Twist and shout

[Meo]

Something happened on November 2nd, and it's not what you think : I sprained my ankle (grade II). So I'm stucked at home since then, reading trip reports, and I'm almost on the verge of a nervous (or "hikeous") breakdown... My last hike took place in mid-october, and I probably won't hike again until early december

My questions are: as it is my fourth sprained ankle in my life, but my first in my hiking "career", I'm not sure how to handle it, so is anybody here had a grade 2 or 3 ankle injury? Grade 2 is partially ripped ligaments, 3 is fully ripped (on both a long blue bruise appears). If so, how many weeks did you wait before hiking again?

Yesterday I used my bike for the first time since nov 2, and it went well. I can walk on a flat surface almost without any problem (I put an orthotic protector when I'm outside the house, just in case). I'm thinking of an easy hike in early december and a tougher dayhike (with crampons, maybe) in mid december. Between Christmas and New Year's Eve, we planned - prior to my accident - a tough Pemigewassett 5 day loop, so I must be well healed and sure of myself by then. Are my plans too ambitious?

Craving Meo

 

[trailbiscuit]

I'm not a doctor, and I don't play one on TV, but I have sprained my ankle more than couple times...

I don't think your plans aren't too ambitious as long as you are diligent with your rehab.

The real problem with sprained ankles is that they are very easy to reinjure. So, while you may be able to complete your hikes as planned, you will need to be cautious of reinjuring it. I sprained my ankle (Grade 1) in late July, and it's still not 100%. Mostly due to a couple smaller tweaks and turns because like you, I have had a very hard time staying off it. It can take a long time to get to 100%.

Be cautious, be careful and good luck.

 

[Dugan]

I don't think you're too ambitious, as long as you do some serious physical therapy (balance as well as strengthening). I sustained a very minor fracture and ruptured ligament (grade 3) this spring.

If memory serves, I used the hospital-supplied splint for approx 2 weeks, then graduated to VERY strong taping for 4 weeks, then compression taping for another couple of weeks. Throughout I did as much PT as possible, iced 2-3x/day, elevated it whenever possible, and loaded on ibuprofen. I found that my ability to recover balance on that leg was significantly affected for 5-6 months.

Within 5-6 weeks I hiked the Wapack Trail (23 miles) with a VFTT group. It was sore at the end, but the knee on the other leg hurt much worse, I'm guessing because of compensating.

If you google search various terms, you can come up with a wealth of PT exercises and taping methods.
This link is similar to what I was doing:
http://www.mindef.gov.sg/life/taping.htm
The stirrups and heel locks make a big difference. I also did a compression wrap over the tape using vetrap.

With all of this said, be careful not to aggrevate by over stressing it. I've read that grade 2 can take 6-8 months to fully heal, and grade 3 10-12 months. Mine still makes itself known on occasion.

 

[Jean]

Méo,

I have strained my ankle grade 2 once before and Nat also had a grade 2 knee strain last year.
The secret for a full recovery is to take it gradually. I think you will have no problem making your late December trip if you give your ankle 3-4 weeks of complete rest and then start testing it gradually with more and more strenuous workouts.
I know your dying to get out there asap but be patient, you wont regret it.

That being said, the problem with ankles is that once you've strained it, it becomes easier to strain again so you'll have to pay extra attention where you step in the future.

 

[jjmcgo]

rehab

Give it all the time it needs. You can't tell now whether you'll be ready by a certain date. Your ankle will tell you when it is ready. If you try to come back too fast, especially by going into wilderness areas where you could sprain it again and have a long walk out, you will extend the time needed to heal. You have a lot of life in front of you (I hope), the mountains will always be there. Heal first.
Rise on toes is a great exercise for strengthening the muscles just above your ankles. Putting your heel on the street and your toes up the curb and slowly leaning forward is a good way to gently stretch those muscles tightened by rise on toes.
Good luck, don't rush it.

 

[SherpaKroto]

Very timely. I am just recovering from similar injuries (mine were a bit worse).

When I was originally diagnosed in June with my sprain (partial tears of the Posterior Talofibular and Calcaneofibular Ligaments and Peroneous Brevis tendon), I was advised to rest it for 3-5 weeks. I rested it 3 weeks, and with Doctor's blessing, hiked Baldpate for Arm's 100th. It felt pretty good (better than before the hike). I rested it for another week then went off to the ADK's for a week. It also felt pretty good all week. Then the problems began, but I found them to be bone related, not ligament/tendon (but that's a whole other story). I was further diagnosed with stress fractures of the 2nd metatarsal and tibia, and needed to be in a cast for 5 weeks. I just did my 1st hike during the whackfest

My advice: have your doctor get you a brace like The Aircast AirSport . I was able to hike comfortably with it all summer. It's a lot easier (and to me, safer) than trying to tape/wrap correctly every time that you go out. Start slowly...

