Just starting the new season of rugby, first pre season training, and what happens? Ankle sprain. Typical. But all is not lost, after a couple of days with crutches, I´m progressing my rehab, and can start running again. Being a physio, I know how to treat myself, and so didn´t go running (I couldn´t have even if I´d wanted to) to the doctor. Often this is the first thing that a lot of spanish do, but I don´t have a lot of faith of the doctors in "Urgencias".
For a simple ankle sprain, the best thing to do is ice, ice and ice. If you were to go to A&E, they would X ray the ankle, then bandage it up, a lot will put the ankle in a half cast (open plaster cast) and bandage it up, and tell you not to put weight on it for 2-3 weeks. The funny thing is, is after telling you this, they don´t provide you with crutches!!!! Amazing! So you hop/hobble out of hosptal, and you have to buy your own crutches.
The thing is, now that they´ve bandaged you up, there´s no chance of you being able to put ice on the ankle, so often the ankle just swells up even more, which leads to secondary damage of the tissues. The body always has an over reaction to try to heal it self. Plus after 3 weeks of no weight on the leg, the ankle is so stiff (due to the swelling and due to immobilisation) that it means extra rehab to gain mobility in the ankle joint, plus the normal rehab to return to sport.
So, what should you do....this is general advice, as every case is different, and also depends on the grade of sprain. If in doubt, always consult a physiotherapist. First things first, is ice the area. Don´t put ice directly on the skin, use a thin towel so that you don´t end up burning the skin. Ice should be used for periods of 15 mins of every hour. Even better is a bucket of water, with ice, and the foot placed in the ice water well above the ankle. This should be done for the next 48hours.
Rest is important to allow the tissues to heal. After 48 hours, progress to partial weightbearing, using crutches, and then progressively to fulll weight bearing. Meanwhile, range of movement exercises can be performed non weightbearing, ie, moving the foot in all directions gently but not into the range where you feel pain. Swimming pools are great because you can practice partial weightbearing by walking in the pool.
Once full weightbearing, you can progress to balance exercies, standing on one foot, trying to keep your balance up to 30seconds, once you achieve this, with the eyes closed to challenge your proprioception, here your ankle has to maintain it´s balance without using your eyes as a visual aid. These balance exercises are the most important so that the ankle regains fine control, and is less likely to reinjure in the future.
This is a very basic resumen, I could talk for ages on the subject, but to be able to return to sport or normal life, each person will need a specific exercise regime. Here I´ve outlined the important aspects only.
Anyway, thanks to the ice I used right from the beginning, my ankle didn´t swell up at all, and by day 4 I now have 90% pain free movement. Within 5 days I should be able to get back to training, but will work on my balance and proprioceptive exercises before the training session to help prepare the ankle for the stresses it will undergo in the session.
So, I´m happy, no doctors, and best of all, no plaster cast!