As many of you know, this spring I trained for the Louisville Triple Crown and the KDF Mini-Marathon. I was very pleased with how my training went, and also with the race results. However, I did get a bit burned out from all the training and I noticed that I started to develop some overuse pains that I wasn’t used to having. So, I have taken some time off from running and those problems have vanished. I have been getting some of my exercise through occasional basketball and street hockey with friends.
This past Monday night, we had just started a basketball game after a good street hockey session, and as I was trying to run down a rebound I stepped on another player’s foot and rolled my left ankle. I knew that I had sprained it badly as soon as it happened, because it really hurt to put any weight on the ankle. I have had several ankle sprains in the past on both ankles, but most have been mild to moderate. I tried to act tough and walk it off, but I could tell this one was worse and there was no way I could finish the game. I drove home and started my treatment right away.
As I have written before, the initial treatment of ankle sprains begins with ice and elevation. I didn’t have an ice pack ready, so I threw one in the freezer and in the meantime I grabbed a bag of frozen cranberries. Despite the complaints from my wife over using her cranberries, they really did make a great ice pack because the bag contoured around my ankle perfectly. It was already late, so I took some ibuprofen and went to bed with my ankle elevated on a large pillow. I woke up around 3:00am needing to go to the bathroom after all the water I had consumed during street hockey. The ankle felt fine on the pillow, but after one or two steps I knew this was going to be a long day. The pain was fairly severe with weight bearing, but I felt confident that I didn’t have a fracture after poking around on my ankle. (However, I don’t advise poking around on your own ankle sprain!)
The other components of the RICE protocol besides ice and elevation are rest and compression. I own some compression socks that I usually wear in the OR when standing all day, so I had that covered. Rest, however, was not really an option since I had a full day of patients scheduled in the office. I was able to hobble through the day, spending more time on the rolling stools in the exam rooms than usual, with occasional short ice breaks. By the end of the day, I had developed quite a bit of swelling and bruising (see picture). I continued on my ibuprofen regimen as well, which helped a lot with the pain.
That first day was the worst. It has been six days now, and it is still sore, swollen, and bruised, but much more tolerable to walk on. It is still quite tender to touch, which has made me re-evaluate how I examine patients with ankle sprains in the office. I generally palpate over all the ankle ligaments to see which are involved and perform exam tests for stability, but after this episode I’m not going to push and pull quite so hard anymore!