Soreness can return before full strength does

Ankle sprain recovery needs balance and strength

Your ankle can feel normal during an easy walk, though a quick sideways step asks much more from it. If strength and balance aren't back, it may roll again. A brace may help during play, but it can't steady every turn.

Start with slow balance practice on flat, firm ground. Notice whether one ankle shakes or tires before the other. Then add speed or quick turns only if you aren't more sore later. An exam can check weakness, looseness or an old injury.

An overuse injury follows too much activity too soon

You may not remember one moment when the ache began. Extra miles, harder games or a new surface can add up. A busy week may be enough to wake an old sore place. The next morning often tells you more than a warm-up does.

Cut back the recent change that brought on soreness. Keep easy movement if you aren't worse later that day. Once the ache settles, add either minutes, speed or one playing day. Don't increase all three during the same week.

A hamstring needs more than time away from sport. Walking may feel fine before faster steps are safe. Sudden bruising, a snap or marked weakness needs an exam. Don't test those signs with another hard run.

Some warning signs need prompt medical care

When is recurring soreness more than a nuisance? Get care soon if you can't put weight on the joint. A hot, red and swollen joint also needs attention. Fever with joint swelling makes the need more urgent.

A pop behind the ankle followed by trouble lifting your heel may mean the thick cord there has torn. Numbness or a pale, cold foot isn't routine soreness. Confusion or repeated vomiting after a head hit needs urgent care. Stumbling or collapse in the heat is an emergency.

For a regular visit, note the day each bout began. Tell the clinician which sport and exact movement brought it on. Explain how the area felt the following morning. Also say what helped and how long the relief lasted.

Sources

1. The updated evidence-based ankle sprain guideline states that ligament damage severity is assessed most reliably by DELAYED physical examination 4-5 days after the injury; that after a short period of immobilisation the patient benefits most from tape or a brace combined with an exercise programme; that NSAIDs may reduce pain and swelling but are not without complications and MAY SUPPRESS THE NATURAL HEALING PROCESS; that supervised exercise-based programmes are preferred over passive modalities; that surgery should be reserved for cases not responding to comprehensive exercise-based treatment; and that ankle braces are efficacious for preventing recurrence.

   Vuurberg G, et al. — Diagnosis, treatment and prevention of ankle sprains: update of an evidence-based clinical guideline.. Br J Sports Med, 2018. DOI: 10.1136/bjsports-2017-098106.

2. Across 15 studies and 8,459 athletes in different sports, ages and sexes, injury-prevention programmes that INCLUDED the Nordic hamstring exercise reduced hamstring injuries with a risk ratio of 0.49 (95% CI 0.32-0.74) - essentially halving them. Restricting the analysis to the eight randomised studies (RR 0.52) or removing the eight high-risk-of-bias studies (RR 0.55) barely moved the estimate.

   van Dyk N, et al. — Including the Nordic hamstring exercise in injury prevention programmes halves the rate of hamstring injuries: a systematic review and meta-analysis of 8459 athletes.. Br J Sports Med, 2019. DOI: 10.1136/bjsports-2018-100045.

3. An overview of 46 systematic reviews on ankle sprain found STRONG evidence for bracing and MODERATE evidence for neuromuscular training in preventing recurrence, and for the acute injury strong evidence for NSAIDs and early mobilisation with moderate evidence for exercise and manual therapy on pain, swelling and function. Evidence for surgery and acupuncture in acute sprain was conflicting, and there was insufficient evidence for therapeutic ultrasound.

   Doherty C, et al. — Treatment and prevention of acute and recurrent ankle sprain: an overview of systematic reviews with meta-analysis.. Br J Sports Med, 2017. DOI: 10.1136/bjsports-2016-096178.

4. The training-injury prevention paradox argues that non-contact soft-tissue injuries are not caused by training as such but by an inappropriate training programme - specifically by excessive and rapid INCREASES in load - and that athletes accustomed to high chronic training loads have fewer injuries than athletes training at lower loads. Under-training may itself raise injury risk. The paper proposes the acute:chronic workload ratio as a way of capturing that.

   Gabbett TJ — The training-injury prevention paradox: should athletes be training smarter and harder?. Br J Sports Med, 2016. DOI: 10.1136/bjsports-2015-095788.

5. A systematic review of long-distance runners found the incidence of lower-extremity running injury ranged from 19.4% to 79.3% depending on the population and definition, with the knee the predominant site. There was STRONG evidence that a long weekly training distance in men and a history of previous injury were risk factors - and, counterintuitively, that an increase in weekly training distance was protective against knee injuries specifically.

   van Gent RN, et al. — Incidence and determinants of lower extremity running injuries in long distance runners: a systematic review.. Br J Sports Med, 2007. DOI: 10.1136/bjsm.2006.033548.

6. The 2023 IOC consensus on Relative Energy Deficiency in Sport describes a syndrome of health and performance consequences in female and male athletes exposed to low energy availability - inadequate energy intake relative to exercise energy expenditure - and introduces updated health, performance and physiological models plus a revised clinical assessment tool. More than 170 original research publications had appeared since the 2018 statement, including emerging data on low carbohydrate availability and on the interplay with mental health.

   Mountjoy M, et al. — 2023 International Olympic Committee's (IOC) consensus statement on Relative Energy Deficiency in Sport (REDs).. Br J Sports Med, 2023. DOI: 10.1136/bjsports-2023-106994.

7. The Munich consensus statement on muscle injuries was written because a survey of 30 English-speaking team doctors and scientists confirmed marked inconsistency in terminology - most obviously for the word 'strain'. It defines four types: functional muscle disorders (type 1 overexertion-related, type 2 neuromuscular) with no macroscopic fibre tear, and structural muscle injuries (type 3 partial tears, type 4 subtotal or total tears and tendinous avulsions).

   Mueller-Wohlfahrt HW, et al. — Terminology and classification of muscle injuries in sport: the Munich consensus statement.. Br J Sports Med, 2013. DOI: 10.1136/bjsports-2012-091448.