APU Health & Fitness Original

Ankle Sprains: Why They Happen and How to Cure the Pain

By Daniel G. Graetzer, Ph.D.
Faculty Member, School of Health Sciences

The statement “an athlete is only as good as his legs” applies to practically every sport. Ankle sprains, the most common lower extremity trauma injury in athletes, can result in soft tissues being crushed, stretched or torn.

Usually occurring as the result of the ankle turning inward, sprains are graded by athletic trainers into three degrees of severity. The more severe the sprain, the more painful it is and the longer it takes to recover.

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The Three Degrees of Sprains

A first-degree sprain involves mild to moderate overstretching of the ligaments, the flexible bands of fibrous tissue which attach bones and cartilage to keep the joints together). If a first-degree sprain is treated quickly and properly, very minimal swelling (edema) and joint instability will occur. Within one to three weeks, a return to normal activity can be expected.

In a second-degree sprain, edema and bruising (ecchymosis) occur within seconds following the injury, due to partial tearing of some ligament fibers. Tenderness in the affected area when touched and a partial loss of joint motion are commonly the result of a second-degree sprain.

A few ligaments may be completely torn (ruptured) in a second-degree sprain, but the overall stability of the injured ankle remains relatively intact. A three to six-week period of active rest may be required before an injured person returns to complete normal activity.

A third-degree sprain generally involves a complete rupture of nearly all the ligament fibers, swelling, severe pain, and an inability to walk or maintain one’s balance. A ghastly popping or snapping sound is often heard by the athlete and others a few feet away. For this type of severe sprain, eight to 12 months are often required for ligaments to heal but surgery is rarely successful or even recommended anymore.

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How to Treat Ankle Sprains with Ice

There are various methods of treating an ankle sprain. Cold application (cryotherapy) and elevating the affected ankle as quickly as possible after an injury will greatly reduce the ankle pain, hasten recovery, and reduce the risk of further injury. Immediate ice application (within minutes if possible) reduces acute tissue damage and accelerates the healing during rehabilitation, minimizing an athlete’s time lost to injury.

Cryotherapy deadens the sensation of pain and reduces muscular spasms by blocking nerve conduction and muscle spindle excitability. Within seconds after an ankle is sprained, inflammation caused by the synthesis of prostaglandins and the release of histamines causes the pain.

The anesthetizing sensation of cryotherapy follows a four-stage progression of cold, burning, pain and numbness. This process generally takes between five and 15 minutes when ice is applied to an injury, depending on the degree of cold, the severity of the injury, and the amount of fat beneath the skin.

Within the body, a narrowing of blood vessels (vasoconstriction) and an increase in blood thickness (viscosity) then ensues, which reduces inflammation and slows down swelling. Edema is caused by the accumulation of blood (local internal bleeding) and is one of the body’s protective mechanisms to bring antibodies and white blood cells (leukocytes) to the site of injury.

However, if there is no open bleeding, then blood collects in an injured area. As a result, the injury takes a longer time to heal.

Several cryotherapy methods are effective in reducing the pain of ankle sprains, including:

  • Massaging the injury with ice
  • Applying ice bags or towels with crushed or shaved ice, which conform better to the body’s contours than cubes will conform better than cubes
  • Immersing the injured foot in a bucket of ice (quite painful, especially for children)
  • Applying refreezable flexible silicone gel packs for 15 minutes (be sure to wipe off the frost before use)
  • Spraying vapo-coolant chemical sprays with ethyl chloride or fluoromethane are also available

Using ice to relieve the pain of ankle sprains is generally the best method. Medical science has never found anything more effective than simple ice since cryotherapy was first documented by Hippocrates in 400 BC. Cryotherapy generally needs to be continued for at least 24 to 72 hours and as long as two to three weeks, depending on the severity of the injury.

How to Perform an Ice Massage

To perform an ice massage on a sprained ankle, freeze water in a foam cup, peel the foam layer away from the ice and gently massage the skin with the ice, using a circular pattern. Poking a toothpick through the cup before the water is frozen is a neat trick to prevent the ice from falling out as it melts during massage.

The ice should be intermittently applied for 20 to 30 minutes every one and a half to two hours until the pain and swelling subside. It’s also useful to let the skin return to a normal temperature before reapplying the ice and never keep the ice on the skin longer than 60 continuous minutes to avoid frostbite.

Remember RICE for Treating Ankle Sprains and Other Injuries

The best methods of treating ankle sprains or other injuries involve rest, ice, compression and elevation (RICE). In addition to using ice, it is useful to rest the injured ankle by elevating the foot higher than the heart. The elevation forces gravity to drain excess fluid away from the injury; it also reduces blood flow and limits the pooling of blood in the veins. Elevating the injured limb during sleep following injury is equally beneficial.

Compression can also aid in helping ankle sprains to heal. For instance, using an elastic compression wrap or splint greatly assists cryotherapy’s effectiveness by forcing fluid buildup away from the injury.

Cryokinetics: Another Way to Heal Injured Ankles

Cryokinetics is a successful rehabilitation technique that combines cold application with stretching and mild exercise in the days or weeks following an injury. The joint or muscle is first numbed by ice and then it is put through various ranges of movement and controlled exercise until discomfort is felt.

