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robertblake60
02-01-2013, 13:37
http://boblake.name/sprained-ankle-my-first-at-challenge/

So long story short, I sprained my ankle on Wednesday (grade 2, no breaks or obvious tears based on the x-rays). My plans have me starting the AT on 3/9.

I work from home, so I've been able to devote the last 40 hours to icing my ankle every 3 hours for 20-25min. And the leg is elevated all other hours of the day. I haven't left my house at all and have done very very little walking on it (maybe 5 minutes total).

I know the first 48 hours are the most critical, so I've tried to be diligent with healing. My question is now for the next 5 weeks before my hike; what is the best way to get this thing healed. Obviously sports, running, etc are out of the question.

I guess my questions are:

1) Should I still ice the ankle every 3 hours? If not, how often?
2) Should I take out the heat pad?
3) I will gradually begin the mobility and strengthening exercises as pain allows.
4) I'll keep the leg elevated as much as possible to keep swelling down.

Anything else?

juma
02-01-2013, 13:49
Generally, it takes 6 months to really get over a ankle sprain. The swelling will go down and stiffness go away in a month but its not really healed and strong again. If you gotta go hike in March, I'd get a brace like the Aircast A-60. I would never have iced it - what is needed is enhanced blood flow to heal the torn/stretched tendons. Icing does reduce swelling and blood flow but that's not really a fix for way weakened tissue.

robertblake60
02-01-2013, 14:26
Hmm...the Ice was part of the treatment plan that the hospital gave me (and generally accepted as part of the RICE method, at least for the first 48 hours). But what's done is done. What I've been reading is about something called a 'contrast bath' where you alternate Ice bath to warm water every 2-4 minutes for up to a half hour....says it generate blood flow.

And yeah, I'll be adding an ankle brace to my gear list.

I've already got one of these
http://lordshopping.com/Active-Ankle-AS1-White-Lace-Up-Volleyball-Basketba.asp

Think it will work?

Maui Rhino
02-01-2013, 14:59
Amond other skills, I am a licensed massage therapist, so here is my advice. You did right in following RICE for the fist 48hrs. After that, You do want to use heat to dialate the blood vessels which will bring oxygen to the cells, promoting healing. Gentle massage and range of motion exercises will help, but you will have to start small on the ROM excercises. Go slow and do small circles within your pain tolerances. Think of it as reminding your body that it can do this motion without pain or damage. As you gradually get better, incorporate longer periods of stretching and walking. You can also use a technique called "focal ice" to help with pain. Take a paper cup and fill it with water, then freeze it. When pain becomes acute after a stretching/exercise session, massage it with the cup of ice for 10 minutes. Then put the ice down and massage it with your hands for 10 minutes. Repeat this process a couple of times. As the ice melts, peel back the paper cup to expose more. An ankle brace will be indespensable at first, but be diligent about gradually reducing use, as it can slow or limit your full recovery, if you come to depend on it. Eventually, during the hike, you will be down to wearing it during the day, and taking it off at camp. You may also want to consider carrying a spare brace to change out each day, allowing the other to dry. This will help them last longer. Neoprene can get nasty sinky fast. More importantly, the brace is probably going to be a vital piece of gear for your hike in the begining, and worth the extra 5oz to have a spare. Be extra vigilant about limiting the miles in the beginning, and if you don't use trekking poles now, you should probably start.

Blissful
02-01-2013, 15:06
RICE rest ice compression elevation. I would never use heat at all. Even after 48 hrs. There is still too much swelling and for weeks to come. Even with tendonitis I get, I still use ice. Ice is the way to go. They use it even in Physical Therapy all the time. That and ultrasound. NO heat!! Blood flow returns to the tissues AFTER the ice is removed. The swelling of tissue that heat brings only restricts the blood flowing to the area. You have an acute injury with inflammation. You need ice. And take Ibuprofen if you have no ulcer issues.
See this link (http://sportsmedicine.about.com/cs/rehab/a/heatorcold.htm) on sports medicine on when to use heat vs ice

Begin rehab when pain allows. It's best to rehab your ankle than relying on a brace as mentioned above. Bracing can really weaken it. Right now you need support but I'd try to limit it's use after a week or two. Wean yourself from it. You must be diligent with rehab. Use ice massage as described above after you work the ankle. I suffered close to a grade 2 sprain on my thru hike. I only used a brace one day when I returned (I did carry it. To this day I always carry a ace wrap). But I was diligent with rehab.

