First Aid Treatment for a Sprained Ankle
Updated: Oct 16, 2019
"E" has sprained her foot really bad. Recommend treatment?
That looks painful and nasty.
(the irony of this inquiry is I sprained my ankle yesterday, just hours after writing this post. Gosh it was painful - all I could do for the first few minutes is lie on the ground and groan due to the paralysing agony!
I'm fine but sore today and will be back in action as of tomorrow).
The first thing that she needs to be doing is getting her leg up, elevated above the level of the body. The worst thing she can be doing right now is letting her leg dangle the way it is in the photo. All of the hydraulic pressure from head to toe is forcing more and more blood and fluid into the damaged ankle tissues. This will compromise healing.
Healing, proper, can only commence AFTER dead blood, dead tissue and toxic fluids are removed from the site of damage.
The key to making a rapid and full recovery from this kind of injury is to prevent bleeding and swelling in the first place.
Please read this series of articles:
Immediate First Aid
Immediately lie down and elevate the injured limb and do so for the best part of 20 minutes before getting up and moving. The only exception to not moving is to make yourself safe. This gives time for blood to clot, sealing off ruptured blood vessels, thus minimising bleeding into the injury site.
Apply compression at the earliest time. This is by way of one or more elastic compression bandages to cover the leg from the toes to the upper calf. Do not just compression bandage the ankle. If you can not compress, do not worry - elevate! You can compress by pressing carefully but firmly on the injury site while it remains elevated by using the broad, flat area of the palm of the hand.
Keep warm and dry.
What about icing the injury?
Icing the injury does nothing of benefit beyond what is achieved by compression and elevation. It may give a little pain relief. Attempting to ice the injury may end up compromising compression and elevation, such as when putting the ankle under a tap or into a stream.
Excessive icing may damage the skin and underlying tissues which are already seriously stressed. Concentrate on compression, elevation, lying still and relaxing for 20 minutes.
Keep Elevation and compression going for about 36 hours to give plenty of time for the ruptured blood vessels to seal so that there is no further bleeding and swelling into the damaged joint and tissues.
Full-length compression stockings and tights may be beneficial to control swelling once the initial swelling has gone.
Elevate the leg while sleeping. Go to bed with little or no compression since doing so may cause pain and cramping.
What about Arnica?
My experience with using Arnica on sprains, strains and bruises is limited, partly because I have not noticed anything of significant benefit, but many people swear by it. There is some evidence that it may assist healing:
Should I immediately go to Accident and Emergency for an Xray?
No. unless it is by ambulance, go home, lie down and keep the leg elevated for the next 1-2 days. If you suspect there may be a fracture nothing is lost by waiting a day. In fact, there is much to gain by waiting. If you rush straight to the hospital your first aid treatment may be compromised and you will be sitting around, tired, cold and hungry. It is likely that the journey to the hospital, then what may amount to hours of waiting with your leg not being elevated will cause the injury to blow out with blood and fluid. If the injury blows out then there can be no treatment, even if there is a fracture, other than giving you a compression bandage, or moon boot, a pair of crutches and some painkillers. What a waste of time! You will be sent away and asked to see a doctor in a week or two when the injury is more treatable.
If you go home, all the time keeping the ankle elevated and compressed, then go to the hospital a day later, timing the visit for a quiet time at the hospital, your injury can be treated properly on the spot. You end up expediting your recovery by at least a couple of weeks. More like a month.
Can I apply heat?
Yes, definitely! From 48 hours recovery is expedited by heat such as a long, hot bath. Add a few handfuls of Epsom Salts to the bath.
Increasing cellular temperatures causes an exponential increase in metabolism which means healing is accelerated. Do not apply ice other than to relieve pain.
Continue to compress and elevate between bathing.
You can also use a heat pack, water bottle or infrared heat lamp, or a sauna, but elevate the leg while doing so and take care not to overheat and damage the tissues.
When can I resume activity?
If there is no fracture, resume gentle exercise after two days. Waiting longer than 2-5 days to begin exercise is counterproductive. If the first aid measures were followed from the moment of the injury, recovery is going to be fast and uncomplicated. Gentle and progressive exercise will assist recovery.
Exercise can begin with walking about the house barefoot for several minutes at a time then gradually ramping that up from one day to the next.
Walk normally, with weight evenly distributed between feet and do not allow the foot to splay out like that of a duck since this could become permanent.
Cycling is excellent and can be started within 48 hours of the accident but take care not to have any unplanned dismounts!
Here is a video for ankle rehab exercises that I made after I seriously smashed my left ankle several years ago (I am fortunate to have recovered as well as I have !):
Elevate and rest the limb between exercise. Do not stand around increasing the hydraulic pressure in the leg! If your job involves a lot of time on your feet please delay the return to work until you have the swelling minimised.
When can I resume running?
Running can be resumed at about one-week post-accident. If it is not possible to jog without limping then it is too soon to begin running. Go back to walking and cycling for a few more days then have another go.
Should I have Physiotherapy?
Your injury should be covered by Accident Compensation so you should be eligible for either a free or heavily subsidised treatment.
But here is the potential problem:
the effort of getting to and from the clinic, the waiting around at reception, not being able to elevate the limb and so on may mean that any benefit from the treatment may be offset by the increase in swelling and pain.
In my experience you are better off staying at home resting, leg elevated and concentrating on recovery and gradual self-monitored mobilisation for the first week. Then consider having a few physio treatments.
Should I take pain-killers and anti-inflammatories?
Do not bother.
Anti-inflammatories do not aid recovery and may even compromise rebuilding a strong structure.
Avoid taking painkillers unless you are suffering. The best time to take painkillers if you must is at bedtime if you find the pain is interfering with sleep.
What supplements are there to aid recovery?
There are three that I have no hesitation to recommend and these are very safe to take and effective (Read the technical stuff to understand why these are beneficial):
https://www.garymoller.com/product-page/reparen-120-caps Assists in tissue healing, bone and ligament repair.
https://www.garymoller.com/product-page/ast-exclzyme-90-caps Reduces inflammation and assists the removal of clotted blood and dead tissue.
https://www.garymoller.com/product-page/allergyresearchgroup-tocomin-suprabio-tocotrienols Assists in tissue healing, building pliable scar and bone-building.
If there is a fracture, these supplements are even more beneficial.
Months have passed, what can I do about residual pain?
One of the legacies of ankle injuries is residual pain. I say that this background pain is there as a reminder that you need to take a little extra care not to sprain again, but also to keep working to improve your ankle strength, flexibility and agility. While this pain should not prevent ot limit activity it can be annoying.
Massage, stretching and strengthening exercises will help. If the pain persists, consider shifting some of your high-impact activities such as running to ones such as rowing, cycling and swimming. Consult an expert about foot exercises.
Please read this article about residual ankle pain:
Your foot may be pronating excessively after the injury (common):
Get a pair of supportive above-ankle shoes with moulded innersoles. This will be as good as or better than expensive orthotics in most cases.
If you have any doubts that the injury is anything less than minor, please go to A&E or your doctor 24-36 hours after the sprain or sooner if you are certain that bleeding and swelling have been stabilised.
If there is an obvious deformity immediately following the sprain, do your elevation and compression for an hour or two, clean yourself up and have a feed, then get down to A&E, all the while maintaining compression and elevation, including while waiting at the hospital.
Handy Tip if there is a fracture with a deformity
Encase the foot in a soft pillow then firmly bandage or tape over the pillow. This will provide some comfort and pain relief while stabilising the fracture site. If a pillow is not available wrap a jersey or something similar around the ankle then carefully bind it with a bandage or tape.
The medics will love you for doing this!