When pain is noticed by a patient, the exercise is stopped and the ice or cold pack is reapplied.  Repeating this cycle several times accelerates injury healing by stimulating blood circulation and also minimizes the deconditioning (atrophy) of surrounding healthy tissue. Contrast treatments (alternating cold and heat therapy) may also assist in healing once the edema has stabilized by increasing circulation, reducing inflammation, and improving the person’s range of motion.

Immediate cryotherapy has the additional advantage of lowering temperature and reducing cellular metabolism in healthy tissues surrounding the injury, which may be deprived of oxygen and nutrients because the swelling disrupts local blood flow. Limiting the extent of the initial injury using cold has long been employed in hospitals to prevent secondary (downstream) tissue damage during organ transplants and amputations.

Cryotherapy, however, should not be used by some people for treating ankle sprains. For instance, if you have a collagen disease such as rheumatoid arthritis, a circulatory disturbance such as Raynaud’s syndrome, or any form of cold allergy (such as hives), there could be secondary complications.

Should Injuries Be Treated with Tape or a Brace?

Competitive and amateur athletes who suffer recurring ankle sprains or simply have weak ankles encounter the age-old question: “Should tape or braces be used to increase ankle stability?” Four factors – the cost, the athlete, the injury and the sport – determine which option is best.

Athletes concerned about cost and convenience usually choose braces over the hassle of repeatedly finding a qualified person to apply the tape properly. Collegiate athletic trainers report that taping a basketball player’s ankles for every practice and game costs just over $100 per season. By contrast, the cost of a quality brace (which lasts a maximum of about two seasons) is $30 to $40.

When the cost is not a problem, the choice between braces and tape becomes more difficult and controversial. A majority of athletic training research studies indicate that braces are often slightly more effective for overall ankle support and protection.

However, tape is more commonly used after ankle sprains because it allows an experienced trainer to have much more flexibility during the tape’s application, such as tightness, the amount of tape and the ability to support specific ankle regions. If only a novice taper is available to treat an injured athlete, braces are probably a better choice.

The two basic categories of braces – lace-up and hinge – have both advantages and disadvantages. It depends upon whether the brace is used for injury prevention or injury treatment. Often, lace-up braces don’t offer enough support for athletes coming off an injury, and athletes in some sports often complain of the discomfort of hinge-type braces.

Preventative and Rehabilitative Ankle Care

There are several exercises that can strengthen muscles and enhance flexibility and stability after an ankle injury. These exercises are also highly recommended for people with weak ankles who are preparing to move up to a higher level of fitness training.

These exercises include:

1. Inversion/eversion with elastic tubing – To improve lateral ankle stability, loop a piece of elastic tubing around the base of the toes and affix the other end to a stationary object or hold the ends firmly in both hands. Resist the pull of the tubing with your ankle in a variety of directions.

Repeat the exercise, pulling the tubing out to the other side to strengthen both the inside and outside ankle muscles. A bike tire’s inner tube or a four-foot piece of 5/8 inch surgical elastic tubing (available at a medical supply store for about $5) will work fine. Be sure to do the exercise with only the foot and ankle and not the whole leg.

2. Towel stretches – Heel-cord flexibility and calf muscle tone can be enhanced by repeatedly flexing the foot against the resistance of a bath towel folded lengthwise. Elastic tubing can also be used for this exercise, but it may not provide enough resistance for stronger athletes.

Another way to perform this exercise is to sit down and perform three sets of 15 repetitions each, holding for 30 to 45 seconds in the plantarflexion (toes down) and dorsiflexion (toes up) positions while applying a moderate degree of resistance. Heel cord stretches can be effectively performed by “wall pushes,” which involve placing your hands on a wall in front of you and extending the ankle to be stretched behind you with the heel flat on the ground.

3. Weighted towel slides – Ankle strength can be improved using a towel lying open on the ground with a five to 10-pound object placed on one end of the towel. You can alternately move the towel and weight by sliding your foot out to the side and inward toward the center of your body against the resistance of the weight, moving it laterally across the floor by pivoting at the heel in each direction.

4. Heel raises – Stand on one foot, slowly raise up the foot with your toes and slowly lower your heel back to the floor. When this exercise feels too simple, progress to doing heel raises on the edge of a step or holding a 10 to 20-pound weight in the hand on the same side of the foot being exercised.

5. Cross-training – Swimming with swim fins, riding a stationary cycle, or stair climbing provides excellent cross-training workouts to increase your ankle strength and mobility. Additional benefits of cross-training include the maintenance of cardiovascular fitness during rehabilitation and reduced boredom by performing a variety of activities.

Interested in sports-related first aid and safety? The University offers two degree programs with courses that cover this topic, including:

Daniel G. Graetzer, Ph.D., received his B.S. from Colorado State University/Fort Collins, MA from the University of North Carolina/Chapel Hill, and Ph.D. from the University of Utah/Salt Lake City and has been a faculty member in the School of Health Sciences, Department of Sports and Health Sciences, since 2015. As a regular columnist in encyclopedias and popular magazines, Dr. Graetzer greatly enjoys helping bridge communication gaps between recent breakthroughs in practical application of developing scientific theories and societal well-being.

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