I blogged (http://blissfulhiking.blogspot.com/2011/05/hiking-and-ankles-whole-story.html) on ankle injury and rehab. I suffered several severe ankle sprains, had physical therapy and came back from them all (I'm also an RN). A wobble board is an excellent way to rehab after an ankle injury and to prepare it for hiking.

A grade two will take several weeks to heal. You should be good to go in March if this month goes well.

jeffmeh
02-01-2013, 15:20
Google "don't ice that ankle sprain" for an alternative treatment protocol that appears to have pretty stunning success in getting athletes rehabbed quickly. One account is here: http://www.t-nation.com/free_online_article/most_recent/radical_methods_of_injury_rehabilitation

Feral Bill
02-01-2013, 15:23
You really need to ask a sports medicine doc. It's what they do.

robertblake60
02-01-2013, 15:33
You really need to ask a sports medicine doc. It's what they do.

I've been to one now (and I called my Primary Care Dr)...and they both had different opinions on what to do...much like this thread.

treesloth
02-01-2013, 15:38
I've been to one now (and I called my Primary Care Dr)...and they both had different opinions on what to do...much like this thread.

Federal Bill is ultimately right though. I'd rather get differing opinions from doctors than hikers when it comes to an injury.

robertblake60
02-01-2013, 15:43
Federal Bill is ultimately right though. I'd rather get differing opinions from doctors than hikers when it comes to an injury.

They've said much of what was on this thread (except the no-ice thing, both agreed on using ice, as well as rest).

Sports Doc said to ice for up to 48 hours, no compression, and elevation, and to get started on exercises as soon as possible (like right now). Suggested 'contrast baths' like I mentioned, going from ice bath to warm water bath repeatedly.

PC Doc said to ice for up to 48 hours, use comporession, and elevation. He didn't offer an opinion on exercises.


Really, I think opinions of hikers who know what to expect is valuable...I'm not going to follow anyone's advice exclusively (or without googling the suggestions). Just wanted some more opinions.

fins1838
02-01-2013, 15:50
2 words-DEER ANTLERS. "Ray Lewis" 52

Feral Bill
02-01-2013, 15:52
How about this: Lighten your load as much as you are comfortable with, use poles, and do not overdo it, especially at first. Also, these things can take a whole lot more time than we want, so try to be patient:rolleyes:.

BuckeyeBill
02-01-2013, 16:13
If you haven't already got them I would start the trail with a midheight boot for extra support. When they wear out you should be healed to the point of using trail runners. JMHO.

MuddyWaters
02-01-2013, 18:45
Your probably good.

But xrays dont show soft-tissue damage, and they dont always show hairline fractures until they have started to heal.

I have multiple experiences with xrays not showing fractures, that MRIs showed clearly.

doheir
02-03-2013, 14:04
Grade 2 sprain means that you have torn two of the three ligaments on the lateral side of the ankle. Ligaments heal slowly, and they are vulnerable to further damage with inversion (rolling your foot over again). Give it time to heal, wear a brace that protects against inversion, and you'll end up with relatively healthy ligaments. If you decide to tough it out, stretch your ligaments repeatedly during their healing phase, then you can end up with chronic ankle instability. We're all used to watching professional athletes sustain sprains and head out again shortly, since they're all taped up & often given an anesthetic that masks the pain (and further damage).

I don't think applying heat or cold make much difference after the initial swelling, but a brace (Aircast or something similar) is the most important step.

ChinMusic
02-03-2013, 15:15
Judy at LightHeart just sprained hers and swears by the acupuncture treatment she received.

The Old Boot
02-03-2013, 16:58
Grade 2 sprain means that you have torn two of the three ligaments on the lateral side of the ankle. Ligaments heal slowly, and they are vulnerable to further damage with inversion (rolling your foot over again). Give it time to heal, wear a brace that protects against inversion, and you'll end up with relatively healthy ligaments. If you decide to tough it out, stretch your ligaments repeatedly during their healing phase, then you can end up with chronic ankle instability. We're all used to watching professional athletes sustain sprains and head out again shortly, since they're all taped up & often given an anesthetic that masks the pain (and further damage).

I don't think applying heat or cold make much difference after the initial swelling, but a brace (Aircast or something similar) is the most important step.

THIS!!

As one who has 'chronic ankle instability' in both ankles from multiple sprains over 5 decades, I strongly suggest that instead of the support you've chosen, you take a serious look at Active Ankles T2 brace - it's much heavier but I can guarantee (from 5 years of hiking in them) that there is no way you will invert the ankle.

