Ankle Injury Recovery - Now What?

So for the past 3 weeks, ive been healing from another ankle injury, except this time its on my right.

I can walk fine now and can even run a little, but i want to get back to training and basketball.

Problem is, its still very noticeable larger than my left ankle and ive been icing it 20 minutes a day/ 20 min break for atleast a couple sessions every night. And before i go to sleep i rotate it and flare it up and down and right and left for 20 second holds.

How do i reduce the swelling or will it go away naturally?

Ice after the first 72 hours is counterproductive. Usually. Ice will ihibit blood flow. You need the opposite.

You want to elevate it. That will help the swelling. Have your foot above the level of your heart. Epsom salt may also help the bruising and swelling. Google it.

Heat treatment is a good idea if the injury was a tendon sprain or partial tear. A broken bone, I’m not sure. And moving it around and stretching is always good if theres no pain.

I’ve had grade 2 sprain (a partial tear)(in two separate ligaments at the same time, yea I got real lucky). And 2 grade 1 sprains after that at different times. Wear an ankle brace every single time you play basketball. You ankle will never be as strong as it was and will continue to get injured. Also make sure your shoes are good for basketball. A shoe with a heavy heel and a light forefoot is bad news.

Compression wraps when you go to bed and during the day will help. If you have access to a qualified practitioner, traction and milk massage will help remove the swelling. Gentle active ankle movement while elevated will help as well.

Also, there is a technique you can try that I have used with athletes that I have had great results with decreasing swelling/edema. You will need a bucket filled with ice and water, big enough to submerge your whole ankle/lower leg to at least the base of the belly of the calf. Also, you will need 4-8 regular sponges and a 4" double length ace wrap.

First, soak the ace wrap and sponges in the ice water. Then place the sponges around your foot/ankle/lower leg and wrap them on tightly with the soaked ace wrap, starting at your toes and moving up your leg. Tuck the end of the ace wrap in on itself so it will stay on and then place your foot wrapped up with the sponges and ace wrap into the ice bucket. While in the ice bucket, pump your ankle up and down, side to side, make circles, spell the alphabet, etc. Just keep in moving. Do this for about 10 minutes. It will be VERY cold and pretty uncomfortable, but I have gotten great results with it.

The premiss behind the technique is to push out the swelling by using the cold therapy and compression with the internal pumping of the blood from the movement as well as the external pumping of the sponges when they empty and fill with water depending on the movement of your ankle.

Thanks for the great responses guys, but headed what is an ace wrap?

If i dont have any of these equipment, should i go out and buy them or is still other ways to downsize the swelling so it can become normal and useful like my left ankle?

I would recommend buying an ace wrap/compression wrap/elastic bandage regardless of if you plan on doing the sponge treatment I described in my previous post. It will be very useful in compression therapy to help push out some of the therapy. I would recommend a 4" x 10 yard wrap, but a 4" x 5 yard wrap might suffice.

Here is one website I found using google to buy an ace wrap at: http://www.colonialmedical.com/product.php?productid=20512
Or you can go to a CVS, Walgreens, etc. to buy one: Shop Beauty, Vitamins, Medicine & Everyday Essentials | CVS Pharmacy

The equipment needed for the sponge treatment is very minimal: Bucket/small trash can, regular sponges (can normally buy a pack of 6 at a grocery store for like $2), the ace wrap (maybe $5-8 depending on where you buy it), and ice/water.

Oh, that is what ace wrap is? I have an ace wrap at my home.

I shall follow your technique then

So basically im supposed to place sponges and ace wrap in water and then basically cover my ankles with the sponges all around and tie it with the ace wrap, can i use the clicks to tie it or stick it into itself like you suggested? and then im to move it in the ways you have described.

How many times should i do this a day? and for how long each session? should i go 20 minutes,break 20 mins, or how?

thanks

Yea, just soak the sponges and ace wrap in the ice water. Then place the sponges around your forefoot, ankle, and lower leg. After you soak the ace wrap, rolling it up again so you can get good tension on it when you wrap it around the sponges on your ankle and wrap from your toes up your lower leg.

I’d say once or twice a day should be fine. Maybe right before bed. If you have two ace wraps, that would be ideal, that way if you do it right before bed, you can wrap your ankle with the dry ace wrap and sleep with the compression on your ankle. I would be elevating your ankle at night while you sleep too. You can put pillows under your foot, but most people end up kicking the pillows off the bed or rolling off them. What I suggest is to put some books under the foot of your mattress, that way the foot of your mattress is always elevated.

What heals injuries? Answer = blood.
you need to get as much blood flow into the the ligament as possible now that you’re out of the RICE phase. Try picking up a copy of “Don’t ice that ankle sprain” for rehab ideas.

