Persistent Ankle Swelling After Sprain: Recovery Tips and Advice

Ankle sprains that are slow to heal?

Hello, about a month ago, I accidentally fell down the stairs in the early morning.
My left ankle on the outer side was very painful at the time.
I managed to go upstairs despite the pain, not realizing that it might be a serious sprain.
I applied some topical analgesic and went back to sleep.
After waking up, I started icing it, but not for long before my family insisted on applying more topical analgesic.
The next day, my left foot hurt less, so I thought it was getting better, although the sprained area was still red and swollen.
Gradually, the pain in my ankle decreased, but the swelling persisted, and even heat therapy seemed ineffective.

A week after the sprain, I visited an orthopedic doctor.
He examined my ankle and said there was no issue with the bones, so an X-ray was unnecessary.
He diagnosed it as a ligament strain and recommended heat therapy and massage.
He prescribed anti-inflammatory medication and topical ointment.
However, even after finishing the medication and applying the ointment, my ankle remained swollen.
It has been nearly a month of swelling, so I consulted another orthopedic doctor, who gave the same diagnosis and prescribed more ointment.

Although I am currently using heat therapy and massage, I feel that my ankle is not only not reducing in swelling but sometimes appears more swollen.
How can I reduce the swelling? Is the increased swelling sometimes due to me massaging too hard, or would it be better to avoid massage altogether? Since I have a habit of exercising, can I start exercising now, or should I wait until the swelling completely subsides before resuming physical activity?

Sakura, 30~39 year old female. Ask Date: 2016/05/23

Dr. Yin Xinbei reply Rehabilitation

If pressing on the swollen area causes pain, and there is also significant pain when pulling the ankle inward, it indicates that the tissue is still inflamed and requires continued treatment.
Please consult a rehabilitation specialist.
If there is no pain, only swelling, at home, in addition to foot exercises and elevating the legs while sleeping, you can also use a contrast bath method (alternating hot and cold) to reduce swelling.
For more information, please refer to the website http://stud.adm.ncku.edu.tw/hea/4work/wedu/e2/e231.htm.
If you wish to massage, you can massage from the toes towards the calf.

Reply Date: 2016/05/23

More Info

Persistent ankle swelling after a sprain can be frustrating and concerning, especially when it lingers for an extended period. Based on your description, it seems you have been following some common recovery protocols, but the swelling persists. Here are some insights and recommendations that may help you navigate your recovery more effectively.

Understanding Ankle Sprains and Swelling
Ankle sprains occur when the ligaments that support the ankle stretch or tear. The swelling you are experiencing is a natural response to injury, as the body sends fluids to the area to promote healing. However, if swelling persists beyond the typical recovery period, it may indicate that the injury is not healing as expected or that there are other underlying issues.

Recovery Tips
1. R.I.C.E. Method: Initially, the R.I.C.E. method (Rest, Ice, Compression, Elevation) is crucial. Although you mentioned using ice and heat, ensure you are applying ice for 15-20 minutes several times a day, especially in the first few days post-injury. After the acute phase, you can switch to heat to promote blood flow, but be cautious not to overdo it.

2. Compression: Using a compression bandage can help reduce swelling. Ensure it is snug but not too tight, as excessive compression can impede circulation.

3. Elevation: Keep your ankle elevated above the level of your heart as much as possible. This can help reduce swelling by facilitating fluid drainage.

4. Gentle Range of Motion Exercises: Once the acute pain subsides, gentle range of motion exercises can help maintain mobility. Avoid aggressive movements that cause pain. Start with simple movements like ankle circles or flexing and pointing your toes.

5. Avoid Aggressive Massage: While massage can be beneficial, be cautious with the intensity. Aggressive massage may exacerbate swelling or cause further irritation. Instead, consider gentle massage techniques or consult a physical therapist for guidance.

6. Gradual Return to Activity: It’s essential to listen to your body. If you have a history of regular exercise, you may be eager to return, but it’s crucial to wait until the swelling significantly decreases and you regain a good range of motion. Start with low-impact activities like swimming or cycling, which can help maintain fitness without putting too much strain on your ankle.

7. Consult a Physical Therapist: If swelling continues to be a problem, consider seeking the help of a physical therapist. They can provide tailored exercises and treatments to facilitate recovery and address any underlying issues.

8. Monitor for Other Symptoms: If you notice increased pain, significant changes in color, or warmth in the ankle, it may indicate complications such as a more severe ligament injury or even a fracture that was initially overlooked. In such cases, further imaging (like an MRI) may be warranted.

Conclusion
Persistent swelling after an ankle sprain can be a sign that your body needs more time to heal or that additional care is necessary. By following the R.I.C.E. method, using compression, elevating your ankle, and engaging in gentle exercises, you can support your recovery. Avoid aggressive massage and listen to your body when considering a return to exercise. If swelling persists, consulting a physical therapist or healthcare provider can provide you with a more personalized recovery plan. Remember, patience is key in the healing process, and taking the right steps now can help prevent long-term issues.

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