After a Sprain, Rest and Treat Before You Walk On It!

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After a Sprain, Rest and Treat Before You Walk On It!

An estimated 28,000 ankle injuries occur daily in the United States, most of them through sporting activities, including jogging on uneven surfaces. But while no one suggests remaining sedentary to protect your ankles, experts wisely warn against purposely putting them at risk by wearing hazardous shoes or getting back in the game before an injured ankle has healed.

The latest information about ankle sprains, released in a position statement last month by the National Athletic Trainers’ Association, clearly shows that ankle injuries should never be taken lightly and are too often mistreated or not treated at all.

The result is an ankle prone to prolonged discomfort, reinjury, chronic disability and early arthritis.

Ankle injuries are the most common mishap among sports participants, accounting for nearly half of all athletic injuries. According to the report by the trainers’ association, the highest incidence occurs in field hockey, followed by volleyball, football, basketball, cheerleading, ice hockey, lacrosse, soccer, rugby, track and field, gymnastics and softball.

Other reasons for ankle injury among athletes include landing awkwardly from jumps, stepping on another athlete’s foot, trauma to the ankle when the heel lands during running, and stressing the foot when it is in a fixed position.

Perhaps the most interesting finding in the new report is the fact that the most widely accepted treatment for an ankle sprain — rest, ice, compression and elevation, popularly called RICE — has yet to be shown to be effective in controlled clinical trials.

I want to suggest that this time-honored remedy NOT be abandoned.  There is nothing wrong with it, it just has not been shown through testing to be effective.

What should be abandoned is the temptation to try to walk off the searing pain of a twisted ankle. In fact, in years past, that’s often what athletes were advised to do. But trying to walk on an injured ankle is precisely the wrong approach, the athletic trainers now say.

Also wrong, I was surprised to learn, is to immediately reach for a nonsteroidal anti-inflammatory drug (NSAID) like ibuprofen or naproxen to relieve pain and prevent swelling. Rather, it’s best to start with acetaminophen to control the pain.

It’s best to wait 48 hours before taking an NSAID because you want the normal inflammatory process to kick in and begin the healing process. Then you take the NSAID to keep the swelling from getting worse.  Don’t take an NSAID on an empty stomach and don’t exceed the dosing directions.

For both people who are physically active and those who are sedentary, the only consistent risk factor for an ankle injury suffering a prior sprain. This fact alone underscores the importance of giving ankle injuries the respect and treatment they deserve.

Have the injury properly diagnosed to determine its extent and, in turn, dictate the proper therapy. This doesn’t necessarily mean you must race off to the emergency room and get an X-ray for every twisted ankle. But coaches, trainers (both athletic and personal), and doctors should know how to do a proper exam, checking for deformity, swelling, discoloration, point tenderness, and the ankle’s range of motion — the foot’s ability to move all its normal positions.

Although X-rays are typically ordered for 80 percent to 95 percent of patients who go to the emergency room with a foot or ankle injury, an X-ray is not warranted unless there is an obvious deformity, bone tenderness, or an inability to bear weight or walk four steps immediately after the injury.

Nor is an M.R.I. especially helpful; both imaging tests mainly add many dollars to the cost of diagnosing and treating an ankle injury.

Immediately after injuring an ankle, begin RICE That means get off the injured foot; prop it up, if possible, higher than the heart; wrap it in a compression bandage; and apply cold. There are various ways to ice an injured ankle: ice packs, immersion in ice water, application of frozen cups of ice or frozen bags of peas, chemical cold packs, and cold sprays.

Apply cold for 10 to 20 minutes at a time, then remove it for 10 minutes and reapply. When using an ice pack or a chemical cold pack, cover the skin first with a wet cloth to avoid tissue damage. Icing can also be used to reduce discomfort before doing exercises prescribed to strengthen an injured ankle.

No longer are prolonged periods of rest recommended. The emphasis now is on “functional rehabilitation — getting patients moving as soon as possible, doing walking exercises, and enhancing joint mobility.  Remember what we say at Chiropractic Lane – “Motion is Health”

Most important of all, and often the most neglected, is balance training, which starts with standing on one foot (the injured one) on a firm, even surface, then on a foam surface or trampoline, first with eyes open, then eyes closed.

Also helpful is strengthening the structures that support ankle stability and flexibility. Older folks take note: ankle problems are a common risk factor for falls among the elderly, and the stronger the muscles in the lower leg, the more support they provide for the ankles.

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