[quote]LevelHeaded wrote:
Yea, just soak the sponges and ace wrap in the ice water. Then place the sponges around your forefoot, ankle, and lower leg. After you soak the ace wrap, rolling it up again so you can get good tension on it when you wrap it around the sponges on your ankle and wrap from your toes up your lower leg.

I’d say once or twice a day should be fine. Maybe right before bed. If you have two ace wraps, that would be ideal, that way if you do it right before bed, you can wrap your ankle with the dry ace wrap and sleep with the compression on your ankle. I would be elevating your ankle at night while you sleep too. You can put pillows under your foot, but most people end up kicking the pillows off the bed or rolling off them. What I suggest is to put some books under the foot of your mattress, that way the foot of your mattress is always elevated.[/quote]

Wait when im soaked in cold water with the sponges on my ankles wrapped in ace wrap, i perfrom movements right. You said something about all the way up to the belly of the calf atleast. Does that mean from the belly of the calf all the way down to my ankles have to be wrapped in sponge with acewrap or just the ankles and that the bucket should be deep enough for me to basically have my whole leg in it minus the thighs.

Then at night before i sleep, i use another ace wrap that wasnt used in this sponge exercise and sleep with the compression? Won’t this limit blood flow? isnt this what i dont want? ok ill elevate it for sure somehow, it just cant be flat like my entire body when im sleeping right?

thanks alot man appreciate the responses

[quote]xiao wrote:
Wait when im soaked in cold water with the sponges on my ankles wrapped in ace wrap, i perfrom movements right. You said something about all the way up to the belly of the calf atleast. Does that mean from the belly of the calf all the way down to my ankles have to be wrapped in sponge with acewrap or just the ankles and that the bucket should be deep enough for me to basically have my whole leg in it minus the thighs.[/quote]

You should have your ankle and up to the base of the calf submerged and then do the movement while it is wrapped and submerged in the ice bucket. It doesn’t have to be up to your knee.

When you wrap it when you go to bed, be sure to wrap it in the direction from your toes up your lower leg (distal to proximal). By doing it in that direction, it will help push the swelling out of the ankle an return it back into the lymphatic and circulatory systems. You said you have excess swelling that has not gone away since the injury. This would probably put you in a sub-acute phase of injury and you have probably had minor instances of re-injury causing extra blood flow to the area. You want to control the swelling and blood flow, which it what the ace wrap will do. The elevation will also help and yes you are correct it just shouldn’t be flat like the rest of your body. I recommend putting some books under the foot of your mattress so that end of the mattress is raised higher then the head of your mattress.

Don’t rely solely on the cold therapy. You should be doing range of motion activities as well to help facilitate healing and flushing of the area. Traction will help as well as milk massage. Again, you don’t want to completely eliminate blood flow to the area, as the “new/fresh” blood will bring in the cells to promote healing, but you want to control the amount of blood coming to the area and eliminate any dead tissue/edema in the area.

Okay, great response levelheaded, but what do you mean by “wrap it in the direction from your toes up your lower leg (distal to proximal)”.

Also, ill be doing it 3 times a day starting tomo when i can get some sponges, do they have to be hard ones or soft ones? Also, how big do they have to be? im not sure on the size. Hopefully by next monday ill be back to normal so i can train again

also, if my bucket isnt large enough, can i use my bath tub?

Hi, new here
if i may echo some of the suggestions:
especially if the pain is largely gone, compression rather than icing is a really good idea. in most studies compression is showing as more effective in dealing with edema than ice.

but the biggie that may be missed here and has been suggested a couple times:
mobility of the joint is really critical - as long as there’s no pain be sure to work the joint in whatever range or motion you can.

ankle circles, ankle tilts, toe flexion and extension, toe pulls, ball of foot circles (both sides; keeping both sides involved in a practice is good for the brain).

Movement is one of the key signals to the body that you’re doing ok, and that it can back off with the inflammation reaction.

