Health & Fitness

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.

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.