5 weeks is NOT enough time for a sprain to heal completely. Going out on rough terrain with a light brace is inviting repeated strains and sprains.

Unfortunately I didn't have access to physiotherapists and sports med drs. until the last few year who might have saved my ankles. I now wear the braces any time I step outside my apartment door. it's a PITA but it means I don't fall down and lose time from work and they allow me to hike.

A pair of hiking poles will help save you from twisting your ankle as well AND take a lot of strain off your knees and back.

Train Wreck
02-03-2013, 17:11
THIS!!

As one who has 'chronic ankle instability' in both ankles from multiple sprains over 5 decades, I strongly suggest that instead of the support you've chosen, you take a serious look at Active Ankles T2 brace - it's much heavier but I can guarantee (from 5 years of hiking in them) that there is no way you will invert the ankle.

5 weeks is NOT enough time for a sprain to heal completely. Going out on rough terrain with a light brace is inviting repeated strains and sprains.

Unfortunately I didn't have access to physiotherapists and sports med drs. until the last few year who might have saved my ankles. I now wear the braces any time I step outside my apartment door. it's a PITA but it means I don't fall down and lose time from work and they allow me to hike.

A pair of hiking poles will help save you from twisting your ankle as well AND take a lot of strain off your knees and back.

I haven't seen that one before. Does the brace ever cause sore spots or blisters when you hike with it? Do you wear a high top, mid top, or low top shoe while hiking with the brace?

Pedaling Fool
02-03-2013, 17:31
I had a really bad sprained ankle from a prep hike back in 1999, that I did about a week before my Rockfish Gap to Harpers Ferry hike. My ankle felt alright, a little pain, but not much, once I started the 160-mile hike I rolled it again on a rock and realized it wasn't alright. Longstory short, I kept hiking through the sprained ankle, no "RICE" treatments or anything. It probably took at least a year after my hike for my ankle to feel normal again. Down side: long time to sustain an injury. Up side: I don't think I can sprain my ankle ever again. And the lesson my body learned from that experience seems to have been applied to my other ankle.

In summary, sprained ankles ain't no big deal. Our bodies evolved to heal itself from typical injuries; cavemen didn't have the luxury to rest. You keep moving or you die.

jeffmeh
02-03-2013, 18:06
I have rolled mine many times, and more than a few times where I had many miles to go over very rugged terrain to get myself out. I do use ice (plunge the ankle into a cooler full of water and ice, grimace through the intense pain until it gets numb, 15 minute timer and out). I will repeat that a few times in the first 24 hours. But I will not stay off it, and will continue walking and moving. Works for me.

Incidentally, I have been rolling it less since switching from boots to low-cut trail shoes. The ligaments are also loose enough at this point that it takes more of a roll to cause a sprain. That's both a blessing and a curse.

Joker4ink
02-03-2013, 20:23
I have had two really bad ankle injuries, both on separate ankles. Each time, there was the dreaded "pop" and I injured the ligaments. I went to physical therapy where they did this ultrasound thing and some electrode stimulation to the ankle, foot, and lower calf/shin.

Outside of spending money on weekly visits to the physical therapists, here's what they had me do to rehab on my own.

Air-cast: This helped tremendously! It didn't allow my ankle to roll out like it did before. It really gave me the stability I needed.
Rest: Limit the weight on your ankle and rest it when you can. This will help reduce swelling.
Exercise: Stretch your ankle
Exercise: Using physical therapy rubber tubbing (or those elastic workout things with handles), use it to do exercises with resistance on the top, bottom, inside, and outside of foot/ankle.
Exercise: Balance on one foot to help strengthen your ankle
Exercise: Make the "ABC's" with your ankle
Exercise: Ride a stationary bike

The Old Boot
02-04-2013, 12:13
I haven't seen that one before. Does the brace ever cause sore spots or blisters when you hike with it? Do you wear a high top, mid top, or low top shoe while hiking with the brace?

I get heat rash from mine when hiking in warmer weather - it's pretty ugly looking but it doesn't hurt. I found that synthetic socks make it worse because they don't soak up the sweat, you might want to use a wool/synthetic blend. I use low top (sneaker height) but have used a high top boot with them. Just make sure that the gusset/tongue will open sufficiently to allow you to get both your foot and the brace into the shoe easily so you're not fighting with them.

I've never gotten blisters or sore spots but then I don't do 20 mile days either. All of my hiking right now is day hiking...sigh! I know within a few feet of walking if I've got one of them pinching or mis-aligned on my feet. They have enough adjustment points on them that I can always get them comfortable on my feet.

