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Acute Management of Lateral Ankle Sprains

Ouch! You rolled your ankle running pick-up basketball this weekend with your friends. Frustrating….we know.

Lateral ankle sprains are injuries that pose a major inconvenience. They limit your ability to walk, move, sleep, and perform your typical self-selected physical activities… plus your friends will be short a player next weekend. Don’t lose hope, we are here to help teach you how to properly manage these injuries and provide advice and strategies for the most effective and efficient rehabilitation.
Lateral Ankle Sprains account for nearly 25% of all musculoskeletal injuries and nearly 10% of all admissions to emergency rooms. However this rush to the emergency room is often unnecessary. The gold standard in the diagnosis of acute lateral ligament injury is the delayed physical examination. Research has shown that, barring the complete inability to bear any weight through the injured ankle, you should be waiting 4-5 days before seeking medical attention. Rushing to the doctor during this acute phase of injury has been shown to result in unreliable diagnosis of the injury. Because of the diffuse location of the pain and swelling, the examiner cannot differentiate the pain or instability you are feeling, leaving you without a true answer or diagnosis.

So what should you do? Remember what your parents always said… ice it! Well how about RICE it.

Well how about RICE it. The combination of Rest, Ice, Compression, and Elevation during that first 4-5 day period has been shown to very effectively reduce pain and swelling. Following this initial period, researchers can tend to disagree. However a majority feel that a brief period of immobilization (5-7 days via air-cast/walking boot) should follow. But don’t baby it! Prolonged use of immobilization (>10 days) can have a detrimental impact on muscles, ligaments and other joint surfaces, resulting in inferior outcomes post-injury. Instead, switch over to a less-rigid support, i.e. compression wraps, lace-up braces, tape.
Finally, at the 7-10 day period, it is now time for a structured, individualized rehabilitation program. Structured physical therapy, from a Certified Doctor of Physical Therapy, focusing on pain relief, swelling reduction, dynamic stability, mechanical analysis/correction of movement, and progressive strengthening of surrounding musculature, has been shown to significantly accelerate the healing process. Not only can therapy help rehabilitate an old injury, it can help prevent a new one. Did you know that the #1 risk factor for a lateral ankle sprain is a previous lateral ankle sprain? With a skilled, trained professional guiding your care, not only will your current injury improve, you will be preparing your body for a safer and more efficient return to activity with an eye towards preventing another injury in the future.
Ankle injuries can be a nuisance. They are painful and difficult to manage. However, utilizing the strategies and guidelines laid out above, you are now equipped with a well rounded approach on how you can help address your injury. By taking the proper steps and seeking the proper care at the appropriate times, you have the tools to turn this potentially chronic issue into an afterthought and before you know it, you will be that mighty weekend warrior once again!

-Dr. Dave Pasi, PT, DPT

Van den Bekerom, M., Kerkhoffs, G., McCollum, G., Calder, J., Niek, C. (2012). Management of acute lateral ankle ligament injury in the athlete. Knee Surgery Sports Traumatology Arthroscopy, 21, 1390-1395