Rapid Ankle Sprain Recovery

Ankle sprains are one of the most common running injuries. Luckily, I’ve been able to run for years without any bad sprains. I took pride in how strong and stable my ankles were. Then disaster struck! I rolled my ankle badly in the midst of a long run. To make matters worse I had to run another 2 hours on the sore, swelling ankle to get back to the car. I was maimed and feeling depressed about the prospect of being out of action. But through a combination of modern recovery principles and a little “bro science,” I was back on my feet and running within 4 days. Here’s how I did it.

Disclaimer: I am not a medical professional and am only telling you what worked for me and there’s no guarantee it will work for you. Some of this article is based on best practice, some is not.

The Incident

I was out for a Saturday morning group run along Thark Ridge and the Montagu thumbs. A few of us in the group were preparing for the kMR mountain marathon and getting some on course training. As we ran, Renae told the story of how she badly rolled her ankle when running down Cathedral Rock during kMR last year, this turned out to be a premonition. Her ankle remained swollen for quite some time and a colleague of her’s (both physios) recommended drinking a stout each night to reduce the swelling. Supposedly this prescription proved effective and I remembered this important piece of information.

As we scampered across the Montagu Thumbs I stopped to admire the view. I grabbed my phone to take a photo and took a step while looking out at the view rather than where my foot was going and rolled my ankle badly. I hobbled on hoping to run it off. But it soon became apparent that this was far worse than the usual harmless ankle roll.

I could still run despite the pain, so I tried to ignore it and hoped it would settle. If I were closer to civilisation I probably would have stopped right there and then. But I was on top of a mountain and still able to move. There isn’t much other option than to run back down or call a helicopter. The latter of which I would only do if I was knocking on deaths door.

So I ran onwards down the steep slopes of Cathedral rock, trying my hardest not to roll the ankle again. At North West Bay River we stopped and waited for the rest of the party. After about 10 minutes I decided to push on alone because I was worried about my ankle cooling down and getting extremely sore.

Before running off I asked Renae her professional opinion on what to do with my ankle, she’s a physio after all. She said avoid ice, elevate it, compress it and keep it moving. I will elaborate on these points later and why they are good recommendations. So on I went alone down the pipeline track for about 8km. I was impatient to finish so I ran faster that I probably should have. Eventually I made it to the car in Ferntree. After stopping for a few minutes I could hardly walk the pain was so intense.

The Aftermath: A Swollen Bruised Kankle

I drove myself home and hobbled around packing away my gear then laid myself down and elevated my foot. After an hour or so I got up to walk to the kitchen and the pain was intense. I had to lay back down and my foot kept throbbing intensely. I cancelled my plans for the rest of the day feeling unable to walk, let alone leave the house.

My ankle was incredibly swollen and sore. I spent the rest of the day mostly immobilised trying to reduce the pain. I elevated my foot and did ankle circles trying to keep some gentle movement in the ankle. While I laid around I started feeling the doom and gloom of an injury plaguing me but Renae messaged assuring me I’d be recovered soon. I held out hope and didn’t allow myself to get too depressed till I gave it a few days.

The swelling remained for a few days and eventually the ankle bruised on both sides. Read on and I will talk about the process I went through to fix myself as rapidly as possible.

Understanding Ankle Sprains: Grades and Severity

Obviously I googled my symptoms in search of a prognosis and a quick fix. I learned that not all ankle sprains are created equal. They’re typically classified into three grades:

• Grade 1: Mild stretching of the ligaments, minimal swelling, and slight pain. (1-3 week recovery)
• Grade 2: Partial tearing of the ligament, moderate pain, swelling, and some instability. (3-6 week recovery)
• Grade 3: Complete tear of the ligament, severe pain, swelling, and inability to bear weight. (up to several months recovery)

Based on the pain and swelling I experienced, I estimated mine was somewhere between a Grade 1 and Grade 2 sprain. It was painful, but I could still put some weight on it, which gave me hope for a quicker recovery.

