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I think I sprained something. How long should I stay off it? A broken ankle's no excuse to put your feet up!

By Alex Hutchinson
Globe and Mail
Thursday, Oct. 15, 2009

The question

Ouch, I think I sprained something. How long should I stay off it?

The answer

Canadian figure skater Anabelle Langlois returned to action last month, earning a bronze medal with partner Cody Hay at a tournament in Germany one year after fracturing her fibula in a training accident. With Olympic dreams on the line, Ms. Langlois's doctors had pursued every possible avenue in her rehabilitation, including two operations.

One thing they didn't recommend, though, was a long period of complete rest for the injured leg.

In the past few decades, doctors have changed their thinking about the best treatment for sports injuries ranging from sprained ankles and pulled muscles to, in some cases, broken bones. After the initial pain and swelling begins to subside - sometimes in as little as a few days - movement and gentle loading of the injured area seems to help muscles heal better, hasten return to full strength, and reduce the risk of recurrence.

That advice remains little heeded, in part because of the very real risks of pushing too soon, and in part because of our natural caution.

"In your head, you want to protect an injury," says Ms. Langlois, who at the urging of her doctor was putting weight on her injured leg within two weeks of surgery, with a still-broken bone and an open surgical wound. "That really surprised me," she says.

The goal of "early mobilization" isn't just to return an injured athlete to competition as quickly as possible. Favouring an injury for too long causes muscles to atrophy from disuse and affects the healing process.

"If an injured muscle heals without any stress being put on it, it will generally heal in a shortened position, and the affected area will be a bit weaker and more fibrotic [from abnormal scar tissue] than the surrounding tissue," says Dr. Shawn Thistle, a clinic director of Shape Health & Wellness Centres in Toronto. "It ends up being the weak link when you return to activity."

A study published last year in Histology and Histopathology illustrates the process. Brazilian researchers compared the recovery of rats who rested with others that began moving their legs either one hour or three days after a muscle injury. Both mobilized groups had more regenerated muscle fibres than the controls, but only the early-mobilization group also had a decrease in fibrotic scar tissue.

Humans and rats recover at different rates, so it's impossible to apply these findings directly to humans (and it's equally difficult to find a group of human subjects with identical injuries to conduct a similar experiment), but the same principles apply.

While excessive scar tissue creates problems, recovery should begin with an initial period of immobilization to allow the formation of scar tissue strong enough to prevent the muscle from retearing. During this period, which for mild injuries may last three to seven days, the "RICE" protocol of rest, ice, compression and elevation hastens recovery.

Once the acute phase has passed, activity can progress in a sequence beginning with simply moving the affected muscle through its range of motion, then load-bearing exercises, and eventually functional activities, says Dr. Thistle, who is also a lecturer in the orthopedics department of the Canadian Memorial Chiropractic College.

You can think of it as "MICE" rather than "RICE," where movement replaces rest. Pain can serve as a useful guide to tell you when you're pushing further than you should.

Of course, elite athletes aside, most people won't have a team of physicians carefully monitoring their progress, which makes it risky to push the pace of rehab too much. Any injury in which the initial pain and swelling persists for more than a day or two should be evaluated by a doctor or sports therapist.

But for the milder tweaks that inevitably accompany many sports, it's worth bearing the principle of "active rehab" in mind. Re-establish the full range of motion as soon as possible, and follow up by loading the muscle. Don't push to the point of pain, but don't hobble yourself by protecting an injury long after it's healed.