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October 2000 Issue
Treat Your Sprained Ankle Right
by Michael Fick
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That takes care of the critical C in RICE. The R and E are usually manageable as long as you realize their importance of preventing and dissipating fluid buildup. Staying off that ankle is fairly easy for an office worker; just prop it up on another chair or a table and whine that you just have no intention of moving around much for a couple of days, that you'll take a couple of days of valid sick leave if they don't like it. If your career absolutely requires walking around and short-term work is more important to you than the long-term health of your ankle and back, get a crutch or two, and tell the macho guys who accuse you of being a wuss that your health is more important than their uninformed opinions. Better yet, tell 'em it's broken, tape the ankle according to a sports medicine book, then watch their eyes bug when you throw away the crutch and make three touchdowns the following weekend. Make sure you wince as you spike the ball.

The I is not too difficult, but is vital in the first hour and for the first day or three. It quickly stops the internal bleeding and most of the other infusion of fluids before they can exacerbate the damage and pain. Soak the ankle in icy water for 20 minutes several times a day, starting minutes after the injury. A less messy and very effective way to ice it is with a Ziploc bag of ice and water applied to the bare ankle.

Take acetaminophen (e.g., Tylenol) for the first day's pain, then ibuprofen (e.g., Motrin, Advil) or aspirin after a couple of days, when the bleeding has stopped and inflammation becomes the bigger issue.

Don't be surprised if a truly severe ankle sprain takes more than a month to heal, even if you treat it perfectly. Fortunately, you'll be surprised how much your ankle can hurt and still have the doctor tell you, "It's just a minor sprain."

You should see a doctor right after your first dose of RICE if the ankle seems loose or walking is difficult, for several reasons. The only way to detect a fracture is by X-ray. Also, if muscle injury is present, there are certain right ways and many wrong ways to stretch the healing muscle to minimize permanent scar tissue. You may need to splint sprained ligaments to prevent injury to the overworked healthy ones. Your doctor can also inform you of rare medical conditions that may contraindicate ice application.

Several precautions really help prevent ankle sprains. One, strengthen them. Fitness books describe several ankle exercises. Two, walk aggressively - one might call it proactively -- when in rough terrain. Tense your ankle muscles as though you were deliberately trying to make distinct footprints, rather than just letting your feet slap the ground passively. Three, wear high-topped shoes when in rough terrain or when playing. They don't really provide significant ankle support, but they do provide greater and quicker feedback when an ankle starts to turn under because the tops of high shoes hit the lower leg when an ankle bends. This gives us extra time to react by tensing or lifting that ankle. Our ankles are supported almost independently by ligaments and muscle, and unless we deliberately tense the muscles to help splint the ankle, ligaments permanently weakened by previous sprains may not have the strength to resist a twist on their own.

Prevent most sprains and properly treat the ones that sneak through your defenses, and you may avoid weeks of extreme ankle pain; months of limp-induced knee, hip or back pain; additional medical expenses and/or chronic ankle problems.

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