The sad part about googling my symptoms is learning the extremely long and conservative estimated recovery times. I am convinced the medical world is too conservative with the recovery of soft tissue injuries and I am determined to beat their timelines by a long way. Most search results still recommend the RICE method despite this no longer being best practice.

Rethinking Recovery: PEACE and LOVE Over RICE

The first thing most people tell me if I say I have rolled my ankle is to put ice on it. The RICE (Rest, Ice, Compression, Elevation) method is still pervasive despite it no longer being a recommended best practice for soft tissue injuries by many health professionals.

These days it’s all about the PEACE and LOVE. I first heard of PEACE and LOVE a few years ago when the Podiatrist told me to treat my foot with PEACE and LOVE. Initially I thought he was some kind of hippy suggesting that through a peaceful and loving approach my foot would heal. But he went on to explain that it is another acronym similar to RICE, albeit longer and harder to remember.

The RICE method is now almost 50 years old and is considered outdated. Even the doctor that coined the term, Dr. Gabe Mirkin, has since recanted his support of the method in 2015. Interestingly, the idea of using ice comes from the story of a severed arm being preserved with ice before being reattached in 1962, sparking the theory that ice helps preserve tissue. Then due to the retelling of the story and facts changing in the retelling people began to consider the use of ice for any injury regardless of the severity (Source).

There is now the notion that ice and rest do not enhance the recovery process and may even slow it down. Both rest and ice reduce blood flow which is crucial to the healing process. And there was never much evidence to support the use of ice in the first place.

The word ‘Rest’ is a runners worst nightmare, especially if it’s prolonged. So, I was happy to hear of this new acronym that shuns the rest. PEACE and LOVE is a two part acronym, the PEACE is for the acute phase of the injury then the LOVE is for the rehabilitation phase. This is what the acronym stands for:

PEACE (Immediate):

• P – Protect: Limit movement/stress, note it doesn’t say rest
• E – Elevate: To reduce swelling, elevate above the height of the heart
• A – Avoid: No anti-inflammatories (NSAIDs)
• C – Compress: Control and reduce swelling with compression
• E – Educate: Understand your injury and the recovery pathways

LOVE (Later):

• L – Load: Gradual movement letting pain be the guide, sometimes called optimal loading
• O – Optimism: Positive mindset, this helps a lot
• V – Vascularisation: Increase blood flow to promote healing
• E – Exercise: Restore function and increase blood flow

My Recovery Procedure

The day of the accident I protected the ankle as much as possible and elevated. I avoided ice and anti-inflammatories despite the pain. The inflammatory response for an injury like this is good, it’s part of the healing process and ice and anti-inflammatories can inhibit the response and prolong recovery. I did take a few paracetamol and I think this did help with the pain.

I avoided compression initially because the pain was too much but on the second day I bought a strap and Renae gave me a compression stocking. With the pain subsiding I made an effort to gently move and load my ankle using the pain as a guide. Pain is the body’s way of telling what movement is ok and what is not.

The reason that movement is recommended over total rest is because the the lymphatic system plays a crucial role in managing swelling by transporting excess fluid, proteins, and waste products from tissues back into the bloodstream. Unlike the circulatory system the the lymphatic system lacks a central pump. Instead it relies heavily on external forces, such as the contraction of surrounding muscles and body movements. It also promotes blood flow to the effected area which aids in recovery.

One extra Physio trick is a thing called the ‘night wrap’. Typically it involves liberally rubbing a topical anti-inflammatory such as voltaren and hirudoid cream on the effected area before bed then wrapping the area in glad wrap. Since I was avoiding anti-inflammatories I opted for a night wrap consisting of just hirudoid cream which is designed to aid with sprains, swelling and reduce bruising. Then on top of the glad wrap layer I would apply my compression sleeve too. I followed this protocol for four nights in a row and it worked wonderfully at reducing the swelling and pain.

