Healing a Sprained Ankle - Part One
Disclaimer: I am not a doctor or a physical therapist. If you are hurt and need help, go in person to a real human with actual degrees to get a medical opinion. Do not stop at WebMD, do not collect $200.
However, I am an experienced coach and athlete who has been surrounded by sprains since I was a kid and I sprained my ankle the day before the prom and my mom still made me wear my high heels because I begged for them and they were expensive. (Sometimes you have to make sacrifices for a great pair of shoes. Don't worry, Mom, I support this highly questionable decision.)
But the foot is on my mind again because I've had like fifteen friends sprain their ankles recently so I thought we could go all Bubba from Forrest Gump here and talk about everything that has ever had to do with sprained ankles.
-What is a sprained ankle
-What happens immediately after spraining an ankle besides it hurts a lot
-How to fix a sprained ankle
-How not to fix a sprained ankle
-Why you shouldn't use crutches if your sprained ankle isn't broken
-Why you shouldn't use a brace on your sprained ankle
-How long until a sprained ankle heals
-How do you know when you can use a sprained ankle safely
-How do you rehab a sprained ankle
-What can you do to prevent a future sprained ankle bc omg every1 sez that if u do it 1nce u do it a thousand times 4evs
Let's start with a reframe. Every time someone sprains their ankle, they go, "UGH, I sprained my stupid ankle."
First of all, I know it sucks, but your ankle is not stupid. Heading out for a run can put up to THIRTEEN TIMES YOUR BODYWEIGHT on the ankle on every step. Spraining your ankle is a risk of having a limb which allows you to run and move like a human instead of like a zombie. Have you seen a zombie? Their plantarflexion blows. If a zombie is chasing you, just run them towards a divot in the ground and their foot will snap right off. So even though you're upset about spraining your ankle, let's all take a minute to be excited that although they sometimes turn over, our feet do not snap off in divots.
(Google says they get like two hundred new searches every day. I've already looked up Zombie Sprained Ankle and Bubba's Sprained Ankle Scampi so I'm thinking I've contributed to today's total.)
Second of all, it's a better topic for a whole separate blog, but hating on your body for getting hurt is a fertile psychological shitpile which can only nurture fear, shame, and distrust of yourself. Getting an injury happens because you, however accidentally, challenged your body to move beyond its limits and it wasn't able to keep up with the demand.
You're not a piece of shit athlete. Your body isn't trash. It doesn't mean running is super dangerous. And you didn't do anything wrong unless you hurt your ankle because you were making a video where you deadlift in stilettos in which case you absolutely did do many things wrong including whatever life trajectory led you to wanting to deadlift in stilettos.
Getting hurt just means that physics wasn't on your side that day, so blame science. Instead of hating your ankle, try hating the limits of torsional shear or tensile strength. You could be like Yo my tibia's Young's modulus is whack tho. Or like OMG YOU GUYS I thought the talofibular ligamentous linear region covered more than 6% strain, I can't believe thisssssss.
I really had fun writing that paragraph that will make everyone want to X out of this blog immediately SO I AM LEAVING IT DON'T X ME IT'S NOT MY FAULT I'M A DORK.
I'm not saying it's no big deal to get hurt, and I'm not saying to pretend like it didn't happen or can't happen. I hate being hurt. But getting hurt is a risk of being active, and believe me you'd way rather have a sprained ankle than have all of your organs rotting away inside your body. You're better off keeping up your level of activity and risking some joint injury along the way than giving up activity and risking kidney dialysis and quadruple bypasses.
A sprained ankle means you rolled over your ankle at high speed and tore some or a bunch of the tendons/ligaments/tissue/matrix that holds your foot together. Although it sounds like tearing things is the most terrifying result of all time, it's actually both normal and fixable without surgery. (Your body can self-heal pretty much any tear, but there are lots of times when surgery would be strongly recommended over not-surgery. Things like Achilles tears, ACL, etc. I'm only talking about sprains here, not other types of tearing, so don't blame me when you fuck something up and say that I told you to do it.)
Again, normal and fixable. You can rehab your sprained ankle quickly, by yourself, and without MRIs or visiting 9000 orthopedists, podiatrists, or other -ists.
What happens directly after spraining your ankle is super cool, even if it hurts like hell. People tend to be more forgiving of catastrophic injuries when they understand why their body is reacting the way that it's reacting, so let's give this a go.
When you tear things, they bleed on the inside, just like your skin does when you cut it. And, just like your skin, all those tears have to clot in order to stop the bleeding. That cadaver bruising you're horrified by? It's a beautiful thing. The blood eventually pools and clots across the injury. It's not only happening so you don't die from blood loss, although that is an excellent side effect. Those clots provide a fibrous scaffolding for new tissues to grow on. It's like a cute little ankle tendon tomato fence.