As a side note, i’d also suggest considering your diet - for this and long term benefit. Making sure you’re getting lots of veggies for the range of minierals and phytonutrients for healing is great, but especially making sure you regularly get good amounts of epa/dha (from omega 3 sources) into you is very important for anti-inflammation support. It takes time to build this up in the body, so good to be a consistent practice.

also bromelain, an extract from pineapple, can also help bring down inflammation.

also,
just a thought
sometimes with inflammation you do want to assist new blood to rush and flush into the area - movement helps this process a lot too, but sometimes - down the road when more of the swelling is gone - you can sometimes use topicals like capsaicin

But sport, just a heads up, three weeks ain’t nothin for sprains if that’s what this is. ligaments take a very long time to heal: unlike bone and other tissue, they have very limited blood supplies, so patience and movement are very good blends.

mc

I have had 2 severe sprains on my R ankle. It is permanently larger in appearance compared to the left. These sprains occured 15 years ago. I suspect the appearance of the larger joint may be secondary to ligamentous laxity.

beef

Thanks supa power,

I ordered the rehab kit from the site with “Don’t ice that ankle sprain”. I’ve had a dozen or more sprains on my right ankle from soccer. I want to continue playing but its becoming a nuisance.

The rehab kit looks interesting. It appears he is doing strengthening under traction. If it works well i will use it for my patients. I am a chiropractor. I’ve used the wobble board with not much success.
http://www.flexbandonline.com/shop/books/dont-ice-that-ankle-sprain.html

For you folks this kit has helped me a lot. http://volleyball.epicsports.com/prod/12429/rapid-recovery-ankle-sprain-kit.html
The main thing here is application of the compression donut immediately after the injury. I have used this and recovered in 1-2 days and kept playing. I even play with the donut inserted in a stabilizing brace.
You don’t need the kit. We have bought the compression donuts in bulk from a PT supplier.

Good luck
Eugene Sabaitis DC

uge,

I personally have used the flex bands and traction technique from the Don’t Ice That Ankle book on myself and several athletes I have worked with. I have found great results in using it. Immediate relief a lot of times and I had a couple athletes who continued to do it even after the injury resolved just because it made their ankle feel better and mobile.

As a chiropractor, I’m sure you know how the talus shifts anteriorly a lot of times (due to injury, stress placed on the ankle during activity, tight achilles) and will cause blockage of dorsiflexion. WIth the traction and AROM with the bands, I have found that it helps perform a active, non-manipulative posterior talar mobilization and helps a lot in general. I definitely highly recommend it.

My only recommendations I have is that if you are going to have your patients perform the technique on their own at home, make sure they know how to set it up properly, etc and re-enforce the proper way to set it up several times. I found that the athletes I worked with needed a lot of practice and instruction before they were able to do it on their own.

compression, great. band work can also be great, but honestly? i’ve found a number of time that puts the cart before the horse.

Why? it adds load before the athlete can really control and own the movement of the ankle, especially at different speeds. Take an ankle circle or ankle figure 8’s. Most of the athletes i work with cannot control a simple circle through the full range of motion evenly at one speed never mind super slow (which is a more loaded effect) or sport speed (the speed at which injury usually takes place).

SO, may i suggest that you give experimenting first with mobility a go, and then consider loading any mobility practice, once they own the movement and the speed of the movement? you may find that you get further with that practice - and not stopping at the ankles - than beginning with load. or if you want to do both at least have some time that just practices the movement, too.

Z-health r-phase ( http://bit.ly/9dbNqh ) has a ton of foot work included - along with drills and a progression for the whole body.

just an idea.

mc

mc,

I think you may have misunderstood the purpose of the bands from the Don’t Ice Your Ankle technique. Initially, the bands are solely there to provide traction to the ankle mortise while the ROM is performed. After going through the initial stages and progressing through proper mobility, they recommend adding band resistance to the movement. I have found great results with decrease in swelling and restoring proper alignment of the talus in the ankle joint. I will use this in conjunction with a traditional ankle mobility routine.

[quote]LevelHeaded wrote:
mc,

I think you may have misunderstood the purpose of the bands from the Don’t Ice Your Ankle technique. Initially, the bands are solely there to provide traction to the ankle mortise while the ROM is performed. After going through the initial stages and progressing through proper mobility, they recommend adding band resistance to the movement. I have found great results with decrease in swelling and restoring proper alignment of the talus in the ankle joint. I will use this in conjunction with a traditional ankle mobility routine. [/quote]

thanks for the clarification.
Have you ever tried the ROM work without traction? just focusing on the mobility?

thanks
mc

mc,

Yes, I do tons of ROM work without traction myself and with those that I work with. With acute or lingering ankle injuries, I have found added success with utilizing the traction technique with the ankle ROM.

The biggest helps I have found from it are:

  1. the re-alignment of the talus to the tib/fib in the talocrural joint
  2. the decrease in swelling due to the traction opening up the joint and allowing for the swelling to flow more
  3. the decrease in pain, which results in more proper movement which will decrease pain and help to restore a proper, uninhibited movement pattern

I just think it is another great tool to use. It doesn’t replace other methods that are tried and true, but helps promote the healing and return to function.

cool stuff levelheaded. thanks for the detail.