Ankle injury!

So the start of January was all about finding my mojo, setting some goals and getting back into some consistent training. I’ve ditched the alcohol and was looking forward to getting back into some form of running. Friday mornings had, in the past been an early morning run with a bit of mud thrown in to set us up for the day ahead. Running off road has always been where my heart lies and especially in the winter I‘ve always felt safer running in the mud or snow than braving the icy pavements. When my alwarm went off on Friday there was a little niggling voice in my head as the temperature had dropped over night and I could see the ice on the cars outside. Ignoring the little voice, I donned my road shoes and set off into the 7am darkness.

We could feel our feet slipping under us as we cautiously set off. About a mile in I’m not sure if I slipped or caught the edge of the pavement but BANG down I went. Now I’m a big girl and there’s quite a lot of me to move about. My ankle had rolled laterally and I felt the pain straight away. I lay on the ground assessing the situation and thinking ’oh crap, no running for me for a bit; have I damaged it badly; have I ripped my running leggings? As the initial shock subsided I managed to get up and weight bare so I knew I hadn’t broken anything. I tentatively set of at a gentle jog then as the adrenaline subsided I knew this wasn’t a good idea so I said cheerio and hobbled home.

I chuckle some ice on it straight away just for 10 mins to help ease the pain, and prayed it wouldn't keep me off my training too long. As a physio it’s always interesting getting injured as it’s a good way to do a bit of anatomy and physiology revision. It puts you in a position that our patients have been in and we should always learn from injuries. So what have I done?

If we first consider the mechanism of injury. As your ankle rolls under you the soft tissue on the outside becomes overstretched and the soft tissue on the inside becomes compressed. There are many ligaments in the ankle and these become overstretched (sprained). Lateral ankle sprains account for 85% of all ankle injuries.

The most commonly injured ligaments is the Anterior Talofibular Ligament (ATFL). There are numerous grading systems for ankle sprains but a nice simple one is:

• Grade I Mild - Little swelling and tenderness with little impact on function

• Grade II Moderate - Moderate swelling, pain and impact on function. Reduced proprioception, ROM and instability

• Grade III Severe - Complete rupture, large swelling, high tenderness loss of function and marked instability

My ankle developed a nice egg sized swelling over the lateral ankle with some paim around the medial side where the ankle bones had squashed together.

With a mild ankle sprain recovery is reasonably quick with most symptoms gone by 14 days. You’ll develop bruising, stiffness and some swelling but weight bearing should be tolerable and with a slight shift in training load you should be able to carry on training in some form. I headed to the gym on day 2 to work on upper body and arms. With more serious ankle injuries there can be a high risk of further injury if rehab is poor. When the soft tissue is damaged there can be a loss of proprioception; the body’s ability to know where it is in space and correct itself. Ligaments play a vital role in this feedback system so damage to them can effect proprioception. If not rehabbed well then the ligaments can become slack, ma the joint less stable and prone to excess movement.

Most of you will be familiar with the RICE protocol (rest, ice, compression, elevation) Current evidence has started to show that using ice can actually slow down the healing process. Our own body is highly effective at healing, and swelling is a fundamental part of this process. Research has shown that optimal loading can assist the recovery process so with these latest findings in mind the guidelines have changed to

POLICE - (Protection, Optimal Loading, Ice, Compression, Elevation). in simplistic terms this mean when you sustain a soft tissue injury you need to protect the area from further injury, start loading the joint/soft tissue within comfortable pain/range of movement limits, use ice to help if the area does feel swollen and sore, strap it if needed for some extra support or if the joint feels unstable and elevate it at the end of the day if swelling is ongoing. Movement and optimal loading is key to providing the soft tissue with new blood and assisting tissue healing so you can adapt your training programme to work around the injury without having to rest. If you are interested in reading more around the question of using ice then have a read here

https://www.physio-network.com/blog/ice-for-acute-injury/

Today is day 3, the swelling is more generic now and the bruising is starting to come out, pain is about 1/10 and my range of movement is only slightly limited at end of ranges. I went spinning this morning and that was fine,no pain at all so I can continue to exercise. Tomorrow I’ll get my wobble cushion out and start some basic single leg work. Other than that I’m walking ok and feeling good. I have berated myself for running on the road when it’s icy, so next week I’m back in the mud and the dark, running where I feel safe and happy. If you have any questions about ankle rehab or need help with ongoing symptoms then please get in touch info@khphysiotherapy.com

stay safe folks