What a recovering ankle sprain should look like
Many of us have experienced an ankle sprain at some point in our lives. Perhaps we stepped off a curb wrong or landed on someone's foot during a basketball game. As a result, our ankle rolled outward while our foot turned inward, rapidly stretching and damaging the ligaments on the outside of the ankle.
Ankle sprains are extremely common in the athletic population, with millions occurring each year in the United States alone. In most cases, ankle sprains will heal in a straightforward and uneventful manner. As this occurs, the body progresses through three independent yet overlapping phases of healing, designed to repair the damage and restore function.
These stages of healing are termed the inflammatory, repair, and remodeling phases, respectively, and here is what you should look for in each.
Inflammatory phase
The first stage of healing after injury is the inflammatory phase, which commences shortly after the sprain and is the body's first-aid response to injury. The damage sustained to the ankle ligaments triggers a release of chemicals that create localized swelling and recruit specialized cells to repair the injured tissue.
The hallmark signs of the inflammatory phase are constant pain, redness, swelling, heat, and a loss of function. Under normal circumstances, the inflammatory phase lasts about a week or so. It is during this time frame that protection from further injury is essential. Rehab should consist of gentle movement that doesn't exacerbate pain. The guidelines of PEACE & LOVE, which I outlined in a recent column, can be employed during the inflammatory phase to enhance recovery.
In some instances, imaging may be required to rule out the presence of a fracture or an injury that results in structural compromise. Your healthcare provider should make this determination based on your presentation. Fractures and structurally compromised injuries are beyond the scope of this column as they behave differently from simple ankle sprains.
Repair phase
The second stage of healing is termed the repair phase. Here, the body sets in motion events to repair the damaged tissue. During this phase, which typically begins 7-10 days after injury and can last weeks, pain and aching should progressively lessen in frequency and intensity. Inflammatory cells, present in great numbers during the first week of healing and the source of constant symptoms, decrease in number during the repair phase. As a result, the constant pain due to chemical irritation will give way to pain felt only when the injury site is stressed. In other words, inflammatory pain is replaced by mechanical pain.
During the repair phase, the specialized cells recruited during the inflammatory stage will amplify their production of new tissue to repair the original damage. These cells do so by laying down a structural protein called collagen, the building block of ligaments and other connective tissues. Most of this collagen is deposited by the third week after injury.
Unfortunately, this new tissue does not have the same physical properties as the original ankle ligament. In healthy tissues, collagen fibers tend to be oriented parallel to one another in the direction of stress commonly applied to that tissue. Interestingly, when collagen is laid down during the repair phase, the body tends to do so haphazardly. The result is a tissue with less strength and flexibility than it had initially.
Thankfully, we can mechanically influence this new tissue through progressive loading. During the repair phase, you can stretch your injured tissue as long as any pain produced by the movement is mild and settles down shortly after coming out of the stretch. Overly vigorous activity during this time, evidenced by aching that remains aggravated long after loading subsides, can re-trigger the inflammatory cycle and should be avoided.
Remodeling phase
The third phase of healing is called the remodeling stage. By the time this phase begins (roughly 3-4 weeks post-injury), much of the recently deposited collagen has been laid down to repair the original tissue damage. During the remodeling phase, which can last months, this newly formed tissue tends to shrink and shorten. This contracted tissue will be weaker and less flexible than normal tissue and will cause pain, stiffness, and weakness when attempting to return to regular activity.
Similar to the repair phase of healing, we can influence the function of this new tissue through proper mechanical stress. During the remodeling phase, loading can be more vigorous than it was previously. This loading results in a robust tissue that enables the individual to return to normal function. Even though you can be more forceful during the remodeling phase, you should still let symptoms guide you. Any pain produced with loading should settle down quickly after stopping the movement.
In most cases, from the time of an ankle sprain to a couple of months post-injury, the body will have progressed through three unique but overlapping phases to heal the damage. When adequately stressed through appropriate movement, the healing tissue reaches a point where it nearly resembles the original tissue.
If symptoms don't abate within this time frame, or if full range of motion and full function aren't achieved, it could indicate that the injury wasn't adequately rehabbed or diagnosed. Lack of appropriate exercise is the most likely reason why soft tissue injuries such as ankle sprains don't fully recover. Failure to adhere to the stages of healing or the ability to recognize atypical presentations may also result in incomplete recovery. In these cases, further assessment is required to provide necessary intervention.
Dr. Jordan Duncan was born and raised in Kitsap County and graduated from the University of Western States in 2011 with a Doctor of Chiropractic Degree. He practices at Silverdale Sport and Spine. He is one of a small handful of chiropractors in Washington state to be credentialed in the McKenzie Method.
This article originally appeared on Kitsap Sun: How to monitor recovery from a sprained ankle
