Grade III Ankle Sprain

I took a long whipper on Castleton Tower last month. My partnered has posted a thread detailing the incident so I wont get into that at this point. What I'm really interested to find out is if there others here who have sustained high grade sprains and been able to eventually return to climbing hard WITHOUT going the route of surgical intervention. More specifically, will I ever climb crack again without an operation?

I luckily have health insurance so its not a problem of cost right now. I'll do what I have to do. But Its been about 5 weeks since, strength is coming back and the PT is helping big time. Stoke is up, I just dont want to lose all this progress and then, have to go another 6 months recovering from the operation if its not completely necessary. BUT i also don't want to live with a glass ankle and never touch a crack ever in my life. who's had experience? Thanks.

I've never been diagnosed with grade III, but have suffered countless grade IIs and I have recovered from all of them to return to crack climbing. That said, I had a solid grade II 4.5 months ago and I'm still avoiding cracks. So I wouldn't plan any trips if I were you. Here is a good resource: Management of Ankle Sprains
Be patient and good luck!

p.s.-post a link to the accident thread!

I had a grade 3 sprain over 2 years ago. I took a leader fall ice climbing and really damaged myself. I thought I would never fully recover. It took me over a year before I could climb with confidence again. This season is the begining of me finally making progress. I did home brew physical therapy and I regret that I didn't follow through with recommended p.t. I would say patience is a virtue and if you don't go the surgery route plan on over a year recovery time with a two steps forward one back progression. Best of luck to you and a speedy recovery

I had a grade III sprain from a work injury last year.

Mri, xray, rehab the whole enchilada.

Took a year to get back to being able to crack climb.

It still hurts on descents and approaches from blocking in the joint.

No surgery though, the tendons were really messed up but healed with 6 months of rehab.

It takes a long time to heal, so don't push it till the time is right.

Thanks for the replies

Link to the accident thread Here

For you guys that took a year to recover, at what time did you get back to any kind of climbing? When would you say you were climbing at half strength, so on so forth?

I will definitely take it slow and understand its a long road ahead. I'm just hoping I can find some activities and forms of climbing that will be doable over the course of the spring and summer.

I had a trip to red rocks nv 4 months post injury. It was paid for so I went. Fun trip, miserable climbing. I was in pain and think I slowed my recovery due to respraining on approaches. Crack climbing technique became tech face and I didn't lead climb at all. I would suggest getting a hangboard and stock in Aleve. The sooner you rush back to climbing the longer you'll wait to get back to where you wanna be. I'm very stubborn and paid a price for it.

Taylor,

Some important information when determining a prognosis for grade III ankle sprains is the type of sprain and the extent of ligament involvement. Was your sprain an inversion (lateral) sprain, or a syndesmotic (high-ankle) sprain? Further, any chance that your PT tested which ligaments were torn and which were preserved? He/She may not have...It may seem counter-intuitive, but ligament testing is often not performed acutely because there is a risk of further damaging ligaments which are partially torn, and the information the tests provide would not necessarily guide your treatment....meaning...knowing that a ligament is partially torn vs completely torn doesn't affect the treatment protocol, since your PT may have you initially undergo the same therapy in both scenarios.

Since lateral ankle sprains are more common, and high ankle sprains involving rupture of the medial deltoid ligament are more likely to result in surgery, I'm going to assume you had a lateral sprain. To the best of my knowledge, the scientific literature has not fully parsed out whether surgery or conservative rehabilitation has better outcomes in grade III lateral ankle sprains. Below is a plain language summary of a comprehensive review by Kerkhoffs (2007) of 20 articles involving grade III lateral ankle sprains in 2,562 males which investigated differences between surgical and conservative management, specifically looking at 1.) non-return to pre-injury level of sports; 2) ankle sprain recurrence 3)long-term pain; 4)subjective or functional instability..

Summary: ["Ankle sprain is one of the commonest musculoskeletal injuries in active people. It generally involves damage to the lateral or outer ligaments, which connect bones together on the outside of the ankle joint. Treatment is usually either immobilisation of the leg in a plaster cast, or 'functional treatment' where the ankle is kept in use while protected by an external support. After treatment, however, some people still have a weak and sometimes painful ankle. This review aimed to find out if primary surgical repair of the torn ligament(s) gives a better result than either of these two non-surgical or conservative treatments.

Twenty trials were included. These involved a total of 2562 mostly young active adult males. All trials had methodological flaws that could have affected their results. Data for pooling individual outcomes were only available for a maximum of 12 trials. Additionally, there was one low quality and potentially biased trial with very positive results in favour of surgery. When this trial was excluded, the findings of better results for surgery in terms of return to sports, re-injury, persistent pain and ankle instability as judged by the patient were no longer statistically significant. Thus, the trend to a better result from surgery remains unproven. Ankle stability, as judged by the clinician using standard tests, was better after surgery than with conservative treatment. Conversely, there was some limited evidence for longer recovery times, and higher incidences of ankle stiffness, impaired ankle mobility and complications in the surgical treatment group.

