Ankle sprains can be a tour-ending injury, and while there’s no magic rub to make them instantly recover, there are a few things you can do to ensure you’re back in the saddle as soon as possible, as Suzie Bostock explains.
An ankle sprain, in particular spraining the outside of your ankle (known as a lateral ankle sprain), is the most common ankle injury caused by things like planting your foot awkwardly, dropping your bike on your ankle, hiking, stumbling home after a few too many drinks… The list goes on!
Aside from the intense pain and reduced mobility an ankle sprain can cause immediately after, if left untreated it can lead to chronic ankle instability causing long-term issues like ankle osteoarthritis. Who is most likely to get an ankle sprain?
People with a previous ankle injury.
People with reduced ankle movement or a hypermobile ankle.
If you like riding off-road and you wear poor boots with rubbish ankle support. Ankle sprains can be graded like this:
Grade I (Mild) – Little swelling and tenderness with little impact on function.
Grade II (Moderate) – Moderate swelling, pain and impact on function. Reduced proprioception, range of movement (ROM) and instability.
Grade III (Severe) – Complete rupture, large swelling, high tenderness loss of function and marked instability.
Always see a physiotherapist where possible, especially with a severe sprain. About 10% of ankle ‘sprains’ will have a fracture, so if it’s bad, get it checked! Regardless, if you’re touring and unfortunate enough to sprain your ankle, there are a few things you can do to minimise damage and maximise recovery.
P.O.L.I.C.E. principles can be used for acute injuries: Protection, Optimum Loading, Ice, Compression and Elevation.
Protect – use crutches if needed and initially just rest.
Optimum Loading – don’t completely immobilise the joint, gently mobilise it so that you don’t lose movement and strength. Start gentle exercise from day two-three onwards (see right).
Ice – Use an ice pack covered in a damp cloth for 10 minutes on the area, remove it for 10 minutes then re-apply for 10 minutes. Do this every two hours. Check your skin regularly.
Compression – use an elastic bandage or tubi-grip, whatever is easiest to find. Obviously, you need to check it’s not too tight on a regular basis, and make sure your toes are still the right colour, i.e. not bright white or red.
Elevation – Lift your ankle up on some pillows and have a lie-down. Talk to a pharmacist about how NSAID’s (Non-steroidal anti-inflammatories), like ibuprofen, might help you.
These early exercises (from day two-three) for mild to moderate (Grade 1-2) sprains can help with ankle mobility. It is important to get your ankle muscles working correctly early on so you don’t lose ankle movement. Make sure you do exercises on both legs (it’s just as important to keep your ‘good’ ankle mobile) but do not do any exercises which cause pain.
Sit or lie down. Circle your ankle in one direction about 30 times and then go in the opposite direction. Repeat this two to three times. Only do as much as comfortable.
Simple calf stretches
Sit with legs out straight. Use a towel/belt to put around the ball of your foot.
Stretch 1: keep your leg straight and gently pull your toes towards you until you feel a gentle (not painful) stretch in your calf. Hold 20-30 seconds. Release. Repeat four-five times.
Stretch 2: as above but bend your knee a little. Hold 20-30 seconds. Release. Repeat this four-five times.
Seated heel raises
Sit down, lift your heels as far as you can off the floor, then lower. Repeat 8-12 times as comfortable. Rest. Repeat two-three times.
Ankle inversion, eversion and dorsi-flexion with/without assistance
Sit with legs out straight. Gently move your feet outwards, keeping legs still. Relax. Repeat 8-12 times as comfortable. Rest. Repeat two-three more times.
Next, gently move your feet inwards, keeping your legs still. Relax. Repeat 8-12 times as comfortable. Rest. Repeat two-three more times.
Finally, gently move your toes upwards. Relax. Repeat 8-12 times as comfortable. Rest. Repeat two-three more times.
If this is too difficult to start with use a towel or belt around your foot to assist the movement.
Sit on a chair with feet flat on the floor. You can place a plastic bag under your feet to help the movement if needed. Slowly slide your feet backwards under the chair as far as comfortable (without pain). Then slide them forwards again. Repeat 8-12 times as comfortable. Rest. Repeat two-three more times.
Sit on a chair. Place a towel etc. under your feet and then practice scrunching it up using your toes and then releasing after a couple of seconds. Practice for 30-60 seconds. Relax and then repeat up to three times.
Place your foot over your knee. Hold your toes and stretch them back. Hold for 30 seconds. Relax. Repeat three-four times.
Elevate your leg and use ice after exercises. If you notice increased swelling after exercising you may be doing too much, so ease off a little. If things are not improving after a week and you have not yet had a professional assessment of your ankle, get it assessed properly.