Sprain > Treatments
and Physical Therapy
Physicians generally recommend that you avoid
sports and everyday physical activities until your sprained
ankle has healed. Crutches are usually prescribed for
the one to three weeks after a moderate or severe sprain.
Household tasks that require you to be on your feet
may be difficult for a few weeks after a moderate to
severe ankle sprain. It can be helpful to arrange for
someone to visit you to help with any physical chores.
In general, you should continue R.I.C.E. treatment as
instructed by your doctor until symptoms go away. After
72 hours, your physician may prescribe heat therapy.
Only apply heat if the sprain has healed, which may
take up to three months. Heat draws blood to the skin
around the ankle, which may increase swelling and internal
bleeding if used too soon after a sprain. Many heating
treatments are available and physicians generally suggest
a specific heat therapy at their discretion. Heating
options include heat lamps, hot showers, heating pads,
heat ointments, and whirlpool or bath treatments. Massage
also may be used to soothe muscle pain. However, massaging
an injured ankle can disrupt the healing process and
damage injured ligaments right after an injury. Your
physician will decide when it is safe to begin ankle
massage. Proper nutrition may also help heal an ankle
sprain. Your physician may suggest taking vitamin supplements
that contain vitamin C, vitamin A, vitamin E, and selenium.
However, research has not yet proven how important nutrition
is for healing nor which vitamins, minerals, or supplements
are the most effective. Your physician will either suggest
physical therapy that can be done at home or refer you
to a physical therapist within a week after the sprain
to help you restore range of motion in your ankle.
Physical therapy usually is
prescribed to help ligaments heal after most moderate
and severe ankle sprains. As soon as possible after
the sprain, your physician may refer you to a physical
therapist to begin early motion, which helps circulate
fluid out of the ankle. Early motion consists of simple
up and down flexion and extension, and progresses to
small circles or drawing the alphabet on the floor with
your toes. Therapists also may use electrical stimulation
to control swelling. Knowing when to start more vigorous
rehabilitation exercises is difficult and should be
decided by your physician. Physicians generally recommend
that you avoid bearing weight and walking in pain after
an ankle sprain. Patients tend to heal better in the
long-term if they start rehab slowly, instead of rushing
to begin painful exercises on an ankle that has not
yet healed. When swelling and pain have gone away and
you feel comfortable without supportive wrapping, you
usually start an exercise program to strengthen all
the muscles around your ankle. Elastic bands are often
used to provide resistance as you move your ankle in
different directions. The amount of resistance increases
over time as you regain strength in the muscles around
the ankle. You may help your ankle feel better by icing
it for 10 minutes both before and after rehab exercises.
It is particularly important to strengthen the peroneal
muscles, located on the outside of your lower leg around
your small lower leg bone (fibula). The peroneals help
keep your ankle from turning inward. Arthritis may result
from repeated ankle sprains, which can hinder your ability
to return to your previous activity level. People with
arthritis or who suffer repeated ankle sprains may need
to spend extra time in rehab and perform a more elaborate
training program. The final steps of rehab help increase
coordination, and may include balance beam exercises
and running in a figure-eight pattern. When the injured
ankle is about 90 to 100 percent as strong as the uninjured
ankle, you may be ready to begin returning to activities.
Most patients can rehabilitate their ankles with less
than three months of physical therapy and return to
activities at full strength.
To prevent the recurrence of ankle sprains, you should
make the stretching and strengthening you learned in
physical therapy part of your regular exercise routine.
A strong and flexible ankle may be better able to withstand
any abnormal positions and strain that occur during
sports and recreational activities. Before activities,
remember to warm up your ankle muscles by stretching
in all directions. Tight ankle muscles and ligaments
may be more apt to pull or tear. Replace athletic shoes
when the padding or the tread wears out. Avoid participating
in activities in old, worn-out shoes because they do
not provide good padding or side-to-side support.
In general, you should try to provide extra support
to your ankle for at least 12 months after a severe
sprain, possibly longer. Taping is a good preventive
measure if it is done immediately before participating
in the sport and if the person doing the taping is trained
in proper techniques. Ankles are usually taped all the
way from the midfoot to the lower calf. Physicians generally
do not advocate the use of braces for people who have
not had ankle injuries. But for people who have had
recurrent injuries and those in the early post-injury
period, braces may be useful to enhance recovery and
prevent further injury. Neoprene sleeves simply provide
compression and other lace-up types of braces provide
more support using metal or plastic strips on the sides
of your ankle.
DEALING WITH PAIN
A small amount of pain is normal during activities,
but if you feel so much pain in your ankle to warrant
taking a painkiller before an activity, you should consider
cutting back or stopping. If you experience significant
pain in your foot or ankle, do not continue to run on
a sore ankle. Pain after rehabilitation could be a sign
that you have excess scar tissue, loose fragments of
bone or cartilage that were not seen on the initial
X-rays, or other minor foot and ankle injuries that
need proper treatment before you can return to activities.
Non-surgical treatment can usually heal ankle sprains.
Physicians typically prescribe a combination of R.I.C.E.
(rest, ice, compression, and elevation), medication,
and physical therapy. Immediately after you suffer an
ankle sprain, you may want to follow the first-aid routine
known as R.I.C.E.:
– Your doctor will likely suggest that you refrain
from sports activities, and lie or sit down for a few
hours at a time every day until your ankle sprain heals.
Just the weight of your body puts pressure on the ankle,
lengthening recovery time.
– initially, your doctor will likely recommend
applying ice packs to the ankle for about 20 minutes
every three or four hours. You will probably need to
do this for two or three days or until the pain subsides,
and you may need to do it after exercise or activities.
One effective way to apply ice is to use a bag of frozen
vegetables, which molds easily to the shape of the injured
area. It won’t leak and it can be re-used. (Warning:
Do not eat the contents after thawing and re-freezing.)
– Doctors often recommend bracing or wrapping
your ankle. There are many different types of bandages,
braces, and splints that your doctor may choose to prescribe.
A wrap is often effective but a removable air cast is
usually the most secure way to stabilize your ankle.
– Raising the ankle to a level higher than the
heart helps reduce swelling. Try to prop your ankle
up on a couple of pillows when lying down or sleeping.
You may be prescribed pain medication as needed, depending
on the severity of your ankle sprain. For minor sprains,
most patients receive adequate pain relief from non-prescription
painkillers like aspirin or ibuprofen. More severe sprains
may require narcotic painkillers or, in rare cases,
an injection of painkiller directly into the ankle.
Your physician will decide when it is appropriate to
visit a physical therapist to begin stretching and strengthening
exercises for the ankle. Most patients begin physical
therapy within a week of an ankle sprain. The time it
takes to heal ankle sprains is highly variable:
sprains typically heal in two to 10 days.
sprains may need ten days to six weeks to heal.
sprains can take between six weeks and four months to
Your physician will probably prescribe a few regular
check-up visits if you have a moderate or severe sprain,
but most of the treatment can be done at home.