Ankle Injury: PT said probably ATFL sprain. Keep training?

On labor day, while trail running down a mountain i tweaked my ankle somehow. I didm’t roll it, but while walking on top of rocks I felt a “shock” type of feeling which followed with some pretty severe pain and a limp for the next 2-3 days. After 4 days there was minimal pain and I commenced to start jogging, then hiking, then trail running again. A month after the original injury I re-tweaked it while trail running, but not in the same area. I can imagine it’s because the ankle was weakened in general and the original injury hadn’t fully healed. I then took measures to let it recover with minimal activity for a few weeks. Fast forward, and now it’s pain free virtually all the time. The only exception is when I purposely invert it to test for pain, there is pain at the site of the original injury albeit mild pain at best. There is also some minor swelling still on the outside of foot below my ankle. PT said ATFL sprain upon minimal examinations and said I’m free to do any physical activity that doesn’t cause it pain. I very recently, in the past few weeks started training for the first time in my life and I’m using a Novice Linear Progression. I’m wondering if any of this sounds like anything you have heard before that’s different than a typical ATFL sprain or if it sounds pretty typical and is indeed an ATFL sprain, and if I should still train right now. There is no pain while training, even with the compound movements of DL and Squat. (I also understand any feedback is nearly theoretical considering proper diagnosis can’t truly be made on a forum, and I’m seeing an Ortho when I visit NY in a couple of weeks). Any feedback would be appreciated. Thank you in advance.

You pointed it out yourself in a way. Your training is pain free in the injured region which means you are fine to continue it without much of a doubt. Make sure you use a (good) pair of weightlifting shoes to provide some support for your feet (I’d suggest using them anyway).
Sometimes the fibula gets dragged in a funny position with the trauma you describe. You can try to push it back with the help from a friend using Mulligans technique.
Doing that should lead to painfree inversion immediatly.
Here is a video of a taping technique but you can also try this without tape (as you can see the guy taping has another pair of helping hands which makes the process easier) - just let a friend push the fibula to the back and upwards with one hand while the other is holding/blocking the shin from the back. Then you invert your foot. If that is pain free (it will be if your friend pushes in the right direction) you apply some mild pressure at the end of the movement with your hand inverting your foot a little bit further. If this is also pain free repeat this 3x for 10 reps. That is probably all you need to do if you want to get rid of this immediatly. Note that this requires 3 Hands and not 2 so ask a friend :wink:

Note that a ankle sprain is usually a bagatelle injury and occurs quite often. Most of the time it doesnt really need a treatment. If you feel funny enough you can google “mulligan ankle sprain fibula” yourself - you will find a lot of reasearch done on the topic.

Good luck with that and don’t worry about it!

Overall, this sounds like an inversion sprain and typically prognosis is quite good and the caveat is to keep moving to tolerance. Unfortunately, an inappropriate expectation was likely set for being pain free, instead a better expectation would have been a tolerable level of symptoms. Given the timeline you presented, perhaps you rushed back to exercise too quickly but this isn’t worth hyper-focusing on. If you are able to train and are improving - then I wouldn’t give this too much attention. I’d also advise not “seeking out pain” as we often can find “problems” if we are seeking them out. Out of curiosity, why are you seeing the ortho in a few weeks?

Thank you for your response! I would definitely characterize the symptoms as you describe when you say tolerable. It is true, I was probably given unrealistic/incomplete expectations which is why I sought advice on this forum! So I appreciate your realistic response. I most definitely rushed back into things too quickly, specifically the running and trail running. I have been doing light hikes the past week a couple of times, as the PT suggested that any activity that doesn’t cause me pain is fair game. Mostly I am pain free on hikes, the exception being yesterday when I took a weird step and was in pain for a little bit. I iced when I got home and now it’s back to status quo…And you raise a good point about “seeking out pain.” I wasn’t necessarily looking to seek out pain as much as I was trying to get a better idea of the nature of the type of movements that cause discomfort, and it appears to be I have full range of motion except for with inversion… My reason for seeing the Ortho frankly is because my father has a friend that runs an ortho office and he is insisting that I see them just to play it safe and to get their feedback. My dad is paying for it so I didn’t object!.…I am going to lay off hiking for at least another 3 weeks though now at this point, and I will continue training. I’ve kept consistent with my training program albeit I did a reset to lower weights because I strained my left adductor last week, and my trainer suggested it was caused by moving up too fast in my loads and that a reset is what he recommends. I am pain free during all training sessions when it comes to my ankle though so that is a huge plus!

A quick update @Michael_Ray …I saw Ortho today as mentioned. As expected, he said I was basically injury free, or at the very least there is no noticeable injury to diagnose. X-ray looked normal. The Doctor said that it’s probably just scar tissue at this point.