Introduction
This is an unplanned first entry! I am going to use the embarrassing incident of me rolling my ankle completely unnecessarily as an educational tool for you. The aim is to show you my journey and thought process throughout my recovery all the way from day 1 until full return to activity. In doing this I hope you pick up some clever and useful ways to manage your own injuries, particularly in the first couple of days before you get to see a physio.
On that note, this is 100% not intended as a replacement for seeing a medical professional. It is only meant to support and speed up your recovery, as well as educating you on the importance and usefulness of early intervention that is all based on active recovery while you also seek professional guidance specific to your case.
The injury is an ankle sprain but many of the principles will apply to similar musculoskeletal injuries around the body.
Day 1: 20th December 2022 – The Incident and Early Intervention
The reason I referred to the event as embarrassing is because I really should have known better. I set myself up for lateral bounds (jumping side to side from one foot to the other) too close to my squat rack and with my back to it. Unfortunately on one of my take-offs I went slightly backwards without realising and landed on the foot of the squat rack, which forced my foot to roll inwards. Normally I am very aware of environmental hazards but for whatever reason I didn’t spot this risk. So it happened and I couldn’t do anything but experience the movement, which felt longer than the brief second it no doubt took, and quickly hobble onto the ground, cursing and panicking my dog in the meanwhile.
It hurt initially but then the pain subsided as I watched a golf ball lump evolve at the front of my ankle. The pain decreasing is pretty typical in a joint injury – swelling seems to stifle nerve sensations in my experience, I remember the same happening for my ACL tear. It can also be because nerve endings can be damaged and so they lose their ability to transmit signals as strongly as before until they heal.
Swelling in a joint is known as ‘hemarthrosis’. It often appears excessive in ankle sprains so don’t panic when you see it because it is not consistently a useful measure for the amount of damage that has occurred. It will however interfere with your joint mechanics and can stiffen it up and lead to atrophy (loss) of the muscles which is not something we want.
So here is what I did for early intervention on that first evening to limit it stiffening up and weakening.
- I encouraged my dog Russ to bark very loudly so my boyfriend would hear and come down. Pretty handy! He was able to distract Russ and then took care of a lot of things for me like arranging an ice bath for my foot and serving me dinner.
- Every hour I did 10 minutes of the ice bath which was 4 rounds before bed.
- In between, I kept the foot elevated in a pain free position and moved it in all pain-free directions regularly. The movements were tiny sometimes but larger when things were feeling better. I also did very gentle self-massage (see video below).
- I got up and walked around as needed – I didn’t need to avoid weight-bearing altogether, though my method of going down the stairs made me feel like I was about 90 years old.
- I took 2 paracetamol over the course of the evening. Ibuprofen is touted as being the monarch of anti-inflammatory medicines but paracetamol has been shown to reduce swelling and is used routinely after surgeries. It doesn’t have the bad rep of causing stomach issues so I chose to take it instead. I don’t actually like using medicines but my boyfriend Ian wouldn’t really shut up about it (though he was far more in favour of ibuprofen) and I decided it was worth it in case there was some pain when I was trying to sleep. Having a bad sleep after an injury is something you want to avoid because sleep is vital for recovery.
- Before bed I wrapped a loose bandage around my foot in a figure of 8 pattern. This does not have to be done in an exact way; the main goal would be to choose a level of tightness that is only slightly compressive and elicits no pain from pressure, then or in an hour’s time so leave some wiggle room. The goal of this move was to limit swelling overnight, though there’s only so much you can do here as the lack of movement for so many hours is always going to increase the likelihood of more swelling.
- I drank plenty of fluids (kombucha and water but go for whatever you like that is not full of sugar) to maintain good hydration to help circulation and healing.
- Lastly, I did some lymph massage techniques on the ankle, followed by the ‘big 6’ from a course I bought before called The Body Aquarium: Lymphatic Mojo. I will be doing this daily. Lymph is huge when it comes to healing. Lymph nodes exist all over the body and in large clusters in particular regions. They contain a lot of important nutrients and immune support cells like lymphocytes. You can read more about the lymphatic system here: https://my.clevelandclinic.org/health/articles/21199-lymphatic-system
Day 2
Today is about assessment! Watch the videos below to see what joint actions I check, which ones are my problem ones to avoid for the moment and how I approach walking to avoid developing unnecessary stiffness and compensatory patterns.
On this day, I continued with my work agenda of adding another strength session recording to the Fitness Hub. In the workout I ended up needing little to no modifications. Make sure you don’t assume you can’t do anything based on your injury, it is far from reality for minor injuries where you can still walk around. You simply won’t know until you try in a lot of cases. HOWEVER, importantly, I put my ankle straight back into an ice bath for 10 minutes after the workout as I knew there was a risk of some extra swelling. I also recommend that even if you can jump, where swelling and healing are occurring, any plyometric and running activity is contraindicated.
I did an ice bath for 10 minutes every 2 hours before bed on day 2.
Before bed, I had restored open chain plantar flexion to feeling 100% comfortable and full range.
Day 3
On day 3 I checked my ankle dorsiflexion range of motion which was 11cm on the left (injured) side and 14.5cm on the right (from the skirting board rather than the wall). This increased just an hour late to 14cm on the left but it was painful. This is the primary mobility check for any ankle sprain. Often it will stay unknowingly reduced for years if not looked after.
I did a normal workout as per my programme without issue plus some balance board work for fun.
Days 4-7
On day 4, I enjoyed a Christmas day and did no more than the usual icing and walking the dog.
On day 5 I was feeling good enough to challenge myself with higher level positions and drills to see if I could notice any functional issues, pain or apprehension. The video below is a snapshot of what I did. Clock reaches were not comfortable in all directions but otherwise everything else felt normal and strong.
Days 5-7 were Christmas eve to Stephen’s Day. I did not force myself to think of having to ‘rehab’ beyond the quick assessment above because these days mean a lot to me when it comes to personal and family time and I had no pressing deadlines to get back to full fitness. I went on long walks through forests (excellent for proprioception) and similar and kept up daily ‘the big 6’.
Days 8-14
These days aren’t too different from each other so I’ll put them all together. The bruising actually got worse this week which is normal. Along with it though did come increased tenderness. The colours progressed in the usual bluey-green-yellow manner and the swelling continued to go down bit by bit. I allowed myself to go running when the swelling was low enough, which was day 13. I just did a 2km fast paced run (at the end of a strength session) and iced it afterwards. At this stage I am only icing after activity I think could aggravate it, which will mostly be running and jumping.
Image: Some photos of the progression of bruising and swelling during week 2
Day 15
My neurological function is great. Everything around it is robust and I am capable of returning to play. However my rehab is NOT over as I still have some bruising and swelling to take care of. Once they’re gone I expect my knee to wall test to be 100% in both range and comfort, as well as my toe sits and heel sits. If they’re not, I have some extra work to do on myself. I also still need to monitor my training loads to ensure I am not over-stressing the joint and under-recovering. It is far easier to heal things back to normal now than to have to try to do it in several months time; this can mean also dealing with other stressed out areas of the body that had to increase their workload becasue the ankle couldn’t do its job at 100%. It can become a domino effect!
