Ankle Sprains in Irish Dance: The PEACE & LOVE Approach
“Sprained ankle” might be one of the most feared phrases in Irish dance (maybe besides “stamina!”) and chances are, either you or one of your dance friends have experienced the dreaded ankle sprain. But what exactly is an ankle sprain? What should you do if you sprain your ankle?
A sprain is an acute injury (an injury that occurs suddenly) of a ligament–a structure that connects two bones. Ligaments work to prevent joints from going too far beyond their range of motion, so if they are suddenly forced beyond that range (like landing a jump wrong) the fibers in the ligament will stretch and tear, resulting in a sprain.
The most common type of ankle sprain is a lateral ankle sprain - a sprain of the ligaments on the outside (lateral side) of your ankle. These types of ankle sprains occur by forced inversion of the ankle, when your foot rolls in and forcefully stretches the ligaments on the lateral side of your ankle.
Sprains are graded on a scale of 1 (least severe) to 3 (most severe). In a Grade 1 sprain, the fibers of the sprained ligament are stretched beyond their "safe" range of motion, but only suffer micro-tears. In a Grade 2 sprain, there is a larger tear in the ligament but it isn't fully torn. Grade 2 covers a huge range of injuries, as a Grade 3 sprain is a complete tear of the ligament. No matter which grade sprain you might have, your ankle requires careful rehabilitation to prevent future injuries and return to dance safely.
So what should you do if you do have an ankle sprain?
Show your ankle (or any injury) some PEACE & LOVE!
Raise your hand if you’ve been told to RICE after an injury like an ankle sprain? RICE- the acronym for Rest, Ice, Compression and Elevation has been widely used as an easy way to remember how to immediately care for an acute injury. In January of 2020, the British Journal of Sports Medicine published an article that presented some different advice, especially for injuries that are sub acute or chronic.
Let’s start by defining phases of an injury. An acute injury happens as a direct result of a fall, for example landing wrong from a leap and rolling your ankle. Incident, injury- acute. Subacute is what happens on an injury that’s healing- say the first 2 or 3 classes back after your ankle sprain, or an injury that occurs but is not quite fully healed. A chronic injury is pain that has lasted for a longer duration of time that you are managing- examples of this include tendinitis, pain like Sever’s or Osgood-Schlater’s that occur with growing, or a recurrent ankle sprain.
The newest evidence shows that PEACE & LOVE cover all of the above phases of injury, so let’s go over them together with the example of an ankle sprain
Let PEACE guide you after injury:
P- Protect. Right after an ankle sprain, the first 24-72 hours have the most pain, bleeding, and inflammation in the injured tissue. This is time to protect and avoid irritating the injury. This might look like taking time off of dancing, but walking is okay (if you can do it without limping or pain!), as well as stationary biking or swimming. This is a great time to focus on core strength and exercises that don’t directly load the ankle itself. Activity promotes blood flow, which helps optimize tissue repair.
E- Elevate. Regular intervals of elevating the ankle will help prevent excess swelling and promote fluid circulation. Give yourself a leg up and heal faster. This is a great time to elevate your ankle, turn on your music and visualize returning to dancing your best.
A- Avoid anti-inflammatories. Science is showing that the inflammatory process is our smart-body’s way of restoration and healing. Using an anti-inflammatory medication stalls the body’s process and can delay tissue repair. New standards of care suggest avoiding these medications. This includes the use of icing (or cryotherapy). While ice can be helpful for pain relief, it constricts blood vessels from delivering nutrients to help tissue heal.
C- Compress. Pressure from an ACE type wrap or compression sock helps prevent excess fluid and manages excess bleeding within the ankle, which can help minimize pain and stiffness post injury. This can aid in returning to weight bearing more quickly, and in the case of an ankle sprain, this is priority to getting back into dance shoes.
E- Educate. Recovery is an ACTIVE process. While the first 24-72 hours are key to protecting the injured tissue, there is so much an athlete can do to keep progressing in training towards their goals while recovering. Activities that are pain free are permitted, and cross training can be helpful for overall wellness and mental health while recovering from what could be a discouraging set back. Taking control of what your body CAN do is so empowering to an athlete. Remember that healing takes time, and might feel slow, so try to focus on what YOU can do for yourself, get creative and stay positive.
Ankles (and all your injuries) need LOVE
L- Load. Active recovery is the best recovery. As soon as the first 72 hours have passed, it’s time to start loading the ankle in pain-free to minimally pain-free ways. If the injury happens in-season, this might look like beginning with toe raises, foot placement exercises, or the balance and strength exercises found on the Target Training program. The goal is to load the ligaments, muscles and tendons without INCREASING pain or swelling. Loading promotes healing, healing promotes growth and a faster, more effective recovery.
O- Optimism. Positive outlook and expectation has been shown to result in better outcomes and prognosis. Expecting the worst, or fear of your ankle can have adverse effects on recovery time. What you believe and feel about your injury effects how your ankle heals! This might mean it’s time to recruit your teammates, or your teacher for a pep talk. Try taking some time to write out what you’re looking forward to as a dancer, what you’re proud of or grateful for when it comes to your dancing. Maybe it’s just finding things that feel good to your mood and your body like listening to your favorite music or wearing your favorite outfit.
V- Vascularisation. Like I said in L, loading in pain free or minimally pain free ways will help lead to healing, but so does getting your blood pumping. Finding ways to get your heart rate up will help increase blood flow to your tissues. This can be started as soon as a few days after injury and may even reduce the need for pain medication.
E- Exercise. If it’s accessible, finding a Physical Therapist or Athletic Trainer to help supervise recovery is an excellent way to getting back to dancing sooner after an ankle sprain. Every body is different, and healing may look a little different for every ankle sprain, so having an expert guide you along the road to recovery can be helpful to prevent returning too soon, risk of reinjury, and overall confidence with return to dance. If you are exercising on your own, or starting to add dancing back into your routine, make sure that you are avoiding increasing pain, swelling or any skills that feel unsure or unsteady. Please be sure to communicate this with your teacher or coach. If you do too much, or experience pain and swelling post activity, work your way back to finding PEACE. Compression and elevation will aide in recovery as you build back into training.
PEACE & LOVE allows a dancer who sustains a discouraging injury the opportunity to be empowered in their recovery and find activity and wellness to feel better, and return to dance sooner.
Dubois B, Esculier JF. Soft-tissue injuries simply need peace and love. J Sports Med. 2020; 54.2
Betsy Hines is a Certified Athletic Trainer and Doctor of Physical Therapy. Her clinical practice in Minneapolis, Minnesota specializes in working with dancers and adolescent athletes. As a TCRG, she understands how important it is to reduce time off after injury and optimize strength and wellness when returning to dance. Betsy graduated from undergrad and graduate school from Marquette University in Milwaukee.
To schedule an appointment with Betsy, call MHealth Fairview at 612-273-6228.
Ella Pomplun is a Physical Therapy student at the University of Minnesota in her second year. As a lifelong Irish dancer, she has a passion for applying principles of exercise physiology and strength training to Irish dance. She has worked with Ellen and Target Training since 2018, and has been the Operations & Communications Manager since 2022. She completed her undergraduate degree in Exercise & Movement Science from the University of Wisconsin-Madison in 2019.