HeartFire
02-04-2013, 17:27
Well, since ChinMusic already brought me up - my ankle is now "50 Shades of Purple" LOL. I've had 3 acupuncture treatments, and can walk (almost) without a limp now - one week out. I've done this before - last time was also in January, right before I was going to hike the AT in April of that year. weeks and weeks of PT that year, and yes, the Air Cast A 60 is a great brace, and I will be wearing one when I hike the CT this year. - it has a lot of velcro on it and chews up the top of the shoe, but it's a great splint.

2NewKnees
02-04-2013, 22:01
Hmm...the Ice was part of the treatment plan that the hospital gave me (and generally accepted as part of the RICE method, at least for the first 48 hours). But what's done is done. What I've been reading is about something called a 'contrast bath' where you alternate Ice bath to warm water every 2-4 minutes for up to a half hour....says it generate blood flow.

And yeah, I'll be adding an ankle brace to my gear list.

I've already got one of these
http://lordshopping.com/Active-Ankle-AS1-White-Lace-Up-Volleyball-Basketba.asp

Think it will work?

I recommend the Mueller ankle brace for all my football players. It is great. Lace up style and gives tremendous support. As far as rehab, I suggest icing your ankle in a 5 gallon bucket of ice water. Put something like a ankle sock on before submerging the whole foot into the bucket. Keep it in for 20 minutes per hour for as many hours a day as you can take. I don't believe in heat therapy. It keeps the swelling in. ASAP start flexing the toes toward your knees, dorsiflexion. And I like using a band for strengthening exercises over the next several weeks. Start walking as soon as it feels good. Good luck and don't let this ankle issue slow you down.

nitewalker
02-05-2013, 06:36
5 weeks to get over a sprain seems a long time unless your a sissy. i balloned my ankle multiple times playing hoops and it never took that long to recover. i suppose if you did what byron mullens did to his ankle it would take 5 weeks..he tore all the connective tissue around the ankle and it has taken him 6 weeks to get back into an nba basketball game. im sure you didnt do what he did. i say once you can walk on it then walk.. tuffin up, lol.....;)

nitewalker
02-05-2013, 06:40
http://boblake.name/sprained-ankle-my-first-at-challenge/

So long story short, I sprained my ankle on Wednesday (grade 2, no breaks or obvious tears based on the x-rays). My plans have me starting the AT on 3/9.

I work from home, so I've been able to devote the last 40 hours to icing my ankle every 3 hours for 20-25min. And the leg is elevated all other hours of the day. I haven't left my house at all and have done very very little walking on it (maybe 5 minutes total).

I know the first 48 hours are the most critical, so I've tried to be diligent with healing. My question is now for the next 5 weeks before my hike; what is the best way to get this thing healed. Obviously sports, running, etc are out of the question.

I guess my questions are:

1) Should I still ice the ankle every 3 hours? If not, how often?
2) Should I take out the heat pad?
3) I will gradually begin the mobility and strengthening exercises as pain allows.
4) I'll keep the leg elevated as much as possible to keep swelling down.

Anything else?

once you can walk comfortably then u must use it cautiously to rehab it. if you do nothing on it then it will actually take longer to get comfortable movement back.

by the way how is your ankle? i hope it feels better..

fiddlehead
02-05-2013, 08:13
Arnica.
I just sprained my wrist 2 weeks ago.
Did ice the first day.
Then arnica.
Played tennis today.
Slightly sore on the overhead shots but felt great for the rest.
I'm with nightwalker on this one: Go hike.

robertblake60
02-05-2013, 17:24
Thanks everyone for the responses. It's been 5 days now, and for the most part I think it's healing pretty damn well. I went the route of icing the ankle in a 5 gallon bucket every 3 hours for 20 minutes and I stayed off of it completely (I even woke up in the middle of the night to ice my ankle). I was pretty much bed-ridden for the first 48 hours with my foot elevated. I have been doing the alphabet thing as well as just normal ankle flexing to increase range of motion. My ankle is still pretty swollen, so I've been icing it occasionally and once a day I've been doing a heated epsom salt bath. The bruising started setting in on Saturday (day 3) and now my foot is mostly black/blue with a little brownish-yellow on top. I also started doing heel raises today. That's pretty painful but it's getting stronger. I've been doing a lot of balancing on one foot too (every chance I get).

I've sprained this ankle once before, and didn't do anywhere near as much 'care' then as I am now and it took a lot longer to heal from what I remember. So, I think it's going pretty well.