We concluded that there was not enough evidence from randomised controlled trials to say whether surgery gives a better result than conservative treatment for acute ankle sprain in adults."]

I am curious as to what recommendations your PT made regarding surgery, if you don't mind sharing? There is some literature to suggest that surgery down the road has the same outcomes as immediate surgery; So if conservative management fails, all hope is not lost. Overall, surgery would most benefit someone with severe ankle instability, and your future ankle stability will be determined by your PT as your therapy progresses. In the meantime, be sure to talk to your PT about your motivation to crack climb again, since he/she may adjust your future treatments to strengthen peroneal muscles or promote ankle eversion (things that help you stay in a crack).

It's difficult to determine how much crack climbing you will do in the future based solely from your report of having a grade III ankle sprain after whipping on Castletown. But I think one very important factor in your recovery is your motivation, so keep the Stoke Up!!! Good luck and stay positive.

Best,

Christian Quijano
Regis University
Doctor of Physical Therapy Student (2017)

Taylor, I'm sorry to hear about your injury!
I am currently healing from a II/III right now. I was skateboarding and rolled the shit out of it trying to land a heel flip. The first thing that went through my head was "oh fuck, there goes climbing". "So much for that phasic training program you were thinking about doing on Rock and Ice". I definitely feel your pain! Right now all I really want to do is improve in climbing and get out as much as possible. I hope for the both of us that we will be 100% soon. This is a minor tragedy, honestly. I have broken my other ankle before I started climbing and it has never bothered me, so I'm thinking, how bad could this be right? Even if it takes a while for our ankles to get healed we can still climb. I've been top roping on easy routes in the gym with my boot on looking stupid but hey, no great reason to not! Good luck dude!

Aluckyduck thankyou for providing such a detailed and informed response. I was not expecting such a thorough answer. To answer your questions, I believe it was a lateral sprain. Following the MRI, my orthopedic indicated I had complete acute tears for the anterior talofibular ligament and calcaneofibular ligament. Also I have a partial tear of the superomedial portion of the spring ligament. When the Orthopedist received these results she recommended PT twice/week for 5 weeks. After the 5th week I supposed to revisit her to assess progress/stability and reevaluate options/surgery at that point in time. So I guess we'll find out.

That is interesting to know that research has been relatively inconclusive as to whether surgery or 'functional treatment' provides best results.

Worth - how difficult was the climbing in red rocks you were doing? I kinda thought for sure id be ok to do some stuff in 4 months, sounds like its going to be a long road, as others have pointed out. (sigh)

Nathan-Good to hear you're making the most of it and climbing in some capacity! heal quick

ALuckyDuck, wow GREAT post! I wish that more people regularly posted that much information lol.

Feel free to PM, me. I suffered a nasty high ankle sprain and injury to both the anterior talofibular ligament and tearing of the syndesmosis between the tib/fib while running past chasm lake on Long's peak. Initial visit to my Doc said- you'll be running again in 3 weeks.

I tried to return to running a few times, but it never felt right and i was very unstable, sort of re-injuring it every time.

Took time off, tested waters, didn't feel right, took more time off. All the while I was climbing and stupidly, bouldering more than roped climbing

That was in July 2015. fast forward to the new year- i decided I was absolutely done with this injury and needed to take healing seriously as my resolution. Sought an MRI and second visit to an orthopedist. worth the spend to know the issue (described first paragraph). Stopped Bouldering, started soaking in hot water daily and doing hot yoga weekly. Taking my PT a bit more seriously (lots of standing on 1 foot to build propriorecepter ability). been running on trails again up to 7 miles at a tick.

Been on a rope, face/sport climbing mostly at a gym. this feels good and i think strengthens the affected area. Using a brace on outdoor approaches. Anything slabby/steep presents an issue and pain as my ankle just doesn't bend that way to well. . To your point- i have NOT crack climbed and declined a trip to go to the Creek already for fear that my ankle isn't up to it. I'm going to give it another couple months before i ease into moderate crack climbing and feel it out.

Also: using Diclofenac which is generic Voltaren gell 2 x's daily on the ATFL- this helps with overall swelling quite a bit. you need a script. a few 100 Mg's of IB before a run or climb doesn't hurt either.

I have had probably a dozen sprains between my to ankles.

I had a Grade three sprain in 2009. I took a month off and climbed only easy rope routes for two-three months.

2010 I moved and did limited bouldering and surfed with minor pain for 9 months. I rode my bike 7 days a week and felt it helped alot

2011 I came back to the mainland US and tried climbing and it worked to an extent but If i fell bouldering my ankle would roll and crack climbing was painful.

2012 I think was the year after another injury I barely climbed for 16 months.

2013-present. 2013 mid summer I returned to climbing and working outside and since then have felt that my Ankle is back to 95% (minus the 5% since I am not 21 like I used to be). I did climb mt washington this year and the cold morning it was a little stiff.

If I had to do it again, I would go the nonsurgery route still. but I would stick to a good PT rehab.

Surgery really sucks in my opinion unless it is an absolute must.