BTW, I'm also dealing with the "compensation" type issues from my injuries that Dugan mentions. From walking with a different gait all summer, I starting having a lot of pain in my knee and found that I had lost some of its flex. I am rehabbing it now.

It's a damn good thing that I love hiking so much!

 

[jjmcgo]

Doctors never tell you to do this but vets do it for their patients all the time: Eat calcium pills while you are mending a broken bone. I broke a small bone in my wrist years ago and a vet I knew suggested it. The doctor said the wrist would be a problem for life. It's been fine.

 

[TCD]

Grade 2 sprain in July, trail running. Fully recovered now. Keys to recovery: 1. Keep moving, keep using the joint; 2. DON"T reinjure it, even a little, especially right now.

Plan on being careful to avoid reinjury for at least 6 months. It sucks getting old. If I had made the same misstep when I was 20, or even 30, the ligaments probably would have stretched and recovered. Not now!

Good luck!

TCD

 

[Waumbek]

Air-Stirrups

I sprained and broke an ankle on a long slide down the Webster-Jackson trail one November, and after it healed I carried my air-stirrup with me on a summer backpack just in case. I did have to use it for the last 3 or 4 days and it helped but I can't say that it was comfortable. In fact, the plastic aircell stirrup that encases the sides of your ankle and leg on the various stirrups models doesn't breath at all and can blister the skin after a few days. If you think you're going to have to depend on it, try it on a day hike first and make sure your boots are comfortable over it. The Aircast Airsport that SherpaK mentions above is probably a better bet for breathability and fit, but the white plastic air stirrup is commonly prescribed by PTs so that's why I had it. (I don't think they mean you to hike with them!)

 

[daxs]

I sprained my ankle in late June of this year. A week later, I went on a scuba diving trip with no problems and a week after that I went on a backpacking trip for 4 days. I wrapped my ankle every day on that trip for support and with the exception of some minor swelling had no problems. I wore an ankle brace on and off the rest of the summer while hiking and running and had some minor discomfort but nothing major.

Alas, I am also "watching from the sidelines" at this time. I had knee surgery (injury unrelated to the ankle sprain) 2 weeks ago and I am in the process of rehab. The surgeon released me to gradually resume normal activities (and he knows my normal activities are far from normal) but the knee doesn't feel ready to hike or run yet. My next major assualt is the Winter gathering.

 

[Jacko]

Well after years of soccer and trail running I have accumulated 3 grade 3 sprains and as many 2's. The warning here is once you get a bad ankle sprain the ligament is stretched and prone to give way again. Touch wood I have been free for a few years. Thats because I have learned to take certain precations. Boots with ankle support - no running in the semi dark or over leaf coverage and most of all if the ankle starts to go over - roll with it.
As regards recovery I have had good results with taping. As is usual it is the outer ligament that gets torn so I have taped up the outer side of the ankle to mimic the ligament and help take the strain off any sudden twist. Also hot and cold water treatment helps aid blood flow and recovery. However recovery to being active can take a couple of months and full recovery ie no awareness of weakness can be longer than a year. Ofcourse this all depends on severity.
This serves as a great reminder to continue to take care - good luck and dont push it

 

[TCD]

Meo,

One more thing that helps me a lot. Most ankle sprains, like mine, are on the lateral side (outside) of the ankle; they are so called "inversion sprains, where the ankle rolls over, "showing" the sole of the foot to the other foot.

I still (probably stupidly) can't stop myself from running trail in the semi dark. The only good defense I've found is to run or walk "duck-footed" or "pied-en-canard," with the feet splayed outwards. It's a little awkward and slows you down (just a little), but with the foot turned well outward it's darn near impossible to incur an inversion sprain.

TCD

 

[Meo]

Yeah, TCD, mine is also on the outer side of my right foot, under the ankle's "knob".

Good advices everybody, I'll take note. I went to a physical therapist last week, and she said that it's not as bad as it looks. She gave me some exercises to do at home, and I'll meet her again next week to begin a strenghtening therapy. I'm a little afraid of walking in crampons, but I'll take it slow (and I'll wait another month at least). I also consider buying plastic boots (like Koflach) this year, the ankle support should be almost bulletproof in these, I guess.

