Grade 2 Ankle Sprain - Pain After 12 Weeks

by Jock Turner
(Cornwall, UK)

36 Hours After Injury

36 Hours After Injury

I sprained my ankle (grade 2) 12 weeks ago and I still get a dull aching pain (after light jogging) and there is some residual swelling which is making it difficult to get a full range of motion when I try to stretch.

Apart from the usual lateral ligament damage, I gather there was some rupturing to the medial deltoid ligament as the pain I have now is around this area. When I first injured the ankle there was a large amount of swelling on both sides of the ankle extending half way up the lower leg.

I've just started taking NSAIDs again to try and reduce the last bit of swelling. I also started taking Glucosamine Chondroitin and Cod Liver Oil (about 2 weeks ago) which I also read was good for joint injuries.

I never expected the injury to last this long, is this normal. I don't know how to get rid of this last bit of pain, any ideas?

Thanks

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Oct 21, 2013
Limited Dorsiflexion NEW
by: Anonymous

Thx Jock so much for your detailed response!
I completely agree with your comments.
I am now entering the 10th week since my bad sprain. Still some pain (seems mostly skeletal), and some swelling.
The other big concern I have is I still have very limited dorsiflexion (and plantar flexion). So if I plant my foot flat on the ground, and then try to slowly lunge forward (without moving my foot), and try to tap the wall with that corresponding knee I cannot do it if I am more than 3.5 inches from the wall. Whereas with my good ankle/foot I can be over 7 inches away.
Have you (or others) had such limited range of motion, and did it just get better on it's own over time?
Thanks again!

Oct 21, 2013
Accelerate the healing... NEW
by: Jock Turner

Hi Chris,

If you have a lot of swelling (as I did) then this will inhibit certain ranges of natural movement. Sometimes you can force your foot into certain positions but that's normally quite painful.

The body is quite a clever thing when you think about it because it produces swelling around the injury which inhibits movement, which in turn allows natural healing.

Of course we try to accelerate that healing - nothing wrong with that - but with it comes a certain amount of discomfort.

I remember spending hours pushing and pulling my ankle to try and regain movement - and in time it all came back (without the pain!).

The best tip I can give now you are at this stage (providing there is no serious skelatel injury of course), is to concentrate on all round movement, in all directions.

Use a heat pad to increase the blood flow for 10 mins, then lots of self massage with your fingers deep into the damaged (but healing) tissue. Small circles will help to loosen and break up any scar tissue. Don't worry if it hurts a bit - you need to stimulate the bodies natural healing mechanisms.

Then after 10 mins of that try some seated stretches using your hands to pull or push the foot that extra inch or two. Then keep your foot up again for another 10 mins. Bandage during the day when you are standing to help stop any further swelling.

Do this twice a day if you can. There will still be some pain ahead but you should be on the road to recovery now.

Let me know how you get on.

Oct 21, 2013
Limited range of Motion NEW
by: Chris

Thank-you so much for taking the time to respond. I really appreciate your comments, and completely agree with what you write ;)
So I am already at the 10th week of my recovery and as mentioned still have pain (seems more skeletal), and still some swelling.
Another big concern is I still very limited dorsiflexion (and plantar flexion) range of motion (ie where I plant my foot flat on the floor, and try to tap that corresponding knee towards the wall). Did you (or any of the others) have similar issues? And did they just completely resolve with time?
Thanks again!

Oct 21, 2013
Update NEW
by: Jock Turner

Well was it really 5 years ago since I had this injury! The ankle is 100% fine again now although it is weaker than my uninjured ankle due to the fact that I have badly twisted the ame ankle at least 3 times (1 again since this photo!).

Looking back there are a couple of things that I would have done differently:

Being in the middle of training for a big race I stupidly thought I would be able to 'run' through the injury - mistake number 1. If you ever badly sprain your ankle take my advice...IMMOBILISE THE ANKLE ASAP.

