How to Treat Sprained Ankles.

Whenever I get several patients who come in with the same ailment, I always feel like the universe is telling me to write about it. When that same ailment happens to me, the hint is as subtle as a two by four to the head. Such is the case with this article.

I have had a lot of patients come in with sprained ankles lately. For me, I didn’t think it was possible to sprain my ankles anymore. The ligaments in my ankles are pretty much gone from spraining them several times playing soccer in high school and college. So much for that. I rolled it jumping on the trampoline with my kids yesterday. It usually smarts initially and that is about it. This time it continued to hurt and started swelling a little, too. So, “Doctor, heal thyself!”

Here is the protocol: First you have to remember the mnemonic PRICE. P=protect, R=rest, I=ice,  C=compress, E=elevate. I stopped jumping and walked it off. I rested with it elevated. Then, I put it in an ice bucket (protocol details below). I planned on wrapping it up but it felt stable and the swelling was down when I woke up this morning so I thought I would be alright. In fact, I walked to work today and it felt just fine.

The most important thing to do if you sprain an ankle is ice it. Ice packs on an ankle are almost useless. You just don’t get enough surface contact to penetrate to the joint. If you are going to do it, be sure to leave it on for 20 minutes. However, the best way to ice the ankle is to put it in an ice bath. Here are the steps:

1.As soon as possible after a sprained ankle get a bucket big enough to fit your foot

2. Fill it with ice about 4 inches deep

3. Fill the bucket with water deep enough to reach just below the calf muscle (higher for high ankle sprains)

4. Cover the toes with a sock if needed

5. Immerse foot for 6-10 minutes until numb.

This is not exactly fun (unless you are a masochist) so, be tough. The stages of icing are intense cold followed by aching then burning then numbness. You have to get to numbness to benefit. Some people cheat a little and put on a sock covered by a baggie. This is ok as long as the sock is not too thick and there is not an air barrier in baggie. It still has to get to numb!

If you chronically sprain your ankles like I used to, you will have to rehab them. The more you sprain a joint, the worse the proprioception or the communication between the brain and the joint. In short, it becomes dull and you are much more likely to sprain it again. I recommend standing on a wobble board for several minutes each day. That will improve the proprioception and dramatically decrease the likelihood of future sprains.

6 Comments

  1. Thanks for the great advice I had a high ankle sprain a couple years ago and they did the ice bath then warm bath for the recovery stage. However I did it again, but lower down. My question was how many times a day should I be Ice Bathing??

    Thanks

    ‘Jay

    1. Great question, Jason! You can ice on the hour. Depending on the severity of the sprain, You might need to ice 5-6 times a day. Usually, morning and night are the minimum. It really depends on how swollen it is and how quickly is swells.

      1. So I sprained my ankle yesterday in a baseball game, the championship is in two days. I just now got it in an ice bucket, and I read somewhere that you should only do it for 20 minutes at a time, how long should the waiting period be until I put it back in the ice bucket?

        1. Matt, you should only leave your leg in the ice buck for about 7 minutes or until it is numb. 20 is too long. It usually takes 40 minutes to an hour to get back to body temp before you can put it back in the ice bucket.

  2. I sprained my ankle 3 weeks ago. I had xrays taken and no breaks or fractures. My ankle is still swollen and I can’t seem to get it down. I just found this website so is it too late to do the ice bucket icing for it? I’ve been taking Advil to help with the swelling. When I get up in the morning, it doesn’t seem bad but by the time noon rolls around, it’s blown back up. I have a desk job so I’m not on my feet alot during the day. Thanks!

    1. It is not too late to use the ice bucket. In fact, it will make a big difference. Ice it as long as there is swelling. Also, keeping it wrapped up during the day will help with the swelling, as well.

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