CONDITION - Chronic (Recurrent) Ankle Sprain
The word chronic usually refers to the fact that either the injury occurred over six (6) weeks ago and it is still painful, or if you have had repetitive injuries to this same ankle.
Sometimes the persistent pain is due to a more severe sprain of your ligaments causing a complete tear and some separation of the bones of your ankle when stress is applied. This is usually referred to as a "Grade 3 sprain". This separation can cause a feeling of instability especially when your foot is on uneven ground or when stepping off a curb.
Patients with chronic ankle sprains complain that their, "ankles feel loose", and have a tendency to turn in easily. These people will sprain their ankles repeatedly, even with mild injuries.
Often, one of the major problems with chronic ankle sprains is that the muscles around the ankle have gotten weak, and the nerve fibers to the ankle itself have become injured. You lose the ability to know exactly where your ankle is subconsciously (that's known as proprioception) and your muscles are not fit to react to the stresses of everyday life. Whether you realize it or not, your body reacts to the world around it millions of times a day by reflex. After repeatedly spraining your ankle, you can lose this protective reflex.
Solutions
Most orthopedic surgeons agree that chronic ankle sprains should first be treated conservatively. Although you may have tried some therapy previously, your doctor or therapist may want to modify your treatment for this diagnosis. So, don't be discouraged. However, each person is different and your doctor may feel you need surgical treatment immediately. If you are told that you will require conservative care you can remember the plan easily by remembering the words: Control, Avoid, and Rehabilitate.
Control: Get your pain under control
- Cryotherapy (ice, cold therapy) is an excellent way to control your pain. Do not apply ice directly to your skin for more than five (5) minutes as it can cause burns. A device specially designed to cool your foot, ankle and heel (see our PolarCare Cub) can be used for longer periods, as long as you carefully follow the directions and discontinue its use if you have pain or a burning sensation.
- Heat is an easy and effective method to control the pain after the welling has reduced (usually after 1-2 weeks). You can apply a heating pad on a low setting for approximately 10-20 minutes at a time. If you do not have a heating pad, you can use a soft terry cloth hand towel placed under warm (not hot) tap water.
- Over-the-counter pain medications can be of use. Acetaminophen (Tylenol™) can provide optimal pain relief with limited side effects. Anti-inflammatories such as Motrin™ (ibuprofen) and Aleve™ (naproxen) may also be beneficial, however, do not take pain medications for a prolonged period of time without consulting your physician. Occasionally, your physician may prescribe prescription medications such as anti-inflammatories or narcotics. However, their use should be limited to only a short period of time.
- Braces provide pain relief by stimulating your nerve fibers which make you feel that your foot is more stable and secure. In addition to providing stability, an ankle brace compresses your surrounding tissue making it actually feel better. This is what occurs when you strike your thumb with a hammer. Even though you just crushed your thumb, you grab it and squeeze it hard. This compresses the nerve fibers making it feel better. An ankle brace works somewhat on the same principle. Our Ascend Stabilizer Brace provides optimal support while allowing you to rehabilitate your ankle with comfort and confidence. This is also one of the best choices to allow you to return to your favorite sporting activities. Another option, especially if your recurrent sprains are occasional severe with significant swelling, is our custom Ankle Sprain Care Kit which provides you with the best ankle brace in the industry and everything you need to recover from an ankle sprain including an ice pack, compressive wrap, exercise band, exercise video and easy to follow instruction booklet.
Avoid activities that cause your pain
Just like the old bad joke about the patient that told the doctor: "Doc, everytime I do this, my knee hurts" and the doctor replies: "Well, don't do that!" Although this may seem humorous, there is some truth to the joke. Avoid such activities as squatting, kneeling, heavy lifting, climbing, and even running. Listen to your body and make a list of activities or movements that increase your pain and DON'T DO THESE THINGS. Also, make a list of activities and movements that reduce your pain and DO THESE THINGS. For example, many doctors recommend the following (be sure to check with yours to make sure he/she agrees):
DON'T DO these if you have recurrent ankle sprains:
- Avoid walking with poorly designed shoes (see our arthritis section for more information on proper shoes).
- Avoid walking on uneven surfaces such as beaches, trails and lawns.
- Avoid using the stairs, ladders, or any unprotected heights where you must balance yourself on one foot.
DO these if you have recurrent ankle sprains:
- Keep your ankle stable with an ace wrap, our Ascend Stabilizer Brace, or our AirCast™ Ankle Sprain Care Kit.
- Keep your ankle cool with an ice bag, frozen vegetables (peas work best) or with our Polar Care Cub to reduce swelling if and when it occurs.
- Do the exercises instructed by your physician or therapist to help regain the motion of your ankle.
- Wear proper fitting, well-constructed shoes (see our arthritis section for more information on proper shoe wear).
Rehabilitate your ankle
The key to this step is to remember controlled motions. This means you have complete control of these motions through a structured rehabilitation program. Most rehabilitation programs can be done in the convenience and privacy of your own home. The basic philosophy of rehabilitation for a chronic ankle sprain is to strengthen the muscles around your ankle to help support the injured and torn muscles, tendons or ligaments. This may include stretching your heel cord and gently moving your ankles in and out to expedite the healing of your ankle ligaments. Your therapist or physician may also recommend exercises to improve your balance called proprioceptive exercises. Remember that keeping your ligaments absolutely still for a prolonged period of time will actually starve your ligaments of the nutrition they need to repair themselves. In specific cases, your doctor may prescribe formalized physical therapy, with a therapist or trainer. The keys to rehabilitation include:
- Motivation to actually do the exercises. See our page on motivational strategies to improve your success.
- Correct exercises for your problem. See your doctor or physical therapist if you need advice in this regard. With the purchase of our AirCast™ Ankle Sprain Care Kit you will receive a set of easy to follow ankle exercises along with videotape to show you the correct sequence and technique.
- Proper equipment. This equipment can either be at your therapist's office; at your health club; or items that you purchase for use at home. We have found that people who do their exercises at home are much more likely to benefit from the program as they more frequently perform the exercises. The AirCast™ Ankle Sprain Care Kit provides you with a Theraband™ progressive resistance elastic tube, which will allow you to add strength training to your recovery program.
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