Next mistake was not keeping off the ankle for any period of time. Being a busy parent, worker, person I was limping around doing lots of things I shouldn't of. Try if you can to raise the injury (especially for the first 24hrs) and use RICE. Really important - I'll say it again use RICE.

Final mistake was not insisting that I got an Xray. After a week or so I went to A&E but they fobbed me off with some bandages and NIADS. I still think there was some small break in there that kept it swollen for longer than normal - but I will never know. So if you can, insist on an xray and if you have broken anything you may have a cast or at the very least tight bandages and even more immobilisation for the first few weeks.

Some final tips: Don't get too depressed about it. Work on your upper body and core muscles. Even if you can't run you can probably swim or find some way to keep your cardio up. This is caled 'active' recovery and will help the transition back into fitness and make you feel a lot better psychologically about being injured.

Good luck - heed my advice for what it's worth and don't let your injury become chronic like mine - through stubborness!

Oct 21, 2013
Any updates? NEW
by: Anonymous

So have any of the folks that posted about their chronic pain/swelling have any recent updates - ot for that matter any folks that ultimately have had some resolution to their suffering after having pain/swelling at the 12th week?
Curious as to what I have to look forward to, being at the 12 week point and still suffering.
Thank-you!

May 13, 2013
badly sprained ankle NEW
by: leanne

I badly sprained my ankle about 17wks wks ago it gets very sore and still very puffy at my ankle should i go back and have it checked again x

Apr 07, 2013
Grade 2 Ankle Sprain - Also have pain after 12 weeks NEW
by: Anonymous

I sprained my ankle 12 weeks ago. Went to the ER and had x-ray and said no broken bones. Put a brace on it and gave me crutches and scheduled an appt. with an orthopedic doctor. Told me to keep it elevated and to ice it which I did. My foot stayed swollen on both sides up to my toes. A week later when I saw the orthopedic, I was put in a cast. I had to wear the cast for 3 weeks. Once cast was removed I was given a paper with exercises to do. At this point I had not walked on my foot for 4 weeks. Another brace was put on my ankle at this point, a lace up brace which I was suppose to be able to wear in a pair of tennis shoes. However, my ankle stayed swollen so much I could not wear shoes. After another 3 weeks I returned to the doctor who said my ankle should be healed and I shouldn't have any problems. Well my ankle still swelled after walking. I was in constant pain. After walking so much I would reach a point I could not walk anymore because the pain was too excruiating. The heel of my foot and my achilis tendon was extremely sore. I couldn't hard bare to touch my foot. The ankle hurts and bothers me so much I don't sleep good. I also felt a lot of burning sensation in my ankle where I injured it. When I asked the doctor about all this he tells me none of my symptoms have anything to do with my injury. What!! I tell him I've never had any issues before my injury. The doctor said that if my continued swelling was due to the ankle sprain, it would swell and never go down. But because when I get up in the mornings, the swelling has gone down it couldn't be from my ankle. Has anyone had symptoms such as these after an ankle sprain? I can't run, jog or anything like that. I still limp after walking for awhile. The more I walk the more stiff my ankle becomes and the more it hurts. Really need some advice.

Aug 17, 2010
i know how u feel
by:

I atually have the same problem you do. I sprained my ankel 12 weeks ago. It was blackish purple for 2 1/2 weeks. The brusing went away for the most part but it still hurts and missively swollen. The only differance is I haven't been able to get to the doctor for lack of having a ride there counting the fact I don't have a car yet and my parents think I'm faking (even tho if u look at it u can tell somethings wrong). And that I also have nerve damage for my elbow on the same side that I've been gt therapy for 3 months now. I showed my school nurse and she didn't know how I was walking (I have very high pain tollerance) and the therapist didn't know anything about foot injurys. So I know how sketchy it is having the injury last this long.

