What To Do When You Sprain Your Ankle in the Wilderness:
After a long day of hiking, you walk down to the tarn to fill up your pot to start cooking dinner. Then, suddenly, you slip. Your ankle twists and you land hard on your butt. As you sit up, you’re relieved to discover that nothing really hurts except your ankle. And then you start to worry.
Is it broken? Is it sprained? Is this a trip-ending injury?
In the backcountry, it’s not practical or possible to diagnose an athletic injury like this. What you can do, however, is determine whether an injury is usable or not. If the limb is usable, you can take care of it with some of the treatments that I will outline below. If the limb is unusable, then you must immobilize it and evacuate.
Athletic injuries, including strains and sprains, are some of the most common injuries encountered in the backcountry.
Sprains are injuries to ligaments, the tissues that connect two bones, and strains are injuries to muscles and tendons.This is what you usually think of as a “pulled” muscle.Tendons connect muscle to muscle or muscle to bone.
Here are some common causes of athletic injuries:
• Tripping while walking in camp
• Stepping over logs
• Crossing streams, including shallow rock hops
• Putting on a backpack
• Lifting a heavy object
• Falling or mis-stepping while hiking with a pack on any terrain
So, how do you know if an injury is usable or unusable?
1. Evaluate the mechanism of injury. How did the patient get hurt? Did the pain come on suddenly, perhaps from a fall, indicating a sprain, or did it get progressively worse, indicating an overuse injury?
2. Evaluate signs and symptoms (see more details below).
3. Perform a usability test. Ask the patient to try to move the joint through its full range of motion. Painless movement is a good sign. If the patient is able to use or bear weight on the affected limb, and pain and swelling aren’t severe, patient may be treated in the field.
DeKUT instructor team perform simulated first-aid maneuvers for musco-skeletal injuries
Signs and Symptoms of Athletic Injuries
• Swelling and discoloration
• Pain or tenderness
• Instability and/or loss of range of motion
• Inability to bear weight
• Point tenderness and obvious deformity (suggests a fracture)
• Severe pain, the sound of a pop at the time of injury, immediate swelling, and inability to use the joint are signs of a serious sprain, possibly a fracture. This injury should be immobilized and the patient evacuated from the field.
Once you’ve determined whether an injury is usable or not, you can start your treatment.
Treating Ankle Sprains
i) Follow the RICE acronym to provide treatment:
o Rest to allow time for healing.
o Ice. Gently rub the injured area with ice, wrapped in fabric to prevent frostbite, for 20 to 40 minutes every two to four hours for 24 to 48 hours. Cooling is thought to decrease nerve conduction and pain, constrict blood vessels, and limit inflammation. If you don’t have ice, use the coldest water available (sometimes, this is simply a bandanna soaked in cool water).
o Compression. Use an elastic bandage to reduce swelling. Do Not exert pressure on an injury that swells dramatically. Be careful not to cut off blood flow to fingers and toes.
o Elevation reduces swelling.
ii) Nonprescription pain medications, such as acetaminophen and ibuprofen, may also help.
Author, Mwai Kennedy, Outdoor Instructor