Roughly two weeks ago I sustained an inversion injury on my right ankle whilst playing football. The injury caused significant bruising and swelling around ankle, significant pain, and difficultly walking. X-rays confirmed there were no breakages, but the suspected diagnosis was a Grade 3 sprain which meant likely ruptures and tears to ankle ligaments (most likely ATFL). It’s now 11 days on from the injury and although swelling and bruising has reduced, there is still significant pain and discomfort when walking. This is especially acute when standing after periods of sitting/lying/sleeping which causes an intense throbbing pain (10/10) on both sides of my ankle for a few moments. Braving a few steps eases the pain eventually. During the day the pain subsides but there is still discomfort and the lack of mobility makes walking and exercise difficult. The discomfort is pretty much round the whole of my ankle.
I’m still awaiting further consultation on diagnosis and treatment from the NHS here in the UK, but this can take significant time and I’m keen to begin doing the right things now to help rehab my ankle. I think it’s safe to assume though that this is a severe ankle sprain due to the level of bruising and swelling (Google Grade 3 Ankle Sprain and the images are pretty consistent with how my foot looks/looked
I’m still barbell training mostly as normal, 3 times a week plus GPP, using rpe to adjust weight where necessary. I’ve had to adjust my squat stance a bit wider, reduce weight and squat depth to reduce pain and mitigate against the lack of ankle mobility. Conventional deadlifts can be tricky some days so have been switching to more SLDLs or sumo when ankle mobility doesn’t allow for conventional
My questions:
Am I ok to continue strength training with this injury (as long as I’m pain free when doing it)?
Is there anything specific I can be doing, and when should I do it, to help rehab this ankle and return it’s mobility?
Can I expect to be able to resume normal sport activities (football/soccer, squash, running) and when can I expect to resume them?
Hey, thanks for the questions. Sorry to hear about your situation. We’d need a consultation with you to assess your situation and provide individual recommendations. We do offer remote consultations. If you are interested, please complete our intake paperwork HERE. Otherwise you can use the Pain in training: what do? article for general recommendations in these scenarios.
Yes, loading to tolerance is typically ok in these scenarios. I’m curious to your scheduled follow-ups. Is the question regarding the need for surgical intervention here?
Typically I begin folks with simple tasks like spelling the alphabet unloaded against gravity. Weight bearing to tolerance for walking and daily activities. As you feel able, a sit to stand is a great place to work on squatting, then goblet squat, then barbell. Similar discussion for deadlifts, starting with a kettlebell deadlift, then barbell deadlift. I’d also dose in single leg work to tolerance such as split squats/step-ups and braced single leg deadlifts. Caveat: much of this may change based on information garnered from a consultation with you and we are speaking in regards to a general approach to ankle sprains.
Most likely yes. Timeframe depends on a number of factors but my expectation would be around 12 weeks or so. During that time progressions would be layered in to return fully to those activities.
Thank you so much for getting back to me, your advice was both helpful and comforting in what was a stressful period
Roughly 3 weeks on from the initial injury now and my ankle is feeling much better. The swelling has all but gone and there is rarely any pain. There is still some limited mobility and discomfort but this is getting better too and is certainly alleviated by exercise. I am able to walk normally and have been able resume mostly normal barbell training, with the exception of squats which still require a wider stance and limited loads.
In regards to the follow ups there was never really a question of surgery here. In the UK at least it’s rare for ankle injuries to be operated on, im not sure if this is the same elsewhere. GPs here often refer out for more in-depth assessment and this is what I was (and still am) waiting for but to be honest I probably won’t bother now. I was referred to Orthopaedics (appointment next week) as this was the next step to getting an MRI to assess the extent of the ligament damage. All that GPs and emergency care here are concerned about with these types of injury is if there are breakages or not, otherwise they send you home to get on with life and if you need any additional diagnosis you have to go through a longer route. I was intrigued to get an MRI, not to push for surgery but to get some idea of recovery time based on severity.
I have also been referred to and had an appointment with a physiotherapist. He said similar things to yourself in relation to continuing training and suggesting exercises and movements specifically for the ankle. He also said that based on my recovery so far and the movement I now have it is unlikely to be as severe an injury as first thought, giving me a recovery window of around 4-6 weeks with the caveat of being somewhat conservative with my return to contact sports.