Ankle sprain is one of the most common injuries of the lower leg. A simple misstep can twist the ankle unnaturally, damage the ligaments in the ankle, causing swelling and pain. While most ankle sprains are mild, with no ligament tears involved, some can be quite severe with torn ligaments and unstable ankle [1].

Healing of a sprained ankle can take a considerable amount of time. Even a mild one can take up to two weeks to heal with more severe incidents require several weeks to months of healing and rehabilitation to return to normal [2]. The good news is that surgery is rarely required even for the most severe ankle sprain [3]. Given time, the sprained ankle can heal by itself.

First aid for sprained ankle

What should you do if you just sprained your ankle? The current advice for first aid of sprained ankle R.I.C.E, which stands for Rest (R), Ice (I), Compress (C), and Elevate (E) [4]. The main purpose of the R.I.C.E. therapy is to help reduce swelling immediate.

1. Rest – You need to rest the injured ankle by not putting weight on it for 48 hours.
2. Ice – Try to apply ice to the area using a cold pack as soon as possible for 15 to 20 minutes. Ice the area four to eight times during the first 48 hours.
3. Compress – wrap the ankle with an elastic bandage to compress it.
4. Elevate – raise the injured ankle above your heart if possible.

Even though R.I.C.E. is widely recommended as the immediate treatment of sprained ankles, not all agree that it is the most effective approach. A systematic review of R.I.C.E. for treatment of sprained ankle did not find sufficient evidence to determine the relative effectiveness of this therapy [5]. Hence, the treatment of sprained ankles beyond first aid can vary significantly depending who you consult with [3].

If you visit a medical doctor after spraining your ankle, a physical examination will be conducted to examine the extend of the injuries. You will mostly likely be advised to take an X-ray to find out any broken bone [1]. Pain killers (non-steroidal anti-inflammatory drugs, NSAIDS) such as ibuprofen are commonly prescribed to reduce swelling and pain [3].

Manual manipulation of a sprained ankle

The treatment approach of manual therapy in Traditional Chinese Medicine (TCM) can be quite different. Instead of rest, a TCM bone setter (跌打医师) will advise starting manual treatment as soon as possible to move the Qi and flow the blood, relax the tendons and ligaments, to reduce swelling, break up bruises, and stop the pain [6]. To do so, however, required experience and skill. An experienced TCM bone setter is hard to find these days though. Nevertheless, there is research evidence supporting the use of manual therapy together with R.I.C.E. to reduce swelling and improved ankle function [7]. Therefore, it may be helpful to consult a TCM bone setter, chiropractor or osteopath for manual manipulation after a sprained ankle to promote healing.

Nutritional supplements for sprained ankle

There are many herbal and nutritional supplements that can aid the healing of a sprained ankle. Here are some of the them [8]:

1. Curcumin – Curcumin is the yellow pigment extract from turmeric. It has strong anti-inflammatory property and has been traditionally used in Ayurveda to treat a wide variety of diseases and conditions including sprains [9].
2. Boswellia (Frankincense) – Another India herb known for as an anti-inflammatory agent [10]. The combination Boswellia and Curcumin is a natural pain relief alternative to NSAIDS, which has been shown to be more effective than NSAIDS in the treatment of osteoarthritis [10].
3. Bromelain – An enzyme from pineapple which strong inflammatory properties and is commonly used in sport injuries [11].
4. Methyl sulfonyl-methane (MSM) – A sulphur compound that is useful for promoting tissue repair [12].
5. Glucosamine and Chondroitin – Commonly indicated for osteoarthritis, both Glucosamine and chondroitin are important for the for the formation of bone, ligaments and tendons.

Summary

Spraining your ankle can be a painful. Your ankle and feet may swell and you may have difficulty walking. Immediately after the injury, you should apply R.I.C.E, i.e. Rest, Ice, Compress, and Elevate. Consult a medical doctor to assess the extent of the damage. Manual therapy such as TCM bone-setting (跌打) can be helpful to promote healing. You can consider taking nutritional supplements such as curcumin, Boswellia, bromelain, MSM, Glucosamine, and chondroitin to reduce pain and inflammation and aid in tissue repair. Full recovery may take time between a couple of weeks to months.   So, be patient.

References

[1]         Ankle sprains: Overview, (2014). https://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0072736/#i2676.symptoms (accessed April 25, 2017).

[2]         T.J. Hubbard, C.A. Hicks-Little, Ankle ligament healing after an acute ankle sprain: an evidence-based approach., J. Athl. Train. 43 (2008) 523–9. doi:10.4085/1062-6050-43.5.523.

[3]         W. Petersen, I.V. Rembitzki, A.G., A. Ellermann, C. Liebau, G.P. Brüggemann, R. Best, Treatment of acute ankle ligament injuries: a systematic review., Arch. Orthop. Trauma Surg. 133 (2013) 1129–41. doi:10.1007/s00402-013-1742-5.

[4]         Sprain: First aid – Mayo Clinic, (n.d.). http://www.mayoclinic.org/first-aid/first-aid-sprain/basics/art-20056622 (accessed April 25, 2017).

[5]         M.P.J. van den Bekerom, P.A.A. Struijs, L. Blankevoort, L. Welling, C.N. van Dijk, G.M.M.J. Kerkhoffs, What is the evidence for rest, ice, compression, and elevation therapy in the treatment of ankle sprains in adults?, J. Athl. Train. 47 (2012) 435–43. doi:10.4085/1062-6050-47.4.14.

[6]         《中医伤科按摩学》_第四章　伤科按摩手法与施治原则_中医世家, (n.d.). http://www.zysj.com.cn/lilunshuji/zhongyishangkeanmoxue/1035-9-0.html (accessed April 25, 2017).

[7]         C.-W.C. Lin, C.E. Hiller, R.A. de Bie, Evidence-based treatment for ankle injuries: a clinical perspective., J. Man. Manip. Ther. 18 (2010) 22–8. doi:10.1179/106698110X12595770849524.

[8]         P.A. Balch, Prescription for Nutritional Healing, 4th ed., Avery, New York, NY, 2006.

[9]         B.B. Aggarwal, C. Sundaram, N. Malani, H. Ichikawa, CURCUMIN: THE INDIAN SOLID GOLD, in: Mol. Targets Ther. Uses Curcumin Heal. Dis., Springer US, Boston, MA, 2007: pp. 1–75. doi:10.1007/978-0-387-46401-5_1.

[10]      M.Z. Siddiqui, Boswellia serrata, a potential antiinflammatory agent: an overview., Indian J. Pharm. Sci. 73 (2011) 255–61. doi:10.4103/0250-474X.93507.

[11]      R. Pavan, S. Jain, Shraddha, A. Kumar, Properties and therapeutic application of bromelain: a review., Biotechnol. Res. Int. 2012 (2012) 976203. doi:10.1155/2012/976203.

[12]      M. Butawan, R.L. Benjamin, R.J. Bloomer, Methylsulfonylmethane: Applications and Safety of a Novel Dietary Supplement., Nutrients. 9 (2017). doi:10.3390/nu9030290.