Sprained Ankle Lessons, Part 1

Injuries stink for everyone. My own ankle sprain just before the 2022 New Year was no different.

I was sitting at my desk chatting on the phone while wearing my ‘at-home uniform’ of yoga clothes and Dansko clogs. I finished the call, stood up and started to walk away from my desk. What I didn’t see was my backpack lying on the floor. I tripped over it, got entangled in the backpack strap as I fell hard and badly twisted my ankle in the process.

It had been 39 years since I last twisted my ankle. 39 years is a long time, especially because I was someone who had suffered chronic ankle sprains as a young dancer.

My ankle hurt so badly and I really wasn’t sure if it was broken so I googled how to determine if an ankle is sprained or broken and found the Ottowa Ankle Rules, which are rules to help predict foot and ankle fractures. All of the places that would be tender to the touch if my ankle was broken seemed ok.

I knew about the Be Calm Protocol, a researched protocol for dealing with acute injuries, and immediately reviewed that online, too. I’m sharing it here because I found it so useful and hope it will be helpful for you too!

Though R.I.C.E. (Rest. Ice. Compression. Elevation.) has long been used to promote healing after an acute injury, it turns out that applying ice can interfere with the natural healing process of our bodies. Today R.I.C.E has even been debunked by its author:

“Coaches have used my “RICE” guideline for decades,
but now it appears that both Ice and complete Rest may delay healing,
instead of helping.”
– Dr. Mirkin

As much as we’d like to reduce its effects, inflammation is necessary to promote healing of an acute injury. Reducing inflammation, even with the use of cortisone and non-steroidal anti-inflammatory drugs, will delay the healing process.

The problem with ice is that it constricts the blood vessels, slowing down the process of healing. (Think of how we move our bodies more easily when we’re warmed up.) Blood vessels remain constricted even when the ice is removed. Applying ice also slows the rate of lymphatic drainage from the injured tissue, another important element of the healing process.

What to do instead?

Use the BE CALM PROTOCOL!

Breathe – Deep breathing to calm the nervous system.

Evaluate – Is it a soft tissue injury or a bone injury? (There’s a different protocol to follow if you suspect an injured bone.)

Compression – Gently wrap the area (not for a fracture, though.)

Able Actions – Practice movements in a pain-free range, even if it’s a very small range.

L = Elevation – Use gravity to help your body naturally limit swelling by simply elevating the injured body part above the level of your heart.

Minimal Ice – For pain control, 5 minutes maximum for ice ON, 20 minutes ice OFF, 5 minutes maximum ice ON. Repeat this once only if needed for pain relief, for a maximum of 2 cycles.

Read more about the Be Calm Protocol, including when heat should be used for an injury.