Question:

I went over on my ankle today at pre-season training, it swelled up around the bony part on the outside of my ankle straight away so I went to the hospital.  They x-rayed it, but said that it was only soft tissue damage to the outside of my ankle and to rest.  What does this mean?  How long can I expect to be out for?  Is there anything I can do to make this time shorter?

Answer:

It sounds like the injury you have sustained is amongst the most common injury seen in footballers of all levels.  However now is the best time for you to start treating the injury and reducing the time that you’ll be out of action.  What they mean by soft tissue in this type of injury is typically the ligaments (they attach from bone to bone) on the outside of your ankle, they can become over stretched and/or torn.  You must immediately start with the PRICE procedure (see the article ‘Just sustained an injury?’), getting rid of the swelling is the most important thing to start with.  This will help reduce the pain and therefore allow you to start walking properly again.  You need to try and stay off the ankle as much as you can for the next 48-72hrs, although keep the ankle moving within your pain.  Up and down movements any gentle circles are best.  Once you can put weight through the ankle without pain it is important that you walk as normally as possible avoiding a limp. 

When the swelling and pain have started to disappear you will need to begin gentle strengthening and balance exercises.

Things as simple as standing on one leg will begin to ‘wake up’ the muscles around the ankle and in the long term help to prevent you re-injuring the ankle.  To progress from standing on one leg either close your eyes or stand on a pillow.  To strengthen the ankle use a THERABAND and use it to resist pointing the toes, pulling them up towards you  as well as inwards and outwards movements of the ankle.  All of these exercises should only attempted if they can be done pain free, do not try and push though the pain, you will only get a reaction and end up prolonging the time you’re out of action. 

Finally but probably the most important question in your mind is how long will you be out for!  This very much depends on the severity of the sprain, on this I can only give you a guide because there are other structures which may also be involved.  Ligament injuries are categorized into 3 Grades. 

Grade 1 (mild) means that you have over stretched or slightly torn the ligaments but will typically have no instability of the joint.  There will be mild swelling and pain but you will not lose much function if any.  Approximate recovery time:  0-6 weeks

Grade 2 (moderate) is a partial tearing of the ligaments, maybe accompanied by instability of the joint and becomes painful to put weight on the ankle.  There will typically be bruising, swelling and pain.  Approximate recovery time:  6-12weeks

Grade 3 (severe) is a complete rupture of the ligament, characterised by severe bruising, swelling and pain, function is lost due to the pain.  At the time of this injury a ‘pop’ may be heard.
Approximate recovery time:  3-6months (dependant on whether surgery is required).

In summary, the most important time for you to make a difference in the recovery time is now, make sure that you follow that PRICE principle until the swelling disappears and this will enable you to get some level of function back in the ankle faster.

If this pain persists or you have any doubts at all then you should always seek the relevant medical advice.  Physiotherapists and sports injury specialists will be able to identify any other structures that have been damaged and provide you with the appropriate exercises for a safe return to training.