On the 7th of January I fell over and sprained my ankle. I had all the common symptoms; egg shaped swelling on the outside of my ankle, swelling just below the inside of my ankle and bruising both on the inside and the outside. I did all the things I know to do. Rest it, bit of ice initially, protect it and try to maintain range of movement without aggravating. I was doing well, recovery wise and had been continuing to cycle, walk and go to the gym. Things felt good and I walked round the Grindleford gallop route with no real pain, it was just tricky on the descents as my range of movement hadn't quite returned. I noticed I couldn't sit back into my heels and side movements did bring on some discomfort. I did a few park runs and some longer runs and felt really quite good. I did a few track sessions with my running club and a couple of evening social runs. My ankle didn't hurt.......it just didn't feel quite right.
On Thursday the 3rd I ran to my club hill session and smashed out some tough hill repeaters. I then ran the 2.5 miles home. On Friday the 4th I thought it may be worthwhile checking the ongoing swelling out. I was starting to get an ache into my ankle joint and couldn't get into full ankle flexion or extension. At the BUPA clinic I work at we have a great MSK consultant who happens to be highly knowledgeable about ankles. He scanned it using an ultra sound machine and then pulled the rug right out from under me. The swelling wasn't just a bit of swelling round my ATFL ligament. The scan showed 2-3 millimeters of swelling in the joint line at the front of the ankle, a 'disrupted ATFL' with some calcification, changes to the distal syndesmotic joint, fluid around the tibialis posterior tendon and the spring ligament.
He advised no running and an MRI to clarify what was driving the swelling. I sort of knew I had maybe over done it on the training but I was genuinely surprised at the mess I saw on the scan images. As a physio I was keen to understand more about the injury, what I could do to help myself and what my options were. As a runner I wanted to know when I could run again. I wasn't in pain and at that time was feeling really good about the upcoming block of training.
I read up on ankle injuries and was shocked to find that although it is one of the most common MSK injuries up to a third of individuals suffer some sort of disability from, pain, functional instability, mechanical instability or recurrent sprains 1- 5 years after the injury (link). One study even found 74% of individuals had at least 1 residual symptom 1-4 years after the sprain. Recovery can take up to 6 months depending on the severity of the injury (link) Oh dear, this wasn't looking good. I felt angry with myself for not giving myself longer recovery and as a physio it feels like the end of the world because we should be able to fix both our patients and ourselves...…shouldn't we? Its like a double whammy of feeling crap......crap physio, unable to run.
I rested for a week from running to see if the swelling would subside. 2 days ago I ran some intervals on the treadmill with no pain or increase in swelling after. The swelling around the anterior joint line and ATFL is reducing. I saw my GP who has referred me for an MRI but who knows how long that will take. If I'm honest I feel frustrated that I cant get in straight away for the MRI but I know its pretty low priority. I'm working on ROM exercises and some eccentric ankle inverter exercises with a band. I'm not in pain and I'm certainly not looking to rush back before I feel 100%. Restoring stability and proprioceptive feedback is an important element of rehab but it has to be coupled with managing the symptoms.
Things I've learnt?? Have private health insurance. If I had PI I would have been in and out by now with results to work from and set a rehab plan. As our NHS buckles under the weight of the effects of covid it is now more important than ever to take responsibility for our own health. Looking after your physical health by eating well, sleeping well and exercising regularly is paramount to preventing chronic illness. I think its well worth having that extra layer of medical care which in the scheme of things is a few bottles of wine or a night out per month.
Don't underestimate an injury as simple as an ankle sprain. The mechanics behind that injury can lead to damage of the ligaments, tendons, connective tissue, bones, syndesmosis and the whole biomechanics of the ankle joint. Don't rush back. I was doing ok till I hit the high intensity sessions and looking back it was too much too soon.
I know this blog is a bit word heavy but I wanted to get across the importance of understanding your ankle sprain. Get it checked out straight away and if symptoms aren't settling over 6-12 weeks then push for an US or an MRI, especially if you are active.
Ive been out this evening for a very gentle run/walk and apart from a bit of an ache there is no pain. I know its still not right but for now I'll keep hitting the gym, walking and doing my rehab exercises. I'll keep you posted.