Ankle Sprains – what to do?

Ankle sprains can put a stop to us taking part in our favourite sport while we recover. James Bainbridge, one of our physiotherapists, tells us about his personal and professional experiences of this common injury and helps us to separate ankle-sprain fact from ankle-sprain fiction.

After spending the last two years working with people with a variety of musculoskeletal injuries, last week I suffered one myself. I have always been involved in sports but up until now, I’ve been very fortunate in avoiding any significant injury. What I’ve noticed with this injury so far, is that not only are the advice and guidance for rehabilitation a minefield, but the attitudes towards acute ankle sprains are far more dooming than the actual injury itself; one study, for example, recently suggested that acute ankle sprain could be a prognostic factor for the likelihood of chronic ankle instability.

So, how did I sprain my ankle? During a football match, I reached to make an interception and then (get ready for the clichés), I “felt it twist”, “heard it pop” and it “puffed out like a balloon”. According to the Ottawa ankle rules, there was a possibility that my symptoms could, in fact, be a fracture, so I headed straight to A&E to rule this out. I was seen promptly and professionally and therefore would like to extend my gratitude’s to Northwick Park Hospital in Harrow!

To RICE or not to RICE?

Having received confirmation that my ankle was indeed sprained, I began my first week of rehabilitation and immediately encountered my first question: to RICE or not to RICE? RICE (Rest, Ice, Compression, Elevation) is well known to most but is it really necessary? According to some evidence, possibly not. There is growing support for the use of POLICE (Protect, Optimal Loading, Ice, Compression and Elevation) instead, which suggests that we should perhaps look away from our reliance on rest and instead focus on returning to function in a sensible and conditioned manner, allowing us to make a faster and more functional recovery.

Time to involve the ‘POLICE’?

So, what does POLICE really mean? The major difference between POLICE and RICE is the introduction of Optimal Loading. Optimal Loading refers to placing enough load, otherwise known as force or stress, through the injured area. The best application of this, is to find that “sweet spot” of enough movement to encourage recovery, but not so much to create tissue overload, risking further injury or prolonging your pain.

Find your “sweet spot”

There are several factors that will impact where your “sweet spot” is and this is something you can discuss with your physiotherapist. By combining this with the use of ice/NSAIDs (Non-steroidal anti-inflammatory drugs, such as ibuprofen), you could find yourself making a stronger comeback from this injury, compared to rest alone.

What exactly is an “Optimal Load”?

To begin with, the best application of an “Optimal Load” for me, was to continue walking. I carried on walking 2 miles a day for my commute, which although I found painful, I was able to complete. It has been identified that being able to walk within the first 48 hours is a good indicator that you will improve, so it is worth attempting a prolonged walk to determine whether this is optimal for you. After 3 days, I noticed a huge improvement in my pain levels.

During the first few days, I had many discussions with people regarding my injury. After all, you don’t need to be at the Edinburgh Fringe to spot the comedic irony in an injured physiotherapist! I spoke with my clients, gym members, my team mates, friends and family and I was shocked by the general perception of an ankle sprain. People have asked me if I will play football again before Christmas, told me soft tissue injuries are worse than a fracture and expressed their surprise that I was even going into work.

Is rest really best for an ankle sprain?

Very few people were positive about the prognosis of an ankle sprain and how it can be managed effectively in the early stages of rehabilitation. When it comes to injuries, advice can spread by word of mouth. Sometimes directly from a professional, often from a family member or friend with a similar experience, or in the worst cases, from Google! And for that, I think we in the healthcare profession, have perhaps misguided or misinformed (unintentionally) our patients, into requiring long periods of rest and discouraging placing any stress in the early phases. Over time, this has trickled down to become the common belief for what to do if you twist your ankle.

The positive side of my ankle sprain

After approximately a week following my injury, I had returned to a near-normal walking pattern, started some early-phase muscle strengthening exercises and drawn up a plan of action to return to football and weight training sooner, rather than later. This injury has even encouraged me to be more aware of what I am doing for myself to prevent such injuries and once fully recovered, I will be sure to incorporate some balance and agility-based exercises into my training to prevent possible reoccurrence.

The best way to manage an acute ankle sprain

Overall, for the best management of an acute ankle sprain, I would recommend breaking it down to three major elements:

• If you suspect a fracture or other serious injury, using the Ottawa guidelines as referenced above, get it checked out at the hospital right away
• Remember POLICE, not RICE
• Once you have begun increasing the amount of pressure or load that you are able to tolerate in your ankle, speak with a physiotherapist who can provide you with a personalised “sweet spot” rehabilitation program, to help you return to your activities in fighting form!