Sprained Ankle? Forget About Rest!

It is estimated that there are 23,000 ankle injuries per day in the United States (Kannus, Pekka). Ankle injuries are most common among athletes, especially in sports such as basketball, soccer, and football. Up until recently the standard treatment protocol for acute ankle sprains has been RICE- Rest, Ice, Compress, and Elevate. However, there still lacks clinical evidence of the effectiveness of the RICE method. In fact, many clinicians in the last decade have moved away from the old regimen of RICE and now are stressing other treatment protocols such as POLICE- Protection, Optimal Loading, ICE, Compression, and Elevation and even more alternative approaches such as MEAT- Movement, Exercise, Analgesics, and Treatment.

Currently, there are no conclusive studies that determine whether RICE, POLICE, or MEAT is the most effective approach to soft tissue rehab. Yet, there appears to be a growing consensus that mobilization and optimal loading is the best strategy for improving injured ligaments and joints. When an injured ankle is immobilized, scar tissue forms in an unorganized pattern and tighter weave causing a stiffer joint and longer recovery time. In addition, when ligaments scar excessively, the ankle joint becomes more prone to future sprains since the ankle is more rigid and there is less give in the system.

Therefore, many practitioners are now recommending treatment protocols with pain free movement or optimal loading. An article in the British Journal of Sports Medicine by CM Bleakly defines optimal loading as, “replacing rest with a balanced and incremental rehabilitation program where early activity encourages early recovery. Injuries vary so there is no single one size fits all strategy or dosage. A loading strategy should reflect the unique mechanical stresses placed upon the injured tissue during functional activities, which varies across tissue type and anatomical region.”

Many people that suffer from sprains often times have to wait several days to be seen by an expert. Here are some steps you can take immediately to help reduce the amount of scar tissue build up while you are waiting for professional assistance.

1. Elevate the injured ankle and if swelling is significant ice, but only for short periods of time, no more than 5 minutes. You can reapply after 10 minutes if the ankle is still hurting. As I said in my last blog post, there is a lack of conclusive evidence of the benefits of icing injuries other than the reduction of pain, making it challenging to provide clinical suggestions for the appropriate use of ice. Based on the severity and type of injury, icing may still be appropriate for controlling excessive swelling and reducing pain.
2. Protect the joint from further damage by not loading it in painful positions. If you choose to use compression only use it for the first day or two to help control bleeding and prevent further damage.
3. Optimal Loading- start moving the joint with muscle pumping to reduce the amount of swelling and keep scare tissue from developing. Only muscle pump within a pain-free range of motion

In addition to movement, Structural Medicine can greatly increase the rate of recovery and restore proper structure and function to a joint after the acute phase of healing by addressing any remaining adhesions, scar tissue, and fascial restrictions. To reach the full potential of healing it is imperative to take the tensional strain off the injured soft tissue. Often times trigger points will result from the stress placed on the muscles surrounding the injured site causing an imbalance of tension around the joint.

Structural Medicine works to restore the tensegrity between the fascia and connective tissues surrounding the injured joint and introduces pain free movement which begins to re-establish mobility at the site of the injury. This movement will also set in effect Wolff’s Law which states connective tissue will arrange itself according to the stress placed on it. Therefore, through joint movement the body signals new connective tissue to establish proper strength, length, and elasticity needed at the joint.

Bodies heal with movement not immobilization and the quickest way to increase mobility of a particular restriction is through hands on manipulation of the soft tissue by a trained expert. By restoring the ankle’s proper structure and function through Structural Medicine you will heal faster and be less prone to future ankle injuries!