A sprained ankle is essentially trauma to the connective tissues that hold the ankle joint in place.. ligament. Ligaments are the bodies strongest ‘connective’ structures, they are strong fibrous cords that bind bones to other bones. The primary damage in sprained ankles is usually damage to the ankle ligaments, although other tissues like tendon, joint capsule, fascia and blood vessels are most likely also affected in bad sprains.
The vast majority of sprained ankles or ‘rolled ankles’ involve ‘rolling over’ on the outside of the foot which damages the ligaments etc on the outside of the ankle. The severity of the sprain is essentially determined by how far the ankle joint rolls over and how much body weight is loaded through the ligaments.
Looking through a microscope at a sprained ankle you would see tears ranging from the extremely tiny and microscopic tears through to completely tears of the ligament. Looking holistically at the whole ankle foot and leg (the opposite of down a microscope) through the eyes of a trained health professional you would usually see signs of significant pre-existing weakness in ankles that get sprained, there is a lot more to most sprained ankles than bad luck.
It is likely that there is no single best sprained ankle treatment in the ‘one size fits all’ sense. There are however most definitely treatments that work on average far better than others. Discovering what the best sprained ankle treatment for you is often a bit of trial and error.
Excellent tools for treatment and prevention of sprained ankles include –
hot & cold
scar tissue stretches & guasha
Ankle sprain recovery time can vary from less than 3 weeks in mild sprains that are managed correctly through to ankles that take many years to recover. Permanent weakness and issues with chronic pain are more common than you might think after bad ankle sprains. If you are concerned about recovery time seek a professional who takes a hands on approach to your pain and have them move you towards a serious approach to rehabilitation. Loosely speaking the recovery time for ankle sprains are as follows.
Grade I Sprained Ankle
This grade of sprained ankle involves microscopic tears in the ligaments of the ankle. The symptoms generally include mild tenderness, mild swelling, and stiffness. The ankle feels relatively stable and it is usually possible to walk even immediately after the injury with moderate or minimal pain.
Grade 1 sprained ankles generally resolve in 1 – 3 weeks sometimes even without treatment. It is worth noting that multiple Grade 1 sprained ankles can set up a weakness in the ankle and should not be ignored. Repeat sprains is generally a sign of weakness as opposed to bad luck.
Grade II Sprained Ankle
A Grade II sprained ankle signifies a minor or partial tear with moderate pain, noteable swelling, and sometimes visible bruising . Although the ankle may feel relatively stable a Grade II sprained ankle can affect the way you walk. The injured area is usually very tender to the touch, and walking is painful.
The recovery time for Grade II sprained ankles varies a great deal and is influenced by many factors. If you are tracking well and your body is not struggling to heal you should most definitely be improving. Planning to be moving well and without pain or limitation in day to day movements within 4-6 weeks is a good start point.
Grade III Sprained Ankle
A Grade III sprained ankle is a major injury, involving a complete tear of a ligament or of multiple ankle ligaments. Grade III ankle sprains all have a significant recovery time that starts with dramatic swelling, joint immobility and visible bruising. The ankle is unstable and usually meaningful weight bearing is not possible due to intense pain.
Even under ideal circumstance it is still perfectly normal for Grade III sprained ankles to take several months just to heal and be relatively pain free. Recovery to full strength after a Grade III ankle sprain is something that warrants the intention of being worked on for years not months. This is due to the likelihood of recurrence and long standing pain syndromes.
The hallmark of a high ankle sprain is pain felt well above the ankle joint itself that increases with outward rotation of the foot. Pain with walking and weight bearing, often with significant bruising and swelling across the upper ankle rather than around the ankle bone itself. Difficulty carrying out a single leg calf raise is a possible indicatorof a high ankle sprain.
Slow recovery of pain and disability after an injury that seems to come from a bit higher than the ankle joint are basically the hallmarks of a high ankle sprain. The classic mechanism of a high ankle sprain is outward rotation of the foot as opposed to rolling over on the ankle.
Pain, stiffness, swelling and bruising are the primary symptoms of an ankle sprain. The symptoms associated with an ankle sprain injury are to a large extent determined by the severity of the sprain. Grade 1 ankle sprains can be virtually invisible to the naked eye and only felt as pain and stiffness by the patient. Grade 3 ankle sprains can be very much visible and their appearance is often that of dramatic swelling and bruising.
Recurring ankle sprains are not caused by bad luck or by ‘clumsiness’. They are caused by misalignments, weakness and disorganised muscle activity in the lower leg. Healthy, strong ankles almost never suffer from sprains. In the same way that someone who suffers with repetitive back injury usually has a weakness in their core, ankle sprain sufferers have comparable weaknesses in their lower limbs.
Most ankle sprain sufferers who take the trouble to learn about their problem find that the weakness in their ankles had been caused by faulty movement patterns and weakness that they had developed without realising. Other possible causes of weakness in an ankle include high arches, flat feet and old lower limb injuries that weren’t properly rehabilitated.
The good news is that by performing specific, targeted strength and balance exercises it is possible to restore the health and strength of the stabilising muscles of the ankle.
Cure is an awkward concept to apply to sprained ankles. There is no way of being able to predict future pain/injury with 100% accuracy. That being said, the pain and stiffness of an ankle sprain can almost always be effective managed. In the long term with the right rehab mindset and the right tools you can definitely expect to be able to work at injury prevention with a great deal of success.
Whether or not your should walk in your sprained ankle is a conversation you should ideally have with your healthcare professional. Weight bearing and walking are an essential part of successful recover from a sprained ankle. Walking on a sprained ankle too soon however can obviously slow the healing process if you overdo it in the early phases of healing. As a rule of thumb we advise pur patients to gently err on the side of doing a little bit more each day as long as they feel it is beneficial and not aggravating.
Traditionally the most important thing to avoid with a sprained ankle is fast paced activity with rapid changes of direction on an uneven surface. Playing rugby on a wet paddock would be an excellent example of such an activity. This type of activity is potentially a worse case scenario for a sprained ankle because it’s usual mechanisms for preventing further injury are compromised. Fast, unpredictable movements on soft ground ask a great deal of the ankles stabilising muscles and connective tissues, all of which take time to be restored to full health after an ankle sprain.
At a lower level of risk there is a need to avoid too much activity while the ankle is healing. There are also some risks in doing too little, a lack of movement inhibits the bodies healing processes. It is also not advisable to put heat on your sprained ankle in the early phases of healing, ice is much more beneficial.
There is a wide range of response rates in people who start to wear orthotics for pain relief. Some find that changes happen so slowly that they are only obvious when they cast their mind back a year or more, to their previous pain levels. Other patients find that their pain reduces in a matter of days once they have orthotics fitted. Orthotics are definitely a form of therapy for the long haul as opposed to a ‘quick fix’.
Thankfully the need for surgery after a sprained ankle is very rare. If you have stubborn pain following an ankle sprain it is more likely that you need an aggressive rehab regime. There are instances where a surgical repair becomes necessary at which point the benefits are likely to be very significant. The simple fact is that ligaments are very bad at healing themselves and do on occasion need to be repaired/replaced with grafts. Once that is done you will still need an aggressive rehab protocol to follow, rehab after such an event requires a long term commitment seldom seen in our society.