You know what, I sprained my ankle while I was bringing flowers to a colleague who was hospitalized. A few yards before the hospital entrance, I missed the end of the sidewalk. Oh, irony...

At least I was at the right place to get a quick medical attention

 

[Waumbek]

Well, Meo, the circumstances of your sprain are very common if that's any consolation. As I parted from my PT after the initial therapy was done, he said I'd be more likely to reinjure the ankle by turning it on the edge of a pavement or sidewalk in town than by doing anything heroic in the mountains. He was right.

 

[Nadine]

Did your colleague ever get the flowers???

It sounds like you're on the road to recovery with good physio

I would highly recommend the Koflach boots for ankle support. They are very stable, with very little give. Much more comfortable than hiking in an air splint. This would support your ankle well all winter, and by spring, you would have built the strength of the tendons and ligaments back up enough to hike in regular boots.

Nadine--hello to Julie!

 

[Dugan]

I was hoping I could find this site again for you

PT for sprained ankle (comprehensive info & exercises)
http://www.aafp.org/afp/20010101/93.html

I see you're in physical therapy which is good. Be sure to talk to the therapist about your goals. I've found that they'll prescribe different exercises and intensities for athletes than inactive people. My questions in the few times that I've done pt is how often I can do the prescribed exercises, and what is the top intensity I should use. They usually prescribe a somewhat minimal amount in order to avoid over stressing non-athletes, and you have to make it clear that "average" (i.e. couch potato) is not your goal when trying to regain hiking fitness.

About the "air stirrup"... I could not hike/jog/run in the one I had. Walking yes, but it was a problem to find a shoe it would fit in. I did carry it as emergency first aid up until recently, in case I reinjured the ankle while hiking.

Once you've got a preferred taping pattern and some practice, taping goes pretty quickly. It's MUCH more supportive than wrapping alone, yet allows a little more freedom of movement than the air stirrup. The material used are thinner than either of those. I found it easier to fit into a trail runner or boot. Beware chafing along the achilles - it was a real problem for me, still have scars from lost skin. Your therapist is probably an excellent source of advice for taping/wrapping.

As for boots being more supportive, that's not always true. My injury happened while wearing newer boots that fit very well, extend above the ankle, and have very firm ankle support.

 

[LittleBear]

Sprains - know them well as my son suffered many during his basketball career. The athletic trainer at his school got him back on the court quickly with this: Active Ankle . He also had good support with this: McDavid brace.

After many sprains, the trainer told us that he should be wearing the brace any time he stepped onto the court - even for practices. When he started doing that, he didn't have any more sprains. You might want to consider wearing a brace whenever you hike.

 

[spaddock]

Sorry to hear the news I know how that goes.

I had a grade 2 sprain in April 2003. Sadly I didn't hike again until March 2004. I wanted to take it extra easy. Like everybody here is saying it takes time to heal and once you have one its easy to get another.

The good news is I've hiked a ton this year and only "felt" it a few times. I definitely reccomend a brace. I use a Swedo-Lock brace that my Physio therapist reccomended, the other braces mentioned might be better, I chose this one because you could wear it without a shoe (beach volleyball).

I DEFINITELY reccomend Physio Therapy, the therapy will help your tendons heal in a proper fashion instead of a criss-crossed heal that will be prone to re-injury (at least that's what I've read on the web, I'm no doctor).

Instead of risking quick re-injury I took up swimming... downhill skiing might not be too bad either since your ankle would be pretty contained.


-Shayne

 

[Meo]

Dugan, you just made my day! I clicked on your link and the text confirmed that my physical therapist was right: it's probably a grade I, and not a grade II. 24h after my sprain, the swelling was quite big to me and my family doctor diagnosed a grade II. Last week, after some tests (pushing the therapist' hand, etc.), I felt less pain than I thought I would, so she said it's probably a grade 1 (a severe grade 1, but a grade 1 nonetheless).

As the ecchymosis was quite big, I assumed my doctor was right (ecchymosis = blood loss, so partial tear of the ligament, I said to myself!), but now I see on this website than a mild to moderate ecchymosis can also occur on a grade 1. So my PT was right! Yee-ha

But of course I'll still do my exercises and pay for a good therapy, I want my ankle back... And I'll ask for taping techniques and/or braces, plus Koflachs

Yes Nadine, I managed to hop to her room. I gave her the flowers, then I asked "can you tell me where is the emergency room?"

 

[SherpaKroto]

Meo: couldn't you find an easier way to justify the Koflach purchase? Heal well!