Mar 21, 2008
Keep up with the exercises
by: Bart - SII

It sounds like you have had a little mis-information. I wonder why they told you to take off the compression wrap? I haven't heard anything about it being counterproductive.

Other than that it sounds like you have done alright with your rehab. It is important to make sure that you have all of your motion back - make sure that your ankle moves the same amount as the other one.

As far as strength, lunges, step ups, step downs, heel raises, and elastic band exercises are all great ways to improve your strength. Some are more functional than others.

I believe that balance exercises are the most important part about ankle sprain rehab. Balancing on unstable surfaces - like a wobble board - is good but even better than that is balancing and then moving your upper or lower body to challenge your body. This will improve your proprioception.

If you have access to a physical therapist, athletic trainer, or physiotherapist I would try to see them for at least an evaluation and some home care instruction. You could have some joint restrictions that are causing your continued pain, or you could have some laxity in the ligament that may be causing your problems.

A good evaluation will tell you more closely what might be going on. 12 weeks and still having pain is not unheard of, but it isn't necessarily normal. I would recommend a good evaluation and then slowly work through some more exercises - and I would hold off on the jogging until you are pain free all the time with walking.

Hope this helps - comment back with other questions.

Mar 19, 2008
Futher information about the injury
by: Jock

Hi, Thanks for getting back so quick!

To answer your questions:

After the injury the first ice application was 1 hr later due to me being a couple of miles away from home at the time and having to hobble home.

Raised the foot and applied ice 10 minutes on 20 mins off for a few hours then once an hour for the rest of the day.

Next day I visited hospital (on a Saturday - no X-Ray department). After palpation of the injury the nurse's advice was 'keep foot raised, apply ice and rest. She thought there was no broken bones and told me to remove the compression bandages that I had on when I went to the hospital as the new medical thinking was that they were 'counterproductive in the rehabilitation of this type of injury'. Yes, I too was surprised with that bit of advice but as this was the first injury I had had in about 5 years, I listened to the expert (even though every piece of advice I read subsequently recommended compression!)

I asked for crutches but these weren't available so I hobbled out of the hospital and was told to try and walk as naturally as possible putting full weight on the ankle (again, weird advice but tried anyway).

Since then I have used ice on and off most days. Some days are better than others and I don't feel much, other days the ankle throbs on and off depending on the amount of time I stay standing on it.

I have tried wobble board and balancing exercises which go fairly well but still aggravate the ankle to the point where it starts to ache again. I have also tried to jog on grass for half a mile or so but it still aches usually for hours after I have finished.

I never got an x-ray even though I went to the doctor's after a few weeks worried that I might have an avulsion fracture. Doctor refused saying even if there was any fracture nothing could be done for it at this stage apart form being patient and waiting for the ankle to heal naturally.

So here I am 12 weeks on still with some swelling and pain and feeling very frustrated.

What should I do now?

Mar 19, 2008
Great Picture!
by: Bart - SII

I know it couldn't have felt good, but that is a great picture of your swelling. It looks like you had a lot, even down into your foot and toes.

Ankle sprains heal differently for everyone. 12 weeks is probably on the long side for most grade II sprains, however, it is highly dependent on the initial care, the rehabilitation you underwent, and how soon you started back to activities.

Just a few follow up questions and then I can give you better advice on where to start from an exercise standpoint -

How long were you off of your ankle - ie. on crutches, resting, etc.

Where you able to apply all of the R.I.C.E. Principles immediately after injury, especially compression?

What kind of exercises have you worked on to improve your strength?

What kind of exercises have you done to improve your balance?

Did you do any type of formal rehabilitation with a physical therapist, physiotherapist, or athletic trainer?

Did you have an X-ray at some point?

I am sure you have probably already read through most of the ankle sprain information on the site, but here is the link just in case...Ankle Rehab These might give you an idea of where you may have overlooked some things.

Use the comment box on your post to reply back and hopefully I can give you a little direction.

Thanks again for the picture!

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