I rolled my ankle! And it’s so painful, what should I do?

Rolling your ankle is a common and, as you’re finding out, can be super painful with swelling, discoloration and difficulty walking. It’s also something we hardly ever get treated or rehabbed properly, presumably because it’s so common. Unfortunately, this can cause a lot of problems – both now and later – as imbalances from the ankle are translated up the legs to the pelvis and lower back (for example).

Rehabbing a rolled ankle is therefore super important if we want to avoid problems. Both now and in the future.

If you’re reading this, then maybe you’re looking for help. And in order to speed you through, we’ve split this article into the following:

  1. Diagnosis and Differential Diagnosis
  2. Imaging
  3. Treatment. A patient protocol
  4. Patient questions
  5. Videos

1. Diagnosis

The first thing to do is get a diagnosis. There are many things that cause pain in a turned ankle from a sprained ligament, to a joint irritation, to a bone fracture.

The question is, how do we know when we suspect a fracture or just a very painful sprain. And what is the best treatment.

Generally, ankle injuries are assessed immediately with the “Ottawa Ankle Rule”. This is a fasttrack way to decide if you need an image because there is a suspected fracture:

“Ottawa Ankle Rule”

  • If ankle pain is present and there is tenderness over the two bony bits of the ankle posterior 6 cm or tip of the bones (lateral or medial malleolus), then ankle x-ray is indicated
  • If midfoot pain is present and tenderness over the navicular or the base of the fifth metatarsal, then foot x-ray is indicated
  • If there is ankle or midfoot pain and you are unable to take four steps both immediately and in the emergency department, then x-ray of the painful area is indicated

The good news though; if you can walk on it then the chances are you do not need an x-ray.

Having a diagnosis helps with rehabilitation and indicates to you how long this may take.

2. Should I get an x-ray or an MRI?

Firstly, no. Your first stop should be a good muscular-skeletal professional (whether that be your local osteo, physio, chiro, or sports doctor). Together, you and your chosen therapist should be able to decide the diagnosis and whether you need any imaging. However, if you meet the criteria listed above, then proceed to A&E.

Secondly, the go-to image is an x-ray. It is quick and easy. It’s important to understand that having an image, like an x-ray, will not treat your ankle problem. It’s a picture, based on the moment, that may indicate to the radiologist and your therapist, the whereabouts of your injury and possibly, the level of trauma. You will still have to work out the best treatment.
A good ultrasound from the NHS (USS) is also a good place to start.

3. Treatment

Say your diagnosis is a ligament sprain. Now let’s talk about the kind of treatment you may expect.

There are 2 main stages to treating an ankle injury – direct therapy and rehabilitation. They are all dependent on several things, like your age, the severity of the injury, your health etc.

Here is an example of a recent patient recovery:

A Patient Example: Mr. C.

1st assessment

  • Detailed knowledge of injury mechanism etc. plus lower extremity anatomical assessment
  • Imbalances noted (pelvic rotation, thoracic twisting, history of ankle strains, knee traumas etc.)
  • Diagnosis made grade 2 ligament sprain to the Anterior Talofibular Ligament.
    Treatment: Soft tissue work to all the muscles of the lower leg. These may be in spasm due to the injury. Assessments to the Superior-Talo-Fibular Joint
  • Trigger point work to both sides of pelvic basin (Gluts, TFL, Piriformis). Where appropriate manipulations to lumbar and thoracic spine
  • Taping to secure the injured ankle. Reducing the risk of re-injury
  • Patient to report response to treatment
  • If improving then begin rehabilitation immediately (see videos, section 5)

2nd appointment

  • Review (patients symptoms and health over past week)
  • Overall imbalances and re-assessments and testing performed. Gains are noted
  • Treatment: Repeat the above
  • Patient to report response to treatment
  • If improving then begin rehabilitation immediately (see videos, section 5)

Please note this is an abridged patient version.

4. Patients Questions: Ankle

How long will my ankle take to heal?
That totally depends on your diagnosis (that’s why a diagnosis is so important). Generally: the worse the injury, the longer it takes.

Is there any treatment I can do at home?
Yes. It’s the key. Rehabilitation exercise is the gold standard.

When can I go to the gym?
The aim is to return to some form of activity as soon as is possible – this is usually down to a clinical meeting between the clinician and yourself.

What treatments do you recommend?

  • Rehabilitation exercises are the gold standard. Whatever else you do; you must do these.
  • Potentially all muscular-skeletal treatments to help keep the body in balance – remember if you’ve been hobbling about, favouring one leg, that means you may have been putting yourself out of balance. This creates additional loading (knots, strains, imbalances).
  • Soft tissue treatments to keep your muscles healthy; articulation to keep your joints in balance; manipulations (if you want/need them) to keep your spine moving freely.

Can I have a massage?
Yes: A massage can really help to treat the body. It’s an important tool in keeping a body healthy. However, extreme care should be used when introducing massage (soft tissue work) to an area of injury. If you’ve ankle bruising, light effleurage and passive movement are excellent to start with as they pump the area.

What are Isometric, Eccentric, Concentric, Plyometric exercises?
These are the different types of muscle movement in the human body.

  • Isometric is a holding tension. Like a bridge or a wall sit.
  • Eccentric is a lengthening movement. Touching your toes lengthens your hamstrings.
  • Concentric is a shortening movement. So, a biceps curl.
  • Plyometric is an explosive spring movement. Hopping, jumping, skipping.

5. Are there any videos I can use?

Yes! Here are a few I use with my patients. But always check with your therapist about what is best suited to your individual issue.

There are many YouTube videos on ankle health, the ones listed here are purely the ones that some of my patients have found useful and is by no means an exhaustive list:

For under 16yrs of age: Basic to Advanced:

For over 16yrs of age:

Also, any of these too: