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Sprained ankle Q&As

Published by Bupa's health information team, April 2009.

Answers to questions about sprained ankle

This section contains answers to common questions about this topic. Questions have been suggested by health professionals, website feedback and requests via email.

 

What is the difference between a sprain and a strain?

A sprain is a stretch or a tear to a ligament and a strain is an injury to a muscle or tendon. Depending on the severity of the strain it can result in a stretch of the muscle and/or tendon, or a complete tear.

Explanation

A sprain is an injury to a ligament. Ligaments are bands of tissue that connect one bone to another. This type of injury usually occurs at the ankle, knee, elbow and fingers. A minor sprain is when a ligament is stretched or partially torn. If you have a minor sprain of the ankle walking is often painful and difficult. In a severe sprain, the ligament tears completely and causes swelling and occasionally bleeding under the skin. This is often very painful and the ankle is unstable and therefore unable to bear weight. Treatment for a sprain follows the RICE procedure (see sprained ankle factsheet for more information).

Most minor sprains will start to respond with gentle movements in all directions of the ankle. Strengthening and balancing exercises will help to achieve normal balance and coordination of muscles that support the ankle. It's best to consult a chartered physiotherapist or sports physician to determine the extent of the injury.

A strain is an injury to either a muscle or tendon. Tendons are bands of contractile tissue that connect muscle to bone. The severity of the strain depends on the degree of overstretching or tearing of the tendon or muscle. The tendon or muscle can be overstretched or partially torn. This is a minor strain. If the tendon or muscle is completely torn it's known as a severe strain. A minor strain will start to heal within a few days. However, a more severe strain will benefit from rehabilitation to speed up the rate of recovery and restore strength. A chartered physiotherapist can provide specialist advice and therapy to rehabilitate your strained ankle.

Sources

  • Ankle sprain. BMJ Clinical Evidence. www.clinicalevidence.bmj.com, accessed 23 September 2008
  • MacAuley D, editor. Oxford Handbook of Sport and Exercise Medicine. 1st ed. Oxford: Oxford University Press, 2006:46
  • Beers MH, Fletcher AJ, Jones TV, Porter R et al. The Merck Manual of Medical Information. 2nd ed. New York: Pocket Books, 2003:405-407
  • Brukner P, Khan K. Clinical sports medicine. 2nd ed: McGraw Hill, 2005:13-14
  • Sprains and strains. Background information. What is it? Clinical Knowledge Summaries. http://cks.library.nhs.uk, accessed 23 September 2008
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How long will it take to recover fully?

It can take between a few weeks and 12 months to recover fully from a sprained ankle. How quickly you recover will depend on how bad the sprain is and the kind of treatment you need for it. Unless you need surgery or have a cast following a severe sprain, the most effective way to a full recovery is to start moving your ankle and to get back on your feet as soon as you're able. You can do this by managing your pain and by starting to move your ankle and foot as soon as the pain allows.

Explanation

Recovering from an ankle sprain happens in two stages. The first stage is the two or three days straight after the sprain, when you're aiming to control your pain and reduce the swelling to your ankle. The second stage follows after that when you are aiming to gradually get back on your feet and recover the full movement and function of your ankle. How long this second stage takes will depend on how bad the sprain was and the type of treatment you have after your injury.

Mild sprains start to get better after a few days though you might find it painful for a few weeks, especially when you're walking. They usually heal in two to four weeks by which time you should be able to put your full weight on your ankle and you should not have any pain when you walk. You will be able to return to sport after two to three months. If you still have pain after the initial two to four weeks and you feel that the sprain isn't improving, see your GP for advice.

More severe sprains may take much longer to heal. Your recovery period can be anything from two to 12 months. If you need an operation to repair your ankle, your recovery is likely to take longer than someone who doesn't need surgery.

How well you follow your suggested treatment is also likely to affect how quickly and how fully you recover. Unless you have a severe sprain, which needs surgery or a cast on it, the most effective way of treating most ankle sprains is to get moving quickly. This means starting to exercise your ankle and starting to move it on the third day after your injury. You can start this gently, moving your ankle and doing any exercises that your doctor, physiotherapist or nurse has given you. By starting to exercise your ankle joint gradually, rather than keeping it immobile and resting it, you will be less likely to injure the same ankle again in the future. You're also likely to have less pain and swelling and will recover more quickly than if you were not exercising your ankle.

Further information

Sources

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Will I have problems in the future with the ankle that I've sprained?

Most people have no long-term problems after a sprained ankle. However, if the sprain is very severe sometimes the ankle can become permanently damaged. This is called ankle instability. The symptoms of ankle instability are pain, swelling, stiffness and a feeling that your ankle is 'giving way'. Many people can improve their condition by having physiotherapy but some will need an operation.

Explanation

Most sprained ankles heal completely and you won't have any long-term problems. However, sometimes after a severe sprain the damage can be permanent. This damage can be to the ankle joint itself or the ligaments around it which can become weakened. Sometimes the nerves in your ligaments and ankle joint also become damaged. This interferes with the messages that your brain receives telling you how your ankle is working.

Around one in every three people who have a severe sprain goes on to have some pain, swelling and stiffness in their ankle. Some people also find that their ankle feels less stable than it did before the sprain. If the nerves are damaged, your ankle might feel like it's giving way and you might go on to have more sprains. If these symptoms carry on for more than six months then it's likely that you have a condition called ankle instability. This is most often due to problems with your nerves rather than the joint or ligaments.

Ankle instability is usually treated first with physiotherapy. This can help to retrain the nerves in your ankle and strengthen the muscles around your joint through special exercises and activities. Your physiotherapist may also ask you to wear an ankle support or brace which can help to support your ankle. Most people find that physiotherapy and an ankle support makes them feel more comfortable.

If other treatments don't work for you or if tests show that the ligaments around your ankle joint are torn, you will probably be referred to see an orthopaedic surgeon who may consider an operation. He or she will be an expert in treating conditions which affect your bones, joints, muscles and ligaments. There are two main kinds of operation:

  • tightening up the ligaments and re-attaching them to your bones
  • using a tendon from elsewhere and stitching it between the bones where your ligaments should be

After an operation you will probably need to wear a brace or have a plaster cast for a few weeks. Then you will need more physiotherapy to help you get back the full use of your ankle. Research shows that starting your rehabilitation early, rather than being immobile, will speed up your recovery.

Further information

Sources

  • Ankle instability. British Orthopaedic Foot & Ankle Society. www.bofas.org.uk, accessed 20 May 2008
  • Sprains and strains. Clinical Knowledge Summary. http://cks.library.nhs.uk, accessed 20 May 2008
  • de Vries JS , Krips R, Sierevelt IN et al. Interventions for treating chronic ankle instability Cochrane Database of Systematic Reviews 2006, Issue 4. Art. No: CD004124. DOI: 10.1002/14651858.CD004124.pub2. www.cochrane.org
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What is the best painkiller to take?

The kind of painkiller that will be best for you will depend on how much pain you have and how bad your sprain is. For a mild sprain paracetamol will probably be effective but for more severe sprains you may need something stronger, such as codeine or a non steroidal anti-inflammatory medicine like ibuprofen. Your doctor or pharmacist will be able to give you advice.

Explanation

Each person is individual when it comes to pain. What one person describes as mild pain may be very painful to someone else. So, it's important to make sure that you take the right painkiller for you, for the level of pain you're experiencing. The type of painkiller that is best for you will depend on how bad your sprain is and how much pain you're feeling as well as your general health.

When you first sprain your ankle you can help to reduce the pain by resting, using ice packs, bandaging your ankle to give it support and by keeping your leg up. If your sprain is mild then paracetamol is likely to be effective at reducing your pain. If your sprain is more severe, you may need to take something stronger.

Another group of tablets called non-steroidal anti-inflammatory drugs (NSAIDs) have also been recommended for pain after an ankle sprain. An example is ibuprofen. However, there is now some research which shows that, although NSAIDs are effective for pain and can help people to get back on their feet again quickly, they may not be the best painkillers for your long-term recovery. Some doctors think that NSAIDs may interfere with your body's natural healing process which can mean that the repair of damaged tissues may take longer. Some doctors also feel that NSAIDs can get you back on your feet too quickly which can increase your chances of having further sprains in the future. Your GP can give you advice about whether NSAIDs are the right painkillers for you.

As well as tablets, NSAIDs come in the form of a gel or cream that you can rub into your skin. This kind of painkiller is no more effective that taking a NSAID tablet. However, if you find that NSAID tablets irritate your stomach, which is their main side-effect, then a cream or gel may be a better choice for you. Ask your doctor or pharmacist for advice.

You can buy many of these painkillers from your pharmacist, but some of the stronger painkillers that contain codeine will need to be prescribed by your doctor. Always ask your doctor or pharmacist for advice and read the patient information leaflet that comes with your medicines. If you have very severe pain, or your pain doesn't improve, see your doctor.

Further information

Sources

  • Sprains and strains. Clinical Knowledge Summaries. http://cks.library.nhs.uk, accessed 20 May 2008
  • Joint Formulary Committee, British National Formulary. 55th ed. London: British Medical Association and Royal Pharmaceutical Society of Great Britain, 2008
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Related topics

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This information was published by Bupa's health information team and is based on reputable sources of medical evidence. It has been peer reviewed by Bupa doctors. The content is intended for general information only and does not replace the need for personal advice from a qualified health professional.

Publication date: April 2009

 

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