It is important to understand the stages of wound healing to know how active you can be on your sprained ankle.
After a sprain, the blood vessels dilate and start the inflammatory phase which will last about 72 hours. During this stage you can expect to see redness, swelling, warmth and pain. During this stage your body sends cells to tear down damaged cells and destroy them. Also, cells will be present to fight infection that may be imminent if there has been a break in the body’s protective layer of skin. The inflammation phase is important for these reasons and it is key in attracting the cells that will start the next phase of proliferation.
During the inflammatory phase your tissue is fragile and is not strong enough to take your weight. It is important to rest it to avoid any further tissue damage. If further damage occurs the inflammatory phase can last longer and lead to a chronic wound. It is best to take care of your ankle with rest, ice, compression, and elevation. Be sure to wiggle your toes, and move your ankle in a circular motion gently to help keep it from getting too stiff.
During the proliferative phase, the fibroblasts will create a collagen framework that will become the structure of the tendon. This stage last 4-21 days after the injury. They will then start to contract. As the injured tissue contracts it will be forming a scar that provides stability. During this stage, it is safe to start gentle stretching and light weight-bearing exercises depending on how your symptoms manifest. If you stress the tissue beyond it’s capacity, you will cycle back to the inflammatory phase and start to produce new inflammation. If you take it easy, you will be able to gradually bear more weight until you are standing comfortably and even starting to walk. It is a safe bet to work on attaining full range of motion first. This means you can flex your foot both up and down and side to side fully with minimal discomfort. A simple rule of thumb is: If you cannot walk without limping you should be using a crutch, brace, or a cane.
Remodeling and maturation phase: This phase will last for the next 2 years. The body will cycle between building a collagen framework, then pruning it according to the line of tension created by your movements. If you have not heeded your body’s warnings, and started to walk and limp on your ankle before it was ready, than your scarring may mature in a maladaptive way. This could cause your ankle to be too loose and unstable, or too tight and constricted. On the other hand, if you recognize the stages of healing that your body is going through and apply the appropriate amount of stress at the right time you can help stimulate the scarring to happen as it was meant to be. You can then return to running, jumping and hiking as you did before your injury. During this phase you will progress through more challenging weight bearing exercises such as standing on 1 leg for balance, heel raises, and lunges. To return to sports you have to relearn how to jump, hop, and skip, before you finally return to running. Increasing the intensity of the exercises helps to direct your body to lay more collagen down where it feels the most stress, thus making it much stronger.
Your physical therapist will know how to identify what stage of healing you are in. The stages begin to blur when sprains have been rushed in their healing process and returned to full function too soon. If one starts jumping and skipping too hard on a sprained ankle that had made it to the remodeling phase, it could actually acutely injure the ankle and return it to the inflammatory phase. Factors that may contribute to non healing sprains include diabetes, blood vessel disease, infection, and metabolic deficiencies of old age. It is not uncommon for someone to come to the clinic saying, “This is my bum ankle, I’ve sprained it several times over the years, but this is a really bad one!” Also, in a situation like this an ankle could have swelling for years. This cycle can be broken with the right attention and respect to wound healing.