Sprained Ankle - Need Advice on Rehabilitation

[robertblake60]

http://boblake.name/sprained-ankle-m...-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]

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]

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...l-Basketba.asp

Think it will work?

[Maui Rhino]

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]

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 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 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]

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_...rehabilitation

[Feral Bill]

You really need to ask a sports medicine doc. It's what they do.

[robertblake60]

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]

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]

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]

2 words-DEER ANTLERS. "Ray Lewis" 52

[Feral Bill]

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.

[BuckeyeBill]

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]

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]

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]

Judy at LightHeart just sprained hers and swears by the acupuncture treatment she received.

[The Old Boot]

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]

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]

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]

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.