The Ankle Sprain….To Rehab or Not?
Oh the dreaded ankle sprain. We’ve all been there. Whether we stepped awkwardly, stepped in a hole, had our foot stepped on, it hurts! The ankle swells, maybe turns black and blue and it hurts to walk. How has society taught us to deal with ankle sprains? Suck it up! OR, if you see a doctor, they may put you in a walking boot for 4 weeks! What!?! Why? Two extremes of treatment here. What other sprain in our body is treated with such disrespect?
The walking boot for an ankle sprain really baffles me. I get it if you can not walk comfortably and the pain is too much. But for the normal healthy person, grab a pair of crutches instead. If a fracture is in question, get diagnostic imaging done. But, in our opinion, these walking boots for ankle sprains is probably the worst thing you can do for your injury (you’ll find literature that contradicts this). One, it keeps your foot at an awkward dorsiflexed angle for prolonged periods of time, two it does not allow for much movement so blood flow is poor to the injured area, three it completely messes with your gait pattern and can create other biomechanical issues up the chain. And to top it off, the doctor will usually prescribe the boot and then instruct them to get out of the boot after their follow up appointment and say ‘you can return to all of your sport activities’. It’s magic! The boot is magic! Ugh, again, why? Do you think that ankle is ready to accept the full loads and agility demands of sports? Probably not, hence why so many athletes wear an ankle brace after that first sprain and then hold onto it for life. Even worse, the ankle sprain creates havoc to the rest of the body over the course of years, showing up as overuse injuries, leg length discrepancy issues/pelvic obliquities, SI joint pain, lower back pain, etc. But come on…..it was just an ankle sprain!
So what CAN be done for an ankle sprain? Respect the pain, manage the swelling, keep the ankle mobile, modify activities until pain subsides and stability returns. Go see your physical therapist! We did a little counting on the patients we have seen for ankle sprains in the past 2 years (all sprains and all grades). Most of our patients came to us in a walking boot or crutches with a severely effused ankle. Our average treatment time to return our patients back to their sport without any deficits is 9 visits in 4 weeks time. Our quickest was 5 visits in 2 weeks and longest time to heal was 12 visits in 8 weeks (high ankle sprain).
What type of treatments do we utilize? It depends on each individual patient but typically we use a smattering of dry needling, cold and compression, taping for edema, taping for stability, instrument assisted soft tissue mobilization, joint mobilizations, proprioceptive exercises and gait training. The key to our success is our patients’ ability to get to us quickly after the initial injury, frequent treatments and patient’s willingness to do their homework. Many of our athletes can continue to play while rehabbing with an ankle taping or a properly fit ASO brace.
So what is the takeaway message here? Don’t brush off your ankle sprain. See your physical therapist and get the treatment you need to help your body heal properly.
(**this blog post is based off of the therapists’ experience with this patient population, written with a bit of sarcasm :) keep it friendly out there, we are all just trying to do our best!)