Why do I keep spraining my ankle?

This is a very common problem, and in my day-to-day practice I talk to many patients who are fed up with frequent ankle injuries. To understand this, we initially have to focus on what happens in an ankle sprain.

Normally it is the ligaments stabilising the ankle joint that are affected. The most common type of ankle sprain is where the ligament structure on the outer side of the ankle is damaged. This is termed lateral ankle sprain, and can occur when we twist our ankle outward and place excessive strain on the ligaments present around those areas – the anterior talofibular ligament (ATFL), calcaneofibular ligament (CFL), and the posterior talofibular ligament (PTFL). 

The severity of the tissue damage depends on the amount of force produced during the injury. Sources of ankle sprain include slipping off steps, stumbling on uneven ground or wearing high heeled shoes. The mechanism of the injury commonly involves the weight of the body rolling over the ankle in an unintended direction. So if your job involves wearing high heels, keeping an extra pair of comfortable flat shoes or sandals could help. You can use them intermittently to avoid continuous load over the tendons and ligaments of your ankle joint.

How can I treat a sprained ankle?

Most simple sprains will heal within two to four weeks by adhering to the following guidance:

  • Protect: Continue your day-to-day activity if you can do so without pain. But refrain from any activity that aggravates or increases your pain
  • Rest: Don’t confine yourself to bed – continue to move your ankle within its normal range of movement
  • Ice: Apply ice to your ankle for up to 15 minutes and repeat every 3-4 hours during the day
  • Compression: You can use a compression bandage to support your ankle. But remove this every few hours to allow your ankle to return to the normal range of motion
  • Elevation: Place your ankle on a cushion so it is above the height of your waist

However you may need the advice of a professional, particularly if – 48 hours after the injury – the ankle remains severely swollen, with a bluish discolouration accompanied with pain when the ankle bears weight. In these circumstances you should contact a Physiotherapist, who will advise on the appropriate level of rest or gentle recovery exercises. Alternatively, their assessment may deem the sprain to be severe enough to require a referral to a doctor.

How can I prevent ankle sprain?

Whether you are stepping out for a walk or any kind of sporting activity, it is very important to warm up and in the same way let your body cool down at the end of the session. Warming up helps to increase circulation, readying the muscle fibres so as to lower the risk of injury. 

Wearing footwear and clothing that is appropriate to your activity is one of the more obvious practices for avoiding an ankle sprain (or, indeed, various other injuries). 

‘Proprioception’ is the body’s ability to perceive its own position in space. For example, if you are running through a forest and suddenly encounter a puddle, it is your proprioception that will determine the ultimate decision made by your brain: to either jump over the puddle or take a step around the side. Whenever you have an ankle sprain, there will be alterations in your proprioception. Ankle stabilisation exercises including proprioceptive training is something that you should consider to prevent first-time or recurrent ankle injury. 

The majority of the ankle sprains I treat seem to occur in patients who have previously suffered one or more sprains. And the common factor with so many of these patients is their previous decision to put up with the pain, opting against any proper rehabilitation that would have maximised their recovery. Given the risk of recurrent sprains, it is concerning that about half of people sustaining an ankle sprain do not seek medical attention. I have many years of experience in the successful treatment of ankle sprains, and welcome contact from anyone who seeks further advice or treatment.

Muscle fever: A positive sign after exercise!

Muscle fever or Delayed onset muscle soreness (“DOMS”, to use the clinical term) is a response of the muscle to an unaccustomed exercise. Sometimes it is mistaken as a muscle strain.

DOMS occurs because of the temporary inflammation or damage to muscle fibres when they are loaded. The soreness begins a day after your exercise and usually peaks at 48 hours.

HOW and WHY does it happen?

  • Concentric (muscle is in shortened position) and eccentric (muscle is in lengthened position) exercises disrupt the structure of the muscle fibre. The effect is seen more in eccentric exercises.
  • Some studies have shown an increase in the muscle enzyme that causes muscle ache.
  • Unaccustomed exercise can cause a build-up of metabolites (a by-product of various chemical processes within the body). This build-up will force an increased pressure on our muscle tissue, with the accumulation of fluid sensitizing the nerves.

Do I have muscle fever or muscle strain?

Muscle strain causes immediate focal pain while contracting concentrically. Whereas DOMS will build over 24 hours before disappearing after 2 to 4 days.

What can I do about DOMS?

  • Active recovery: Light exercises should be performed to improve the blood flow.
  • Stretching: Gentle stretches are effective. Avoid ballistic i.e fast movements while stretching.
  • Foam roll: Gentle massaging effect of foam rolling may help to alleviate symptoms.
  • Massage: Avoid deep tissue massage. Gentle light massage may help with the draining of metabolites in the lymphatic system.
  • Wearing compression garments post-exercise can be an effective way to reduce DOMS and accelerate recovery.
  • Hydration: drink sufficient fluids before, during and after exercise to reduce the likelihood of muscle fever
  • The prevention of muscle fever is the very reason we are taught to perform warm-up and cool-down exercises before and after every fitness session.

DOMS is actually a positive sign that your muscle is recovering into a stronger state. 

Please follow the tips to improve your symptoms and let us know how it helped.

Happy exercising!