Bro Science and Wives’ Tales: The Guinness Method

Since I am impartial to a pint of stout and willing to try literally anything to help my ankle get better, I purchased myself a six-pack of Guinness, for medicinal purposes of course.

When I researched whether there’s any truth to the rumor that stout could help with an ankle sprain, I found little evidence. Most sources say it is detrimental because the alcohol acts as a blood thinner and makes bruising worse. There are some claims that the iron, polyphenols and such may be of benefit but the alcohol probably cancels out any benefits.

Regardless of the health benefits a stout each night definitely helped me with the Optimism part of the PEACE and LOVE. It was an enjoyable ritual with a nice calming effect to self medicate myself through the injury trauma.

Going off on a slight tangent here; while researching Guinness I learned that the widget, the small plastic device in the can of Guinness to make it nice and creamy, was voted the best invention of the year in 1994. It beat the internet in a peoples choice award. Some would argue that even today, knowing what the internet has done to the world, maybe the widget still is the better invention.

Returning to Activity: Promoting Blood Flow and Healing

In the days following, I was quick to resume activity, both to help the ankle and to maintain my sanity. I went for walks, rode my bike and did elliptical at the gym. Elliptical is mind numbingly boring but I find if I get a good audiobook on the go I can find enjoyment in at least getting my heart rate up and doing something. I am such a cardio addict that I feel a type of malaise when I don’t exercise for a few days.

While I was on the elliptical I looked at my elevated heart rate and visualised the blood flowing down to my ankle and ligaments and healing them. This greatly improved my morale. There is a lot to be gained in visualisation in events and outcomes in life so why not apply it to the healing of my ankle.

Strength and Conditioning of the Ligaments

Once the swelling and pain allowed, I began loading my ankle again. I have a family plan on Strava Premium and Recover Athletics is included in the subscription. I have been following an ankle rehab strength routine on there and doing it almost every second day. Even once the pain had subsided I noticed that my single leg balance on the right leg is terrible. The little ligaments that do all of the micro adjustments for balance still need a significant amount of conditioning. The workout is shown below and I’ve included a link for those that use Recover Athletics.

My Road to Recovery

I’ve created a diagram below showing my road to recovery. I took 3 days off running completely but I didn’t rest, I kept active and cross trained. Then on the fourth day I went for a short 5km run at a super cruisy pace. The ankle still had pain but it was about 2/10, I monitored it and was going to stop if it got worse. I noticed that I was incredibly tentative with my footing not trusting my balance yet.

The first run back gave me confidence to keep running the subsequent days. Despite the impact of running the pain and swelling kept subsiding. I ran with my ankle taped for extra support and to prevent the swelling coming back. Trails were avoided in favour of flat running for quite some time till I felt more confident in my ankle stability. I was signed up to be a sweeper at the Tayayna ultra and was worried about my duties. But the ankle kept rapidly improving and once the week arrived I was confident I was going to be ok moving at sweeper pace.

I had a great time sweeping at Takayna and my ankle held up well. I even went for another run afterwards. Now as I write this I just did an 18km run on trails and my ankle was mostly fine. There is still some tenderness and I still have a lot of work to do to get back to my rock solid ankle stability. But I feel as though I have recovered far quicker than the google doctor prognosis. Hopefully the ankle can survive the kMR mountain marathon in a couple of weeks, that will be the ultimate test.

Conclusion: Moving Forward

Recovering from an ankle sprain doesn’t have to be a long, drawn-out process. By combining modern recovery principles, a few pints of Guinness, and a proactive approach to movement, I was able to bounce back quicker than expected. In a weird kind of way I kind of enjoyed the recovery process and feel like I’ve learned a lot about myself and how to treat soft tissue injuries.

I hope this post encourages others to tackle their injuries with a holistic mindset: listen to your body, stay optimistic, and don’t be afraid to find little joys along the way. Sometimes, a bit of Guinness-fueled optimism is just what the doctor didn’t order, but probably should have!