Why Is My Ankle Swelling Again After Rehabilitation?

Ligament injury rehabilitation but swelling occurs!

Hello Doctor: Three weeks ago, I sprained my ankle while playing badminton.
I visited three hospitals for examination, and the results showed no fractures, but rather a ligament injury.
During the first week, there was significant swelling and bruising.
In the second week, I started using topical ointments, but the swelling only reduced slightly.
By the end of the second week, I stopped using the ointment and began applying heat daily.
This week, the third week, I noticed a significant reduction in swelling and returned to the doctor to check the condition.
The doctor recommended physical therapy and prescribed oral medications for reducing swelling and muscle relaxants.
I then went to the physical therapy clinic for rehabilitation.
However, after doing ankle inversion exercises at home, I noticed that my ankle started to swell slightly again.
(Additional information: The swollen areas include the dorsum of the right foot and the right ankle.
Since the beginning until the third week, lightly touching the dorsum of the foot causes a tingling sensation, but the injured area of the ankle only feels sore when pressed after the third week.) Could you please explain the reason for the swelling after rehabilitation? Should I stop taking the medication or discontinue rehabilitation? Thank you!

Cǎoméi, 20~29 year old female. Ask Date: 2012/03/28

Dr. Pan Yingda reply Rehabilitation

It's difficult for me to answer this question because I haven't seen your situation and I'm not aware of how their rehabilitation is being conducted.
However, one thing is certain: you can stop taking the medication! Generally, if a sprain hasn't healed after three weeks, that's a bit prolonged.
Please consult your nearby rehabilitation physician and ask them for further advice!

Reply Date: 2012/03/28

More Info

After an ankle sprain, it's not uncommon to experience swelling, especially during the rehabilitation process. Your situation, where the swelling has returned after starting rehabilitation exercises, can be concerning, but it is important to understand the underlying reasons and how to manage them effectively.

Understanding Ankle Swelling Post-Rehabilitation
1. Inflammatory Response: After an injury, the body initiates an inflammatory response to promote healing. This can lead to swelling, which is a natural part of the healing process. Even after the initial swelling subsides, engaging in rehabilitation exercises can sometimes provoke a mild inflammatory response, leading to temporary swelling.

2. Overexertion: If you have recently increased your activity level or intensity of rehabilitation exercises, this could lead to overexertion of the injured ligaments. This is especially true if the exercises involve movements that put stress on the ankle, such as twisting or bearing weight. It’s essential to gradually increase the intensity of your rehabilitation to avoid exacerbating the injury.

3. Improper Technique: Sometimes, the way exercises are performed can lead to additional strain on the ankle. If you are not using proper form or if the exercises are too advanced for your current stage of recovery, this can lead to increased swelling and discomfort. It may be beneficial to consult with your physical therapist to ensure that you are performing the exercises correctly.

4. Residual Pain and Sensitivity: The fact that you are experiencing tenderness when touching the ankle suggests that the area is still sensitive and may not be fully healed. This sensitivity can contribute to swelling as the body continues to react to the injury.

5. Fluid Accumulation: After an injury, the body may retain fluid in the affected area. This can be exacerbated by prolonged periods of inactivity or elevation of the foot. If you are sitting for long periods or not elevating your ankle when resting, this could contribute to swelling.

Recommendations
1. Rest and Ice: If you notice swelling after rehabilitation exercises, it may be wise to take a step back. Resting the ankle and applying ice can help reduce swelling and manage pain. Ice should be applied for 15-20 minutes at a time, several times a day.

2. Modify Rehabilitation Exercises: Consult your physical therapist about modifying your rehabilitation program. They may suggest reducing the intensity or frequency of certain exercises or incorporating more gentle movements that promote mobility without overstraining the ankle.

3. Medication Management: Continue taking any anti-inflammatory or muscle relaxant medications as prescribed by your doctor. However, if you notice that the swelling persists or worsens despite medication, it’s important to discuss this with your healthcare provider.

4. Monitor Symptoms: Keep track of your symptoms. If the swelling does not improve with rest and modification of activities, or if you experience increased pain, it may be necessary to revisit your doctor for further evaluation.

5. Gradual Progression: As your ankle begins to heal, gradually reintroduce activities and exercises. Focus on low-impact movements that promote strength and flexibility without putting excessive strain on the ankle.

Conclusion
Swelling after an ankle sprain during rehabilitation can be a normal part of the healing process, but it’s crucial to listen to your body and adjust your rehabilitation accordingly. If swelling persists or worsens, or if you have concerns about your recovery, do not hesitate to reach out to your healthcare provider for further guidance. They can help ensure that you are on the right track to recovery and can provide additional interventions if necessary.

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