Just two days after you tear a tendon, your body starts stacking new tendon-making cells right on top of those clots. It also dials all the inflammatory vacuum cleaner cells for a cleanup on aisle eight. Your immune system swoops around like Ms. Pac Man, searching out and eating all the cells that you destroyed beyond repair when you decided that you could totally make it from the garage roof to the trampoline to the pool.
Since your body is a massive biome where trillions of processes are happening simultaneously, these vacuum cleaners aren't only sweeping up the broken glass. The mere presence of those clustered immune cells sends out a bat signal to your genes. Your DNA starts pumping out all of the neat-o chemicals that make our tissues grow bigger and get stronger. Remember in NES Dragon Warrior how the Healmore spell was one of the last things you can learn because it was so badass to be able to get better immediately? (I know you don't, because that game came out in 1989 you weren't even born yet goddammit.) Well, you've been able to Healmore since you were born. Even in video games, you're not as cool as you are in real life.
Your body's healing process is really, really good. Sometimes it goes on for too long, but we'll come back to that. Just remember that you can trust it, so don't waste precious mental space being anxious about whether you'll ever walk normally again when you can waste precious mental space being anxious about how Blake and Caelynn's text messages are affecting the dynamic on Bachelor in Paradise.
And you ARE going to walk and run normally again. Here are two really important parts about acute injuries like ankle sprains. We're always told to reduce swelling by any means possible, usually by Rest, Ice, Compression, and Elevation, plus anti-inflammatories like Motrin and Advil.
Stop doing this. Especially the rest part. Maybe even if a doctor told you to do it.*
*Doctors, I'm sorry to say, are not typically up to date on exercise science and protocol. Even orthos and podiatrists are bad at this, because it's not really their job to be good at it. Their job is to make sure your ankle isn't broken (this is an excellent reason to visit a doctor) and to do something for you today that can make your ankle feel better today. This might include painkillers, crutches, a brace, or surgery. It's true that those things can make your ankle feel better today but they're simply not the recommended treatments for sprained ankles anymore because of the problems they cause with rehab later.
You need the swelling. We love the swelling. The swelling is a sign of anger and your ankle has a right to be angry. Wanting your ankle not to swell after pissing it off is like wanting your spouse to think it's fine that you watched the latest episode of Ozark when she was working late. It's not fine, Billy. It's messed up.
Here's why you don't want to try to keep the swelling and inflammation down. Your injured limb swells because it's flooding your joint with as many cells as possible that can help the healing process. The instant you do damage to some tissue, your body releases prostaglandins to increase pain and fever (like the heat you feel in a fresh injury). Pain sucks, but it's also useful because it reminds you that you aren't supposed to be moving that joint. If you sprain your ankle and then try to run a few steps, your prostaglandins are gonna let you know that you must be out of your damn mind.
Anti-inflammatories (Motrin, Advil, etc) block this prostaglandin action. The dulling of pain is tempting, but better off resisted. NSAIDs (anti-inflammatories) have their place and I've often suggested people use them for specific reasons, but this isn't one of them.
For one thing, any time you medicinally dull body pain you're simply covering up what you know is a problem. Cortisone shots are similar. This faux sense of feeling better might lull you into thinking your injury isn't as bad as it seems, and you may start using the joint before it's safe to use.
For another thing, amplifying pain isn't your prostaglandins' sole responsibility. They also play several important parts in the healing process, beginning immediately after the tear. When you take an NSAID, it is dulling the pain, but it's also reducing the quantity and quality of the prostaglandin healing actions. It would be like hamstringing the firefighters who are trying to fight a fire.
Remember how your body almost instantly starts generating new tendon cells to replace the broken ones? Interfering with the inflammatory process also interferes with the new-tendon-creation process. Studies in rats show that tendons treated with anti-inflammatories are smaller, weaker, and less stiff than tendons allowed to heal on their own. Nobody wants a flaccid tendon, so you've got good reason to stay away from this.
There is some research that suggests that taking Advil a week or two after the initial inflammatory cascade might help. (The Inflammatory Cascade sounds like Susan demanding to speak to the manager.) Reducing the amount of old inflammatory cells may assist the process later down the road. However, usually the person is starting to use the joint again by then, so the data seems unclear as to whether it's the NSAIDs or the improved mobility which are helping the tendons. Either way, if you can handle it, try to just let your ankle do its thing naturally.
