Just gone over on your ankle? Twisted ankles, often known as an ankle sprain, are painful, tend to swell a lot and as a result can take a very long time to heal. Even then, they tend to give issues for years to come. When you go over on your ankle, the muscles can tear and the ligaments often get stretched, causing an ankle sprain. Once an ankle sprain has occurred once, it tends to be a weak point, leaving it vulnerable to further ankle sprains as time goes on.
Slow though ankles can be when healing, there are plenty of things you can do to support the healing process and most importantly to ensure the ankle doesn’t become that weak area, causing you to go over on it time and time again.
1 – Ice is best on an Ankle sprain.
Firstly, and most importantly, get that ice pack out! 
Ankles are notorious for slow healing, so anything you can do to help that is important. When icing, add a bag of peas (or something similar) and leave it on for only 10 minutes. Try to repeat every hour. The point of the ice isn’t to stop inflammation, it is to limit the inflammation.
When we damage a joint, the body creates inflammation for two reasons. Firstly to immobilise the joint, it is very hard to move a swollen joint. Secondly it dilates the blood vessels so that blood can get into the area quickly. The increased blood flow transports nutrients into the damaged area to begin the healing process, clearing the damage rebuilding the tissues. This process is very important and we don’t want to stop it. The excessive use of anti inflammatories can often affect this and actually slow the healing process.
So we are trying to control the inflammation rather than stop it completely. Icing for just 10 minutes every hour allows the body to cool the area, limiting the inflammation but not stopping it. Ideally this inflammatory process will go on for around 2 days and during that time you need to rest the area and apply ice every hour. Interestingly using ice for a prolonged amount of time often has the opposite effect, the body gets too cold so sends more blood into the area to warm it up, and so the healing process takes longer. So only ice for 10 minutes every hour.
We have seen clients who haven’t used ice correctly and still have an ankle sprain presenting, as effectively an acute injury, weeks after the event took place. So be careful to ice smartly. 👍
2 – Keep the ankle moving!
Movement is actually very important, even with an acute injury like an Ankle Sprain. We are assuming here that you are happy you haven’t broken anything. If you suspect a broken ankle please go straight to A&E and ask for an X-Ray. Usually a broken ankle will be very swollen, often with heavy bruising and an inability to put weight on it or move it. If that is you, stop reading and head for an X-Ray!
However, if you are happy it isn’t broken it is important to keep it moving. However, the movements you use should be PAIN FREE. So, if you have any pain free movement, use it. Move your ankle up and down and from side to side. This will help the scar tissue to align into the correct orientation and stop you having a long term weak ankle. If it is painful to move DON’T force it, only use the pain free part of any movement you have.
When we damage any soft tissue structures, such as in an ankle sprain, the body will quickly put down connective tissue to help to fix the damage. This is laid down in a very haphazard way, and looks a bit like a spiders web. Initially the scar tissue is very fragile and can be easily re-damaged, but as time goes by it becomes thicker and stronger.
If we immobilise the sprained ankle, so it doesn’t move, the scar tissue will stay in the same orientation it was initially laid down in, e.g the spider’s web. But if we use movement, we can realign this fragile scar tissue along the correct line of force for the movement. Meaning, when it thickens and hardens, it runs along it’s natural force lines and is less liable to damage in the future.
So active movements are important. However, the initial scar tissue is very weak and if you force the movement, it will get damaged again, so only use PAIN FREE movement. Pain = Damage! 😀 👍 You can use any pain free movement from day one of healing.
3 – Strengthen the Ankle Strain.
Once you have full movement, that is completely pain free, it is time to strengthen. 
Strengthening is important, because although your new scar tissue is now in the correct orientation, due to your active movements, it is still weak. Without strength work you will remain with a weak ankle, which is liable to more ankle sprains.
Balancing on one foot is a great place to start, this helps especially for ankle sprains as it targets the ligaments. Literally balancing on one foot for several minutes 3 times a day will start to strengthen all the stabilising structures that were damaged during your ankle sprain injury.
If you have some exercise bands, they can work well for the muscles that create movement of the ankle, rather than ankle stability. Give some resistance to those active movements you have been doing in stage 2. Use the band and push it, pull it and get the ankle having to work against resistance. 3 sets of 10 reps is a great way to build up the strength, working from initially a light band, such as a yellow band, and working through the different resistance levels to green or blue.
Once you can balance and the band work has given the wider muscles more strength, it is time to add some additional resistance in the form of hopping. This uses both the muscle strength and the stabilising strength and if you are a runner, don’t miss this area of strengthening. Hop forwards and STOP, balance and stabilise before hopping again. Do the same in a backwards direction, hop backwards and STOP. Repeat for lots of different angles not just forwards and backwards until you can hop and stabilise easily in all directions.
Most ankle sprains, following this regime, will be significantly better within 2 weeks. If yours isn’t, or you still have weakness, pain, bruising or swelling Book on in for an assessment. Ankle sprains can create issues for years, so the sooner we can start working on it, the sooner it will get fixed. 
For more information on Ankle Sprains, take a look at this NHS website.
