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October 2000 Issue
Treat Your Sprained Ankle Right
by Michael Fick
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Two men each sprained an ankle playing football on the same weekend. One of them made three touchdowns the following weekend; the other still couldn't play comfortably a year later. The primary difference was in the treatment they received.

The man who played the following weekend was a pro football payer. The other was a weekend warrior. But the differences in their treatments were not an army of physicians, a boatload of chemicals, and deep pockets. The difference is that the pro and his providers treated the sprain aggressively and properly, beginning within a minute of the injury, but the "civilian" just let it heal. We weekend warriors can give ourselves most of the more successful treatment with a little knowledge and a sock.

You know we should apply RICE to a sprain, right? Rest, Ice, Compression, and Elevation? That's really all the pro ball payer got, but he got them all within five minutes, and that made a huge difference in his recovery.

First, he got off the field without walking on the ankle. He began the Rest immediately, not when it became convenient. His trainers then Elevated, Iced, and Compressed (wrapped) the ankle as quickly as they could work. Then the pro aggressively treated his ankle 24 hours a day until it was healed

The civilian hobbled around on the ankle until treatment was convenient, slapping on some RICE each evening and hoping it would fix itself - just as most of us do. That's why he was still walking funny next football season.

A sprain is an overstressed ligament (the fibrous bands that bind joints together), ranging from minor microscopic tears to gaping rips that require surgery. Either one can be excruciating. In response to a sprain, some blood escapes and the body deliberately floods the area with more fluids to fight the injury in several ways. All this fluid, though, doesn't fit neatly into the confined spaces of a joint, so it produces internal pressure and swelling. This further displaces both injured and uninjured parts, causing further injury and pain. The swelling must be controlled if we want a quick recovery from the pain and injury. The purpose of the RICE is to prevent most of the swelling, help the unavoidable swelling dissipate, and promote healing and cleansing normal blood flow through the area.

The swelling starts when blood capillaries rupture, maybe before we even hit the ground. The sooner we apply RICE, the less swelling we get. The swelling continues for a few days, so applying RICE during those first few days is critical to a quick recovery. Letting it "heal on its own" causes us more pain, and often costs us more down time, than treating it properly, aggressively, and immediately.

The swelling can cause more tissue damage than the initial sprain. Limping causes ... heck, limping is ... unbalanced stress that often injures leg and back muscles and joints, so your sprained ankle can easily send you back to your wonderful HMO repeatedly as the effects of that ankle injury propagate up your skeleton. An improperly or incompletely healed ankle is subject to repeated sprains that repeat and worsen the cycle.

Aggressively heal your ankle the same way the pros do it. Get off of it immediately. Hop, or lean on something or someone, to get to the nearest seat. Prop it up. Ice it. Wrap it right. And keep the RICE coming until you can walk on it with almost no limp.

That paragraph should be crystal clear, except maybe for the word, "right". Two of the biggest differences between playing again in a week or two and seeing your doctor for months - or wishing you had - are prompt treatment and the right wrapping technique.

The purpose of immediate wrapping is to minimize swelling, but the ankle bone acts like a tent pole to shield the most swelling-prone area - the circle of soft tissue around the ankle bone - from the wrap's beneficial pressure. Soon after the sprain, that soft circle of flesh swells outward to meet the wrap or your shoe, causing more damage and pain.

The solution is simple and crucial: fill that circular void with something before wrapping the ankle. A sock coiled into a circle, or a toroid (donut) cut from a thick pad of something like felt, neoprene, or dense foam such as carpet pad material will work. Apply the padding around the ankle bone, wrap the ankle snugly with a substantial elastic ankle bandage, and make sure it's not so tight the toes turn purple or get numb. The wrapping should feel good, not bad.

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