You have rolled your ankle!
We have all been there - playing sport, walking on uneven ground or just stepping off a step. There is such a high proportion of us that roll our ankles - but not many of us actually seek treatment. And because of that - ankle sprains have a very high recurrence rate. Of the general population about 20% or 1 in 5 will re-roll their ankles (at least once) and up to 50% or 1 in 2 in an athletic population (any recreational runners, juniour or senior sports players etc) will have recurring ankle problems.
So - what is the best practice. Firstly - clearing a fracture. There are a set of rules, called the Ottowa Ankle Rules that dictate if an x-ray is needed or not. If there is bony tenderness at the back edge or tip of the bumps on the outside or inside of the ankle (the lateral or medial malleloi) or if you are unable weightbear for 4 steps immediately or in the emergency department - then you should get an x-ray. If this criteria doesn't apply - then you may not need one.
Secondly - restoring range of movement by reducing pain. Apart from all of the icing, elevating and compression that you should be doing, it is also important to restore movement - initially pain free movement and then whole joint movement. this is where hands on physiotherapy comes in. It is also most important to start this process as early as possible. Delay in restoring movement prolongs the time of injury and games missed. Studies will show that as little as a 2cm difference in range of movement between your two ankles will mean that you are more at risk of re-injury, or an injury to another body part!
Thirdly is rehabilitation. If you make it through the first two steps - that is fantastic - but that is where a lot of people (and physios/GP's) stop. A systematic review (the highest level of evidence) by Doherty et al. 2016 called 'Treatment and prevention of acute and recurrent ankle sprain: an overview of systematic reviews with meta-analysis' shows that exercise rehabilitaton is the best way to reduce ankle sprains. Exercises performed in high doses (more than 900 minutes) reduces the change of lateral ankle sprain by 42%! Given that nearly half will have a recurent sprain anyway, that is a great result!
So - what does 900 minutes look like? The best thing to do is 5, 30 minute sessions per week, for 6 weeks. That's right - to best rehabilitate the ankle sprain - 6 weeks of exercise is the minimum recommended!
So - the take home messages
Please complete your prescribed exercise rehabilitation program. It helps in preventing recurring ankle sprains and chronic ankle instability.