"Nagging Rave Injuries" - A New Series

Pt 1: The Dreaded Twisted Ankle

Our ankles have tough, fibrous tissues called “ligaments” that connect the shinbone (the “tibia”), the calf bone (the “fibula”), and the ankle bone (the “talus”) and provide support.

When these ligaments stretch in an unnatural way or tear, the injured tissue releases chemicals (prostaglandins, histamine, bradykinin, cytokines). 

These chemicals work to widen surrounding blood vessels to increase white blood cell and platelets and promote injury healing. The increase in blood flow results in swelling of the area. 

The ankle also has several thin blood vessels which can tear when the ankle is even mildly twisted, which causes internal bleeding (called “hematoma”) and leads to bruising/discoloration.

Why Does Dancing Cause This?

The biggest risk-factors for twisted ankles are repetitive motion and overuse, especially during activities that involve explosive, high-impact movements.

Studies show that dancers often take tens of thousands of steps in short periods of time, and repetitively jump up and down, often in uncomfortable or poorly-fitted shoes. 

Research also suggests that women are generally more prone to twisted ankles than men due to the tendency to wear heels, having less stable joints, and having wider pelvises which affect knee-ankle alignment and balance.

So You Twisted Your Ankle: What Should You Do?

Right After:

• Apply ice for 15-20 mins. Repeat every 2-4 hours. 

  
  

• Take Non-Steroid Anti-Inflammatory Drugs:

  • Ibuprofen (Motrin, Advil) - 200 to 400 mg every 4 to 6 hours // 600 to 800 mg every 6 to 8 hours

  • Naproxen (Aleve) - 200 to 440 mg every 12 hours 

  • Aspirin - 325 to 1000 mg every 4 to 6 hours

    
    

• While acetaminophen (Tylenol) doesn’t have anti-inflammatory properties, it does offer pain relief benefits and can be safely mixed with NSAIDs. 

If you have a bandage, wrapping your ankle pushes out excess fluid from the injured area while also stabilizing it. Click here for a demonstration video on ankle-wrapping. 

It’s important to note that ankle sprains have a spectrum of severity. If there’s a “popping sound”, or if pain and swelling are extraordinarily severe, seeking medical attention is advised. 

24-48+ Hours After:

Once a full day passes, the goals are to reduce fluid accumulation in the ankle, improve circulation, and reduce pain. Elevating a sprained ankle for at least 24-48 hours after the injury does all of this by using gravity to pull fluid away from the area, allowing for improved blood flow.

If there has not been significant reductions in swelling or pain after 2-3 days, or if they worsen, seeking medical attention is advised, as well as if you experience intense discomfort while putting weight on the ankle after 7 days.

Warning: DO NOT apply heat to an injury until at least 3 days afterward. Heat widens blood vessels, which could actually promote inflammation and delay healing and swelling.

A Word About Drugs: How do They Come In?

Stimulants can make people dance harder, faster, and more intensely. Most stimulant drugs have anaesthetic effects, which could mask the pain or severity of the injury. 

Sedatives also reduce pain temporarily, and could impede one’s balance and coordination, leading to higher likelihood of falling or awkward movements that lead to injury. 

Also, sedative drugs are shown to delay the release of pro-immunity chemicals that promote inflammation, which consequently slows down the whole healing process.

Works Cited

Cleveland Clinic medical. “Ankle: Anatomy & How It Works.” Cleveland Clinic, 18 May 2025, my.clevelandclinic.org/health/body/24909-ankle-joint. 

“Swelling: The Body’s Reaction to Injury.” Nationwide Children’s Hospital, www.nationwidechildrens.org/specialties/sports-medicine/sports-medicine-articles/swelling-the-bodys-reaction-to-injury. Accessed 20 Oct. 2025. 

Struijs PA, Kerkhoffs GM. Ankle sprain: the effects of non-steroidal anti-inflammatory drugs. BMJ Clin Evid 2015: pii: 1115. 

Al-Mohrej OA, Al-Kenani NS. Chronic ankle instability: Current perspectives. Avicenna J Med. 2016 Oct-Dec;6(4):103-108. doi: 10.4103/2231-0770.191446. PMID: 27843798; PMCID: PMC5054646.

“Common Dance Injuries and Prevention Tips.” Johns Hopkins Medicine, 7 July 2022, www.hopkinsmedicine.org/health/conditions-and-diseases/sports-injuries/common-dance-injuries-and-prevention-tips. 

Robert H. Shmerling, MD. “The Gender Gap in Sports Injuries.” Harvard Health, 22 June 2020, www.health.harvard.edu/blog/the-gender-gap-in-sports-injuries-201512038708. 

Wilkerson RD, Mason MA. Differences in men's and women's mean ankle ligamentous laxity. Iowa Orthop J. 2000;20:46-8. PMID: 10934624; PMCID: PMC1888743.

Villa, G., Mega, C., Senzi, A. (2018). Sedation and the Immune System. In: De Gaudio, A., Romagnoli, S. (eds) Critical Care Sedation. Springer, Cham. https://doi.org/10.1007/978-3-319-59312-8_11

“How to Apply a Compression Wrap for a Sprained Ankle.” How to Apply a Compression Wrap for a Sprained Ankle Video & Image, www.columbiadoctors.org/health-library/multimedia/how-apply-compression-wrap-sprained-ankle/. Accessed 21 Oct. 2025.