ankle should be elevated above the chest for 48 hours. Rest your ankle and try not to walk on it. Use compression dressings and wraps to immobilize and support the ankle. Grade 2: Utilize the R.I.C.E. guidelines and allow more time for healing to occur. An immobilization device or splint is also recommended. Grade 3: Permanent instability can occur with a grade three sprain. A cast or a brace may be required for a couple weeks. Anti-inflammatory drugs like ibuprofen can be used to control pain and inflammation with a sprain. Surgery may be considered in younger, athletically active patients. If an ankle sprain isn’t treated with the necessary attention and care, chronic problems of pain and instability can result. The best way to prevent ankle sprains is to maintain good strength, muscle balance and flexibility. Here are some additional prevention steps: Wear good shoes Warm up before doing exercises and vigorous activities Pay attention to surfaces on which you run and walk Reinforce the foot and ankle’s stability with a brace if needed Pay attention to the body’s warning signs to slow down when you feel fatigue or pain. : Varying Degrees of Ankle Sprains Is a sprained ankle still stiff after 3 months? ‘An ankle sprain that lingers beyond 3 months is often an injury to a bone, tendon or ligament that is unlikely to heal without intervention,’ he says. ‘And the longer an ankle injury persists without proper treatment, the greater the likelihood that permanent disability will result.’ What To Wear With Sports Leggings? Which Fighting Sport Should I Do?