"Mia, my doctor told me to wrap my foot and put me on crutches for four weeks. Are you saying that all my doctor's medical training to treat sprained ankles is wrong?"
Obnoxious answer: Yes.
Moderately less obnoxious answer: Yes, if they're putting you in braces and crutches for an extended period of time.
Here's the deal. If you can't put any weight at all on a sprained ankle without excruciating pain, use the brace or crutches. You NEVER want to be using a joint through extreme pain. However! If you can put weight on the foot, even if it's just standing still, you'll want to start doing it. People who start using their ankle immediately after spraining it report a faster return to activity, less instability, and a lower re-injury rate than people who are immobilized for a period of time afterwards. For sure the jury is still out on the best sprain recovery technique, but more and more we are realizing that our decades of advice to brace and sit was probably wrong.
What's so wrong with immobilization anyway? It prevents further injury to injured tissue, right?
Not really, but I get it. It's reassuring to feel that layer of protection surrounding something you know is hurt. And it may reduce your pain in the moment. But it isn't necessary. Your body is already bracing the injury for you. You know how your sprain looks like Veruca Salt after she eats the blueberry?
This is a good thing. Swelling creates a natural brace for your ankle, by preventing you from moving the injured tissue. This natural bracing has an important ability which a synthetic brace does not have. Even if you're limping, your leg can still move as closely to its natural manner as possible, which helps with long-term healing. A hard plastic cast will always unnaturally change your gait and movement patterns.
Here's why this matters. When your body builds new tissues, whether in normal maintenance mode or in emergency repair mode, it doesn't just lay the cells down and forget about them. Instead, it lays the cells down and then the cells gradually re-align themselves along the lines of motion that you create. When you sprain a ligament, for example, your body lays down new ligament cells in the damaged area. Those cells are placed haphazardly on the fibrous tomato fence, with no particular rhyme or reason other than to fill the hole. But when you start using and moving and bearing weight on that ligament, those cells readjust their positioning based on the stresses you're applying. They situate themselves to be in the best places to absorb future stress on the ligament. Put another way, gently putting weight on a sprained ankle helps teach your new cells where to go to be most useful. It's like putting a large shmear of plaster across a wall and then using the scraper to guide it specifically into the crack. You really want to help guide those small but mighty legos into the right place.
The next part of this blog is going to talk about what to do once your ankle starts feeling better. We'll look at how to rehab your strength, mobility, and confidence. But for now, here's your bottom line: Your body is never subtle when it comes to pain. If you move in a way it doesn't like, it's going to let you know. So if you've got a sprained ankle and there's any—ANY—movement that you can do without pain, you're probably safe to do it.
AT NO POINT ARE YOU ALLOWED TO MOVE INTO PAIN.
However, any range of motion that's pain-free is probably safe. The instant you get that oh, hell no signal, obey it. But the sooner you start moving and using your ankle, the faster it's going to heal. The last time I sprained my ankle was a severe sprain sixteen days before the American Ninja Warrior Las Vegas finals. I couldn't walk on day one, and I was able to both run and do single leg jumps on day sixteen. It wasn't fully healed, so I taped my ankle for safety during the filming, but sixteen days is a pretty good turnaround time to functionality. Also, lest you think I was some extremely young chicken, I was twenty-nine years old.
Movements you can try immediately after a sprained ankle:
-Gentle pointing and flexing, either while sitting or lying down. When a sprain is fresh, you might only be able to move your foot a half an inch in either direction. That's fine. That half inch is still valuable.
-Gentle side to side movements. This one might be impossible in the beginning (since your ankle got hurt by rolling to the side), so if it is, leave it be. But again, if you even have a half inch of movement, take it.
-Toe curls. These are separate from the ankle movements above, so even if you can't complete the ankle movements without pain, you will probably be able to curl and uncurl your toes to some extent.
-Bending and straightening your knee, either sitting or lying down. Just like the toe curls, you can always rehab a joint by moving the joints which surround the injured one. Remember everything works together in one chain.
-Manually moving your ankle. You can try using your hands to passively move the foot in all directions, if actively moving it is still too painful.
-Standing still on two feet with any amount of weight on the foot. Feel free to hold onto a counter, chair, or doorframe for a balance assist.
-Standing on two feet apart, gently shifting your weight side to side. Again, only as much weight as you can bear pain-free. Not a little bit of pain. Pain-free. Feel free to also use a chair or counter for this one.
-As soon as you're able to take a tiny step, start walking.
Most of all, don't hate on your ankle, and don't be afraid of it. Recognize that it is reacting in a very reasonable way, appreciate its outstanding abilities to heal, and be an active partner in putting it back together again. See you in part two, where you'll progress to this in no time: