Bleeding, swelling and pain always occur at the injury site. The amount of swelling and bleeding depends on the rapidity of blood circulation at the moment of injury. During sporting activity, heart rate is fast and blood circulation in the muscles is maximal. In this case, swelling and bleeding at the injury site may become severe without first aid.
If first aid is given quickly, bleeding at the injury site can be stopped. Leg elevation and compression control the bleeding and cold therapy constricts the blood vessels and alleviates the pain. These three procedures are used to reduce swelling.
It is important to perform all three procedures. Cold therapy alone is not enough. It has to be combined with elevation and the use of a compression bandage that should be tight, but not too tight to prevent blood circulation. The right kind of first aid speeds up recovery significantly.
Compression Compression of the injury site should be started as quickly as possible (with hands, a scarf or a bandage).
Cold therapy Immediate cold therapy of the injury site: put ice, snow, a frozen vegetables bag or a cold pack directly on the injury site or immerse the foot in cold water for 15 to 20 minutes at a time, repeat every 2 hours as necessary. Avoid frostbite of the skin, e.g. by placing a towel between the cold pack and the skin. Cold therapy should be given frequently during the first 24 hours.
Elevation The limb should be raised above the level of the heart at a 45 degree angle and held in that position as often as possible during the first 24 hours.
If walking is possible without too much discomfort, reducing stress on the ankle is sufficient. If necessary, crutches can be borrowed e.g. from the FSHS. Walking with crutches should be as natural as possible and it is important to take equally long steps with both feet. If stepping on the foot is painful, the injury should be examined by a doctor. Cold therapy and elevation of the foot should be continued for 2 to 3 days if swelling is pronounced. When necessary, cold therapy can be repeated later if swelling occurs after exertion. Bending your toes is important from the very beginning to promote blood circulation in the affected muscles.
Bleeding in the tissue stops 24 to 48 hours after the injury. At this stage, the patient may usually start moving without crutches and start using an ankle support that prevents the ankle from twisting sideways (can be borrowed from the FSHS). In a normal ankle sprain injury, this ankle support is used on average for a couple of weeks. In some cases, longer-term use of a lighter ankle support is more appropriate, and for athletes a 3-to-6-week support period is recommended. A ligament usually takes 3 to 6 weeks to heal. Most ankle sprains heal within a couple of months, though in some cases, recovery can take several months. Determined rehabilitation that lasts for weeks or even months is needed to achieve sufficient elasticity, strength and mobility.
The best outcome can be achieved by combining good first aid with active rehabilitation. Ankle physiotherapy exercises should be started as soon as the pain allows (Exercises after ankle sprain - phase I and Ankle stretching). To start with, exercises can be performed with an ankle support. Those eager to exercise are not always patient enough to wait but start vigorous exercise too early. Signs of healing include painlessness and recovery of range of movement and strength. The physiotherapists and public health nurses at FSHS can give you more detailed instructions on mobility and strength exercises (Ankle physiotherapy exercises - phase II and Ankle stretching). If necessary, e.g. during sports, the ankle can be taped (see Ankle taping) or an ankle support can be used that allows movement but prevents the foot from moving sideways. There should be no return to sporting activity before the ankle is painless and normal mobility and strength have been achieved (standing on tiptoe on one foot is a good test). The break from sporting activity should last for 1 to 3 months.
Article written by physiotherapist Seija Salmikivi
Article updated by physiotherapists Kati Kauppala and Marko Hänninen/2 May 2012
Key words: Physiotherapy, Ankle, Spraiden ankle