Hey Team!

 

This summer has gone by quickly! School is back in session, which means so are sports. Today, we will review chronic ankle pain and its effects on your function.

 

I loved playing baseball, and naturally, I loved hitting the ball. I remember my first ankle sprain vividly. I was fortunate enough to hit a ball into the right-center gap in one of my games, and as I rounded first base, I sprinted to second. Before I could reach second base, my foot landed in a small hole, and I immediately fell to the ground as my ankle rolled. Intense burning, aching, and pain ensued.

 

THE RECURRING ISSUE

 

My goal is not to discuss old high school injuries (glory days!) but what occurred after this injury. I wanted to continue playing and attempted to perform most of my baseball practices and games with my ankle wrapped in athletic tape. I did not realize the repeated injury that would occur with daily activities. Getting out of the car, walking on gravel, and mild slipping on the ice are all activities that would exacerbate my ankle injury. Soon, a week turned into a month and a month turned into six months of ankle pain. This pain was not constant; however, I would repeatedly re-injure it with daily activities. I also found that my ankle mobility became very restricted. I had more difficulty squatting (I was a catcher), which made practices and games more challenging.

 

This illustration emphasizes recovery from an ankle injury can be challenging, chronic, and frustrating with your attempt to return to activity.

 

FIVE WAYS TO HELP WITH CHRONIC ANKLE SPRAINS

 

The best way to assist a chronic ankle sprain is to prevent one in the first place. Here we review strategies you can initially use to improve an ankle sprain and ways to recover when the ankle sprain becomes recurring.

 

1. Ice Initially: Don't Heat (EVER!): Ice helps minimize blood to the area and reduce excessive swelling. You will need to ice until the ankle is numb (about 15 minutes). Continue to ice every two hours to allow the ankle to regain warmth.

 

2. Begin Range of Motion Early: Begin early mobility to the ankle without creating pain. The ankle will want to tighten during healing; therefore, you must continue maintaining motion during the healing phase. An easy example of early movement is to perform the alphabet with your foot in a sitting position. This exercise allows you to experience which motion is restricted and which is painful. Attempt to gradually work with your discomfort but don't push through your pain.

 

3. Begin Gradual Weight Bearing: Too much walking will create more pain and swelling, but no weight bearing will delay healing. You need to find the Goldilocks approach to healing (just right!). Use an assistive device to allow a regular gait pattern and unweight the leg. You can perform with partial or no weight-bearing (as pain warrants), but you can use a typical walking pattern while unweighting the injured ankle.

 

4. Ankle Activation: With an ankle sprain, the muscles to the outside of the ankle become injured. These muscles help right the foot position when the ankle begins to roll. Most of the time, these muscles cannot overcome the force exerted on the ankle; therefore, they become stretched and sore. Once initial swelling and pain decrease, you can slowly introduce light ankle exercises. These exercises consist of calf raises or a stretch band around the ankle to strengthen the muscles on the outside of the foot.

 

5. Balance Training: Balance training is required to heal a chronic ankle sprain successfully. Our joints and surrounding tendons have receptors called proprioceptors. These receptors become impacted when an injury occurs, and their feedback on the joint position is less efficient—a chance of re-injury increases due to this involvement. Joint position and our awareness of our ankle position create a delay; therefore, we don't step where we should. An example of balance training to the ankle is standing on one leg in a safe environment with eyes open and then again with our eyes closed.

 

THE SUCCESS IS IN THE TRANSITION

 

Recurrent ankle sprains can be frustrating. When you feel your ankles turn the corner and you're doing very well, a slight movement, or slip, will re-aggravate an old injury. A successful transition of these phases determines the success in improving your ankle function with a chronic ankle sprain. Improving range of motion slowly after the initial injury, beginning light strengthening exercises in a pain-free fashion, and beginning balance exercises cautiously will determine the long-term success with your ankle sprain. Moving too fast between these phases will increase your propensity for re-injury. Continuing to protect the joint through ankle wraps, ankle taping, or ankle bracing is essential during these phases. As explained above, re-injuring the ankle is easy to do, and it only delays healing.

 

OK team, feel free to reach out by email, phone, or text message if you have further questions on recovering from a chronic ankle sprain. I enjoy helping. Keep Moving!

 

 

•           The author, Rob Sumner, is a Doctor of Physical Therapy and owner of Sumner Specialized Physical Therapy. He's happy to answer any questions about this article, wellness, fitness, or physical therapy overall by phone at (509) 684-5621 or by email at Rob@SumnerPT.com