When learning massage, I could never remember the difference between a “Strain” and a “Sprain.” The words sounded so similar. An easy way to remember is that the word Strain has the letter “t” in it. So, a strain is a damage to the tendon. By process of elimination, a sprain is a damage of the ligament. The common denominator is that both Strains and Sprains cause pain and reduce mobility.
A tendon is an extension of the muscle and attaches to the bone. For example, the achilles tendon is an extension of the gastrocs and soleus muscle and inserts into the heel. A ligament is really a supporting structure that connects bone to bone. Some ligaments restrict the mobility of where joints articulate with other joints. They may even prevent certain movements altogether.
When I was walking the Camino through northern Spain back in 2010, there was much uneven ground and I had to be careful not to “rick” the ankle. Sometimes the inevitable happens and you get hurt. Perhaps you were walking along and suddenly by mistake, walk on the side of your heel. A ligament is like an elastic band: once it has been over stretched, you can’t really fix it. How is the best way to treat a sprain?
Immediately apply an icepack. The first 24 to 36 hours is called the “acute” stage, you never want to apply heat because you would be adding heat to an area that already has inflammation. Perhaps you might try to apply ice at least four or five times a day. Try to keep your weight off the affected ankle.
The following day, also try to keep your weight off the ankle and continue to ice. By day three you might try adding a few very simple exercises. Don’t try anything aggressive but limit the exercise to doing simple toe extensions and ankle rotations. Certainly do not go out to play soccer or a game of squash.
By day four, the ankle may be feeling good, but you still don’t want to overdo it. When there is any sort of an injury, there is build up of scar tissue. This is an informal mish-mash of inflexible fibrous collagen tissue that surrounds and makes up for the injured elastic band-like ligament. If you don’t do anything further, that scar tissue will never be properly aligned and you will end up with much restricted range of motion in the ankle joint. If you return to your pre-injury activities at this stage, you are likely to re-injure your ankle.
Now is the time to start applying a heating pad and to come for massage therapy. Continue with gentle exercises that increase your pain free range of motion. Gentle stretching is always important and will be the subject of a future blog
By week two you should be able to incorporate weight-bearing and very slightly more aggressive repair exercises. I recommend walking. By the end of that week, you should be able to return to normal fitness activities.