Ways to Treat a Sprained Ankle

What is a Sprained Ankle?

Sprains occur when the ligaments are stretched beyond their limits tearing the fibres of, or the entire ligament. Ligaments are short, strong bands of tissue that connect your bones at a joint, holding them together. The most common type of ankle sprain is an injury to the ligaments on the outside of the ankle as a result of the foot turning inwards. A sprain to the inside ankle ligaments from the foot turning outwards, is less common. Sprains can vary depending on how many ligaments are involved and how badly they are torn. There are three grades to classify the severity of an ankle sprain. These are:

• Grade one (mild): when the ligament is slightly stretched but there is no joint instability. The joint may be mildly tender, bruised and swollen, but is not painful when you put weight on it. It can take hours to days, to heal.
• Grade two (moderate to severe): when the ligament is partially torn but there may be none, or slight joint instability, but walking might be mildly painful. The ankle is often swollen and bruised and may take days to weeks to heal.
• Grade three (very severe): A complete tear or rupture of the ligament, with substantial joint instability, making it very painful to walk. The whole ankle may feel very tender, appear bruised and swollen. Healing can take from 6 to 8 weeks.

A doctor may request an X-ray to check for broken (fractured) bones if you're unable to walk on your injured ankle.

Symptoms of a Sprained Ankle

Depending on the severity of the sprain (see grade classification above), symptoms of a sprained ankle may include pain, tenderness, bruising or swelling around your ankle, trouble putting weight on your foot, walking on it and not being able to move your ankle the way you normally would.

Mild to moderate ankle sprains can take days or weeks to heal, whereas a severe sprain could take several months to heal. It’s advisable to avoid strenuous exercise for up to 8 weeks after a sprain to avoid causing further damage, however the first goal in recovery is to regain the normal range of motion, even if you can't put full weight on the injured area yet. Recovery may include exercises to improve movement control, balance, and coordination, strengthening exercises and physiotherpay.

Causes of a Sprained Ankle

Most sprains occur when you twist, stretch or bend your foot too far inwards in a forceful way, which can cause injury to the outside ligaments of the ankle.

Some common causes of a sprained ankle may include:

• Certain types of sports activities that involve running, sudden changing of direction and jumping, such as basketball, football, volleyball and climbing.
• When the foot changes direction, turns abnormally or slips during activities like walking on an uneven surface, falling or tripping, wearing unstable shoes such as high heels or going down a step.

The likelihood of an ankle sprain is higher in people with reduced strength, flexibility or co-ordination such as people who are inactive, poor exercise technique, not having the right equipment or not doing enough warming up before or cooling down after exercising.

Other things that could increase your risk of a sprain, include getting older and if you’ve had previous sprains.

Ways to Treat a Sprained Ankle

Mild sprains can be treated at home and usually heal within a few weeks. In the first 48 to 72 hours after injury, you should follow the PRICE steps to treat a sprained ankle:

• Protection – protect your ankle from further injury by wearing supportive shoes, or a splint, brace, taping or elastic bandages.
• Rest – rest your ankle for the first 2 to 3 days, avoiding putting weight on it.
• Ice – apply an ice pack or bag of frozen peas wrapped in a towel, to your ankle to reduce swelling. Apply ice for up to 20 minutes, every 2 to 3 hours.
• Compression – apply an elastic bandage to help reduce swelling, making sure that it’s a snug fit but not too tight. Remove the bandage at night before going to sleep.
• Elevation – raise your ankle higher than your hip when lying down or sitting by supporting it on a pillow until the swelling reduces.

During treatment for a sprained ankle, you should also avoid:

• Heat, such as hot baths or heat packs for the first couple of days to help prevent further swelling.
• Alcohol, for the first couple of days.
• Massages, also for the first couple of days after injury.
• Inappropriate shoes, such as high heels, tight fitting shoes, or shoes that do not provide sufficient ankle support such as sandals.
• Strenuous exercise for up to 8 weeks, as you may risk further damage to your ankle.

If your sprained ankle is taking longer than usual, to improve, physiotherapy might be a good option for you.

Short-term medication to help relieve pain

You can take paracetamol tablets or apply a non-steroidal anti-inflammatory drug (NSAIDs) such as ibuprofen gel or cream onto the painful area, to ease pain and swelling.

