Slow Recovery from Ankle Sprains: Causes and Solutions

Sports injuries, foot issues?

Hello doctor, about three and a half months ago, I sprained my ankle while landing on one foot after a jump.
X-rays and ultrasound confirmed that there were no fractures, ligament tears, or tendon injuries.
I rested for about 30 days before starting to play basketball again.
Initially, I did not apply ice to the injury, but I have been doing heat therapy afterward.
Three months post-injury, I received electrical stimulation therapy from a rehabilitation specialist, and prior to that, I had acupuncture treatment from a traditional Chinese medicine practitioner.

Now, I can walk and run normally, but I experience severe pain in the inner tendons and the medial malleolus when the ankle is inverted.
Additionally, when shifting my weight forward, I feel discomfort in the tendons on the lateral side of the foot and the outer ankle.
I would like to add that my recovery from sprains is generally very slow; for example, I sprained my finger a year ago and it has not fully healed to the point where I can play basketball at full strength, and bending it still causes pain.
Could this be an issue related to my inherent physical condition?

Niming Daxuesheng, 20~29 year old female. Ask Date: 2016/08/22

Dr. Shen Boquan reply Orthopedics

Hello,
Ankle sprains can be quite troublesome.
Depending on the severity of the sprain, we recommend resting for two to three months before gradually starting light exercises.
If there are no issues, you can then increase the intensity and duration of your workouts.
Based on your description, if you are still experiencing severe pain after three and a half months of rest, it may be advisable to consult a physician, particularly a foot and ankle specialist in orthopedics, to evaluate for any other underlying issues.
If it is simply an inflammation issue, taking anti-inflammatory pain medications or continuing rehabilitation therapy while progressively increasing activity levels should lead to recovery.

For finger sprains that have not healed after a year, it is important to have an evaluation by a hand surgeon to check for any structural damage and to discuss whether further treatment is necessary.

Wishing you good health.

Reply Date: 2016/08/22

More Info

Understanding slow recovery from ankle sprains can be quite complex, as it involves various factors including the nature of the injury, individual healing capacity, and rehabilitation practices. Ankle sprains are common injuries that occur when the ligaments supporting the ankle are stretched or torn, often due to sudden twisting or impact. While many people recover quickly, others, like yourself, may experience prolonged symptoms and discomfort.

From your description, it seems that you sustained an ankle sprain approximately three and a half months ago, and despite initial assessments showing no significant damage to bones, ligaments, or tendons, you are still experiencing pain and discomfort during specific movements. This situation can be attributed to several factors:
1. Incomplete Healing: Even if imaging studies show no major tears, the ligaments and surrounding tissues may not have fully healed. Ligaments can take a considerable amount of time to recover, especially if they were significantly stretched. The healing process can be influenced by factors such as age, overall health, and the severity of the initial injury.

2. Chronic Inflammation: Sometimes, after an injury, inflammation can persist longer than expected. This chronic inflammation can lead to pain and discomfort during movement, particularly when the ankle is put under stress. It’s essential to manage inflammation through appropriate rest, ice, compression, and elevation (RICE), along with anti-inflammatory medications if tolerated.

3. Muscle Weakness and Imbalance: After an ankle sprain, the muscles surrounding the ankle may weaken due to disuse or protective mechanisms. Weakness in the peroneal muscles (which help stabilize the ankle) can lead to instability and pain during activities that require balance or quick movements. Strengthening exercises focusing on the ankle and surrounding musculature are crucial for recovery.

4. Proprioceptive Deficits: Proprioception refers to the body’s ability to sense its position in space. Ankle sprains can disrupt proprioceptive feedback, leading to difficulties in balance and coordination. This can contribute to a feeling of instability and discomfort during activities. Rehabilitation should include proprioceptive training to enhance balance and coordination.

5. Individual Healing Capacity: Some individuals may have a genetic predisposition to slower healing or may have underlying conditions that affect recovery. Factors such as previous injuries, overall fitness level, and even psychological aspects can influence how quickly one recovers from an injury.

6. Rehabilitation Practices: The effectiveness of your rehabilitation program can significantly impact recovery. While you have engaged in various treatments, including physical therapy and acupuncture, it’s essential to ensure that your rehabilitation is comprehensive and tailored to your specific needs. This includes not only pain management but also strength training, flexibility exercises, and functional training to prepare you for sports activities.

Given your ongoing symptoms, it may be beneficial to consult with a sports medicine specialist or a physical therapist who can assess your ankle's stability and function more thoroughly. They can provide a tailored rehabilitation program that addresses your specific deficits and helps you regain strength and stability.

In the meantime, consider the following strategies to aid your recovery:
- Continue Rehabilitation: Focus on a structured rehabilitation program that includes strengthening exercises for the ankle, proprioceptive training, and gradual return to sport-specific activities.

- Manage Pain and Inflammation: Use ice and anti-inflammatory measures as needed, and consider modalities like ultrasound or electrical stimulation if recommended by your therapist.

- Avoid High-Impact Activities: Until you have regained full strength and stability, avoid activities that put excessive strain on your ankle, such as jumping or rapid lateral movements.

- Listen to Your Body: Pay attention to pain signals and avoid pushing through pain, as this can lead to further injury.

In conclusion, slow recovery from an ankle sprain can be multifactorial, and addressing each aspect of your rehabilitation is crucial for a successful outcome. With appropriate care and a tailored rehabilitation program, you can work towards regaining full function and returning to your desired activities.

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