A strained ankle or tendonopathy can be very painful and annoying to many people who train. It is particularly common in runners and footballers who are constantly rolling their ankles. We all know that it hurts and seems to take ages to heal but what is actually happening to the ankle and how can we speed up the healing process to get us back to full fitness?
Lets make it simple, there are four phases of recovery in any injury, and the symptoms are easily recognisable and easy to treat.
1.The Inflammation phase, approximately 72 hours from the injury: This is the instant response to any injury where by the body lays down an instant protection of edema and blood to the area to protect you from further injury.
These are the classic symptoms of the inflammation phase:
•Pain- due to the chemicals stimulating pain and telling you that you're injured;
•Swelling- Due to the blood and edema influx to the area to remove damaged cells and protect the area from further damage;
•Redness and heat around the area- Which is due to vasodilation (widening) of the blood vessels surrounding the tendon which allows blood and 'the healing soup' to the area.
•Loss of mobility and use- Due to increased swelling and pain.
How do I treat this?: A simple way of limiting the effect of inflammation is to use an ice pack for ten minutes followed by ten minutes of compression from your hand. This simple effect known as the 'Hunting effect' will restrict inflammation whilst also flushing the area and promoting circulation in the area.
2.The Proliferation phase, approximately 2-3 days from the injury: This is where instant Type III Collagen (Scaffolding) is thrown down around injured area. This scaffolding or collagen allows repair and regeneration by building up scar tissue.
Normally you would feel like you could weight bear on your ankle, but it will still feel very weak and delicate on movement.
How do I treat this?: In order to encourage the fibroblasts (builders) to the area to lay down the scaffolding you must encourage circulation and red blood cells. This means using a hot water bottle for 15minutes to remove the 'healing soup' from the inflammation phase, and encourage builders to the area. You can do this by moving the joint in open chain exercises (Basically movement without weight bearing).
3.The Remodelling phase, This is approximately 6 weeks to 2 years from the injury: This is when the collagen (scaffolding) is realigning to orientate itself into its old positions. It can take years before the injury is fully healed and the collagen has matured into Type I, which is what you originally started with, pre injury.
You will know when you have reached this stage as you will be walking normally and fully active again.
But how do I reach this phase?: This is what Physiotherapy is all about, mobilising, manipulating and exercising the joint to align the fibres.
The best way you can achieve this is through building up the surrounding muscle and slowly returning to your active lifestyle.
Try walking in a swimming pool first, as you can slowly load the ankle without your full weight. Then, when ready try standing on one leg- how's your balance and strength? If it is good try to stand on one leg on an unstable surface. Then if that feels good try hopping on your bad leg.
If you're a keen runner then try gentle jogging, BUT make sure you have good ankle support in the early days. It is best to build up slowly as once you have damaged your ankle it is more susceptible to further injuries.
*Dave's Tip = Don't leave the ankle support on for too long, otherwise the muscles and tendons never fully recover their strength because they are constantly acclimatised to the support being there. You need to leave the ankle strap at home eventually!