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Ankle Sprain Again: How Do I Prevent This From Happening?
Posted by Jodi Jainchill PT, CFMTI just sprained my ankle again and now I cannot put much weight on it. Why do I keep spraining my ankle? I wonder how long this will take before I can hoop and exercise as I wish? I do not understand why this keeps happening?
After my hoop camp experience, I learned that many hoopers have re-occurring ankle sprains. So, I wanted to share my experience in working with patients as well as personal experience with ankle injuries.
An initial ankle injury could be due to trauma like a car accident or a horse falling on you, as I have experienced. It may also be just simply not stretching your calves out properly before an activity or wearing heels you do not have the strength to wear. It may also be just a missed step on stairs or an uneven surface that your ankle does not have the awareness or proprioception to do so.
Once you sprain your ankle, it is very common to re-sprain your ankle if you do not rehab your ankle properly. It is ideal to be guided by a medical doctor or physical therapist. When you ‘twist’ your ankle, there are three ‘grades’ to determine how severe the sprain is. Each ‘grade’ is a reflection of the degree the ankle ligaments are torn and the degree of instability in the ankle. The most common ankle sprain is an ‘inversion’ sprain. This will effect the lateral/outside ligaments. So basically, it means you roll you ankle ‘out’.
Once you sprain your ankle and determine it is a mild sprain, there are a few basic steps to be aware of for treatment. If there is a lot of swelling and black and blue around the ankle, it would be wise and highly recommended to see an medical doctor to rule out any fractures. Otherwise, for a mild ankle sprain, the recipe during the initial/ ‘acute’ stage is RICE.
R: ‘Rest’ The injured ligaments need time to heal. Therefore, not bearing weight can relieve stress to the ligaments. Sometimes, crutches are necessary. Limping is not a good choice. Limping could cause secondary injury to other parts of the body like the sacroiliac joint (SIJ).
I: ‘Ice’ To decrease the inflammation from an ankle sprain, ice is a good remedy. The best way is using an ice bath. Fill a bucket up with water and ice and place your foot in for about ten minutes. It should be cold enough that it is uncomfortable initially and then the ankle will feel better as the foot feels ‘numb’. Do not leave in much longer than ten minutes since over icing can cause adverse effects. You can ice for ten minutes every one to two hours for the first 48-72 hours. Also, an anti-inflammatory prescribed by your medical doctor may also be beneficial. Also, the homeopathic remedy Arnica Montana may be helpful if used soon after the initial injury.
C: ‘Compression’. By applying an equal distribution of compression with an ace bandage, you can control the amount of swelling. It is important to wrap using ‘figure 8’s’. Otherwise, circular wrapping could impede blood flow. I also find at the initial stage to tape the foot using a ’stirrup’ technique is very helpful. I will talk more about this later in this article.
E: ‘Elevation’ It is important to keep your injured ankle above the heart. So when lying down, place pillows under your leg to keep it safely supported above the heart. From my experience, this will help the throbbing pain that can wake you up in the middle of the night after an ankle sprain.
Once you are past the acute stages of your ankle injury, it is time to slowly rehab your ankle. The acute stage can last up to two weeks. But, you must be sure enough healing has occurred, otherwise you can easily re-injure your ankle. A common reason why people re-sprain their ankle after healing, is not having the correct strength, flexibility, and proprioception return which allows for safety with daily activities as well as exercises like hoop dance.
I find increasing your ankles stability during this stage is essential. You can use an ankle brace which can be purchased from the local pharmacy or my preferred method, the stirrup. As a PT, my patients are always amazed at how much support this stirrup method of taping gives their ankle. This McConnel taping technique places strong tape like a stirrup to add support to the ankles medial/lateral stability. This taping will allow more comfort with weight bearing since it is reinforcing the ankles ligaments and muscles that may have weakened.
Another important aspect during this healing stage is to increase range of motion (ROM) in the ankle. After swelling and keeping the ankle immobile, the ankle gets stiff. It is best to start with non-weight bearing exercises like spelling the alphabet in mid air. Once you are able to have full range of motion in all directions without stiffness or pain, then you can progress to flexibility in weight bearing.
It is important to regain flexibility of your calves. A simple calf stretch against the wall performed 7x a day for about 20 seconds at a time is most beneficial. Make sure your toes are turned slightly in and that you stretch your calf with the knee straight and bent. In addition to gaining flexibility, it is also time to increase your strength of your ankle.
There are several ways to safely strengthen your ankle. It is best to start in non-weight bearing. You can use a light theraband for resistance. Then, slowly move to weight bearing exercises like heel raises. In addition to weight bearing, a very important element to work with in conjunction to strengthening is proprioception.
One of the main reasons people re-sprain their ankle is because they never reinstate proprioception. This means, they never teach their ankle where it is in space. One good exercise is to simply stand on one leg. You can add difficulty to challenge your proprioception by standing on a pillow. And then, when you are safe, closing your eyes to further challenge your proprioception.
If you reach all these rehab goals for your ankle, your ankle will have more stability and awareness. These aspects will benefit your ankle’s integrity to perform your daily activities and hoop dance regime. Remember, it is important to maintain flexibility, strength and proprioception in order to keep your ankle safe from re-injury.
Jodi Jainchill PT CFMT