I'm not convinced I need a huge, elaborate brace for the hike. I'll start out with something, but I'm not convinced my ankle problems are from them being weak. Both times I sprained this ankle was from landing on someones foot after jumping for a volleyball. I'm not clumsy and in all the running and volleyball playing I've done, the only issues I've ever had were from collisions. I have an aircast, maybe I'll bring it...we'll see how things go over the next 5 weeks.

kidchill
02-05-2013, 18:05
Listen, I work in healthcare, but I don't do ortho, so I'm just gonna tell you my thoughts on the matter. I wouldn't go crazy with any kind of treatment. RICE is fine for the first 48, as well as NSAIDS (ibuprofen, aleve, wtvr works best for you). If it feels tight, stretch it. Once you're past the initial insult (which it sounds like you are), slowly increase activity. I think you have plenty of time to be fine. I sprained the **** outta my ankle in the 100mile wilderness and just kept going. I practically used my poles as crutches, cut back on my speed and mileage, and moved slowly. No, it wasn't smart to keep going, but I really had no choice. I would rest my ankle in the cold streams for 5-10minutes here and there, elevate in my hammock when I slept at night, and then took 2 days off when I hit Monson. My ankle was huge, red, and all kinds of pissed off, but I survived and still have my ankle. Let pain be your guide, but don't be afraid to use the NSAIDs to reduce the inflammation.

juma
02-16-2013, 15:50
Thanks everyone for the responses. It's been 5 days now, and for the most part I think it's healing pretty damn well. I went the route of icing the ankle in a 5 gallon bucket every 3 hours for 20 minutes and I stayed off of it completely (I even woke up in the middle of the night to ice my ankle). I was pretty much bed-ridden for the first 48 hours with my foot elevated. I have been doing the alphabet thing as well as just normal ankle flexing to increase range of motion. My ankle is still pretty swollen, so I've been icing it occasionally and once a day I've been doing a heated epsom salt bath. The bruising started setting in on Saturday (day 3) and now my foot is mostly black/blue with a little brownish-yellow on top. I also started doing heel raises today. That's pretty painful but it's getting stronger. I've been doing a lot of balancing on one foot too (every chance I get).

I've sprained this ankle once before, and didn't do anywhere near as much 'care' then as I am now and it took a lot longer to heal from what I remember. So, I think it's going pretty well.

I'm not convinced I need a huge, elaborate brace for the hike. I'll start out with something, but I'm not convinced my ankle problems are from them being weak. Both times I sprained this ankle was from landing on someones foot after jumping for a volleyball. I'm not clumsy and in all the running and volleyball playing I've done, the only issues I've ever had were from collisions. I have an aircast, maybe I'll bring it...we'll see how things go over the next 5 weeks.

you'll be sorreeee! naw, just kidding. you're about to walk over a lot of uneven ground, occasionally making short jumps, with 20-25 pounds on your back. I don't think you'll get through 3 days before it rolls again late in the day-wear brace at the start. The medical doctrine I adhere to is from the medical specialty of Rehabilitation and Physical Medicine - Physiatrists. There are a number of specialties out there and I think these guys have the knowhow for sprains. If it doesn't bounce back, consider the treatment of prolotherapy which is available from the physiatrists. YMMV.

Kerosene
02-18-2013, 12:45
I suggest that you avoid the brace unless the ankle is still very weak, in which case you probably shouldn't be on a long-distance hike. Note that wearing a brace all the time will not let the ankle get appreciably stronger.

Sounds as if you're doing the right exercises. Slow down if you experience a lot of additional swelling, and consider elevating the ankle while you're sitting as well as anti-inflammatories.

betzt
02-18-2013, 21:14
I am a nurse (doesn't mean I am an expert). I've sprained and broken my ankle and honestly it took longer for the sprain to heel. I think the best therapy is don't do anything that hurts. Pain is natures way of saying STOP.

Pedaling Fool
02-19-2013, 11:16
I am a nurse (doesn't mean I am an expert). I've sprained and broken my ankle and honestly it took longer for the sprain to heel. I think the best therapy is don't do anything that hurts. Pain is natures way of saying STOP.
Yeah, the question is, why does connective tissue take so long to heal?

robertblake60
02-19-2013, 15:18
So it's been almost 3 weeks, the swelling is almost gone. I'm walking just about normal. I have almost all my balance back (can stand on one foot for at least 3 minutes, then I stop). I have some soreness in my heel where the achillies attaches to the foot, but that's getting better every day. I've got 3 weeks left, I think I'll be pretty close to 100%.

Whew.