If needed, you could take ibuprofen tablets to help reduce pain.

Recovery Exercises for Sprained Ankles

To fully recover from an ankle sprain, it’s advisable to work towards regaining your normal range of motion and to strengthen the ligaments and muscles around your injured ankle. Research shows restoring ankle function using support that allows for movement, for example taping or elastic bandages, can help you return to normal activities sooner than if you weren’t moving the ankle at all. This is known as "functional treatment".

To reduce pain, swelling, and prevent further injury, first follow the PRICE steps, (mentioned above) in the first 24 to 48 hours. In the next 48 to 72 hours you can then move to functional treatment, working on range-of-motion and strengthening exercises. As your recovery progresses, you can then try endurance and balance training.

Functional exercises that may help with recovery from ankle sprains, focus on range of motion, balance and strengthening. A physiotherapist or doctor can advise you on the appropriate exercises or if your sprain is mild, you can slowly start to try these exercises once the swelling and pain reduces enough to let you move your ankle without too much discomfort:

Range of motion exercises

Please find illustrated guides here.

• Ankle stretch pulls:
• Take a towel or elasticised resistance band, looped around the ball of your foot, pulling your toes towards your body. Try to keep your knee straight.
• Hold like this for 30 seconds and repeat 3 times on each foot.
• If you have back problems, take care whilst sitting in this position.
• You can also try pressing your foot down against the resistance and away from your body.

Wall pushes:

• Facing a wall, put both of your hands on the wall at shoulder height, with one foot in front of the other. Your front foot should be about 30 cm from the wall.
• With the front knee bent and back knee straight, bend the front knee towards the wall until the calf in your back leg feels tight.
• Relax and repeat 10 times.
• Repeat the above exercise but this time bring your back foot forward a little, so that both knees are slightly bent.
• Repeat this 10 times.

Alphabet writing

• Sitting down on a chair, lift your injured ankle up and write the alphabet in the air with your big toe, by only moving your ankle.
• Try writing the whole alphabet twice a day.

Strengthening Exercise

It’s important to strengthen the muscles that turn your ankle outwards:

• Sitting on a chair with both heels on the floor, loop an elastic resistance band around both of your feet.
• Keeping your heel fixed on the ground, turn the toes of your injured foot outwards, against the resistance of the band.
• Keep your uninjured foot straight and bring your injured foot back to the original position slowly.
• Build up to repeating this 10 times and doing the set 3 times a day.

Balancing Exercises

Try to take any opportunities to practise standing on one leg – building it into your daily activities will help you get better.

Basic balance

• Balance on your injured foot, by raising your uninjured foot off the floor. Make sure you are holding a stable object such as a kitchen counter, for support.
• Build up how long you do this for, aiming for one minute. Try to do this three times, resting in-between each minute.
• Repeat the set twice a day.

Pillow balance

• Once you feel confident with basic balance exercise, you can make it harder by standing on a cushion or pillow.
• Build up the amount you do slowly.

8 Ways to Avoid Ankle Sprains

1. Warm up before exercising by doing light activities to slowly increase your heart rate and get your body ready.
2. Cool down after exercising by gradually slowing down your activity until your breathing and heart rate return to normal. Then, do some gentle stretches while your muscles are still warm.
3. Use the right equipment for your activity.
4. Wear proper shoes for your sport and replace them when they wear out.
5. Wear comfortable and appropriate clothes that allow you to move freely whilst exercising.
6. Have a balanced fitness plan that includes cardio, strength training, and flexibility exercises. Add new activities slowly.
7. Avoid exercising when you are tired or in pain.
8. Take regular rest days from exercise.

When to see a doctor

If your symptoms aren’t improving soon after the injury or after treating it yourself, contact your doctor. Particularly if the pain, bruising and swelling are severe, or if your ankle feels numb or you can't put weight on it.

Other reasons to contact your doctor are:

• Your pain, swelling or bruising is getting worse
• Your ankle feels very stiff or is difficult to move
• you also have a very high temperature or feel hot and shivery – this could be an infection

You could also go to an urgent treatment centre if your doctor is unavailable.