Lots of men worry about their back going out or their knees just going. The lowly ankle sprain, however, is viewed as the common cold of musculoskeletal injuries. It happens – and you get over it. It’s hard to avoid. But a growing number of researchers, surgeons and trainers believe it’s time to rethink this. A sprained ankle is the most common injury in sports, and yet our understanding of it is only now coming into focus. Sprains cause more damage than we once thought they did, and we can do a lot more to prevent the fallout. In short, “walk or run it off” may not be the proper response.
Jay Hertel, PhD, who studies ankles at the University of Virginia in the US, says that, until recently, sprains were considered largely benign after the initial pain and swelling went away. “But opinions have changed. Inadequate treatment could prime you for years of residual pain and re-sprains,” he adds. Some 30 per cent of sprain victims face chronic ankle instability. In one study, 34 per cent of people who sprained an ankle went on to sprain it again within the following three years.
The ligaments in your ankle, Hertel says, are laced with sensory receptors. “These are responsible for telling the brain where the ankle is in space,” he says. When a sprain occurs, some of these sensors are permanently damaged. As a result, your ankle can’t communicate as well with your brain. That’s where rehab comes in. “If you stop treating an injured ankle as soon as the symptoms go away, you will have problems down the line,” Hertel says.
Rehab, when approached correctly, can help you regain a kind of ankle virginity – that is, if you remain sprain-free for a year, your risk returns to what it was before your mishap. The secret to reclaiming your ankle’s V-card lies in the following four steps.
Beneath that bloated purple mass are three groups of ligaments that hold (or used to hold) the joint in place. They can stretch and loosen (a Grade I sprain), stretch and partially tear (Grade II) or tear completely (Grade III). In the “high ankle sprain” commonly seen in contact sports such as rugby and American football, the large ligaments connecting the ankle to the two lower-leg bones are also damaged. The immediate diagnosis is simple: “There’s mild or severe. You can either walk or you can’t,” says orthopaedic surgeon Dr John Kennedy. If you aren’t able to bear weight on your foot, seek immediate medical attention so a doctor can further diagnose the severity of your sprain. Otherwise, proceed to the next step.
And add to this “ice”, “compression” and “elevation” for the textbook RICE treatment, which everyone knows about – and almost everyone bungles. Once at rest, wrap a compression bandage comfortably around the foot and ankle to minimise swelling. “When an ankle is swollen, the fibres in the ligaments are pushed in different directions, and they may not heal in their natural anatomic positions,” says orthopaedic surgeon Dr Mark Drakos.
Elevate your ankle above your heart to prevent fluid accumulation, and apply an ice pack for 20 minutes. This requires a couch or bed – your desk chair won’t work. For two days, ice the joint for 20 minutes every two hours. Of course, you still have to move around. “The biggest difference between the way you treat a sprained ankle and the way a pro athlete treats one,” Hertel says, “is when the pro leaves the stadium, his foot is immobilised in a walking boot.” A British study found that immobilisation is a more effective sprain healing strategy than a simple elastic bandage.
So, for a severe sprain, a compression bandage isn’t immobilising enough. Ask your doctor if you can use a walking boot, so you can resume part of your regular life. But you can take immobilisation too far. You still have to…
With your foot elevated and your heel held still, write the alphabet in capital letters with your big toe. Complete this 10-minute range of motion routine four times a day the first two days after your injury, says Dr Drakos.
After 48 hours, here’s your drill: Set up two tubs – one with hot water and the other with crushed ice and water. Take off any wrap or boot you’re using, immerse your ankle in the hot water, and do the alphabet exercise for 5 minutes. Then dunk your foot in the ice water, keeping your heel at the bottom of the tub and lifting your toes so they touch the side. Hold that position for 8 seconds, and relax for 2 seconds. Repeat 6 times. Then alternate 30-second hot and cold dunks for the next 4 minutes.
Do this drill three more times throughout the day, reducing the hot water alphabet step by 1 minute each time. This causes your blood vessels to dilate, helping to clear fluid and reduce inflammation. Keep wearing the compression wrap when you’re not dunking your ankle, or until it is no longer swollen or painful.
When the ankle looks normal and feels good again, most men end treatment and start thinking about their next game. But the next step – called proprioceptive training – is crucial. It encourages balance, stability and a sense of where your ankle is in space.
“It’s a huge component of what we do,” says Jack McPhilemy, an orthopaedic surgeon and doctor for the NBA’s Philadelphia 76ers. “We’re trying to make athletes more aware of when the ankle is beginning to roll; to make that message to the brain travel faster, so it sends out a signal to resist.”
Your first move: Lift your healthy foot and stand on the other while you brush your teeth. Do this twice a day for three minutes, and you’ve engaged in the most basic form of proprioceptive training.
One unpublished study of volleyball players showed that balance training can reduce the incidence of ankle sprains by at least half. Researchers say our brains need up to 120 milliseconds – three times longer than the 30 to 50 milliseconds it takes to roll an ankle – to send a message to stop the process. So balance training may be massaging your mind.
“Patients who have had a significant ankle injury often feel they are performing at a lower level than they were before the injury – even if they aren’t,” says Dr Kennedy. “They come to feel it’s a weaker part of their body. And the only solution is to make them feel it can become the strongest part of their body with these exercises. At the core of these is balance. You know, life is balance; balance is life. It’s not just in your ankle, but it’s a good place to start.”