Category: Newsletter

Newsletter #314 Your instinct to rest your sprained knee or ankle is outdated

14/11/2025

✔ Here's what to do

⭑ Pain relief tablets lengthen healing times for knees and ankle injuries - item #1.
⭑ Why sprains hurt more at night - this is natural, learn why - item #2.
⭑ Amazingly this diet speeds sprain and strain recovery! Here's why - item #3.
⭑ Your instinct to rest your sprained knee or ankle is outdated - item #4.

I trust you are well and active.

The most common "goodbye" to amateur runners from their physiotherapist is "remember, don’t do too much too soon". I didn't listen (again), and cooked my left knee. The good news? I have some useful tips to share with you about tendon and ligament injuries.

It helps to know that tendons connect muscles to bones whereas ligaments connect bone to bone. Tendons are generally stronger and better shock absorbers, such as from jumping, than ligaments. Ligaments are more elastic because they have to bend with joints but still hold the joints together.

Tendons suffer from strain injuries - muscle to tendon - and ligaments suffer from sprain injuries - tear of the ligament. They both have poor blood supply and heal slowly.

There are common vexed questions about knee and ligament injuries, for example, should I take aspirin or ibuprofen? Is it better to rest and keep the knee immobilised or keep moving and walking? Should I keep exercising or will it make things worse? Are there foods that will help my ligaments recover faster? Why does it hurt so much at night should I see a doctor?

I dug deeply and found scientifically validated answers. Read on to learn how to worry less about the pain at night, accelerate the growth of stronger tendons and ligaments and shorten the recovery time through exercise.
//
01 To Tablet or Not To Tablet? The Definitive Answer

After injuring my right hamstring 14 months ago I was coming back into running form and at the Wednesday night athletics 10 days go the crowd cheered me on "Walter's back!". Harder I pushed.

The next morning I could barely walk, the pain in my left knee was excruciating. I did too much too soon.
It is during this period of high pain, and even higher during the night - more on this below - that we generally reach for an aspirin or ibuprofen.

⇒ For faster healing it is best to not take these.

The initial acute period is stimulated by a rush of white blood cells and bleeding, swelling and pain usually for 7 to 10 days. This period ends when the body has the removed enough debris, germs, and damaged tissue to start the actual healing process.

At this time, our body stimulates release of powerful analgesics (SPMs) and in turn the SPMs trigger the release of specialist chemical messengers which start the healing process. At this time you will notice the daytime decrease considerably. In my case, at day 9, the daytime pain level dropped by about 50%.

What this means for you ... Emerging research evidence reveals NSAIDs e.g. aspirin (such as Disprin) ibuprofen (such as Nurofen) naproxen (such as Naprosyn), may prolong pain duration by suppressing the SPM activity necessary for the healing process to begin.

In other words, NSAIDs may provide short-term pain relief but compromise long-term healing and extend overall pain duration.

Now, hold on to your seat, because for the same biological reason the ICE component of the near-universal RICE method (Rest-Ice-Compression-Elevation) will also provide short-term pain relief but compromise long-term healing and extend overall pain duration.

Ice constricts blood vessels, decreasing blood flow and oxygen/nutrient delivery at the injury. But increased blood flow and some swelling are essential components of effective damage control.

⇒ If you can stand the pain, the evidence says to avoid NSAIDS and icing for faster overall healing.

//
02 Yes, Nighttime Pain IS Worse. Don't Panic

Should I see a doctor? Is it getting worse? Why is it SOOO painful?

You *might* need to see a doctor - I don't know - but don't panic *just* about the nighttime pain of your sprain or strain - it's normal.

Our circadian rhythm includes a cortisol cycle. Cortisol keeps us alert and aware and ready for "fight or flight". It helps our brain override, or smother, little niggles and pains which otherwise might make us hesitate to run from a lion i.e. because we have a sore knee.

An hour or so after your usual bedtime your body turns down your cortisol levels so that you can enter deep restorative sleep.

⇒ The reduced cortisol also allows your body to become aware of all your little niggles and pains and then take action to attend to them, like a micro-version of the drama going on with your knee or shoulder or ankle.

Unfortunately this also means that your sprained ankle or knee REALLY hurts - you can’t escape it no matter which way you place your leg or foot. But the underlying injury is not worse, you are just feeling it "unmasked".

What this means for you ... Consider these two scenarios:

Scenario 1: Know that your cortisol level turns back up to daytime level at around your normal wakeup time and just cope with the nighttime pain.
Scenario 2: Take a NSAID to relieve the pain and potentially improve your sleep knowing that it may delay a little the onset of the healing phase.

⇒ They are both good choices according to your circumstances.

The high pain should quell between 7 and 10 days, if it doesn’t then get advice. Mine dropped by about half at day 9, which is typical for older adults.

//
03 How Diet Helps Healing Tendons - Timing and Dose Matter

Other than water our ligaments are 85% collagen. During tissue repair your body must synthesise new collagen, which requires specific amino acids (proline and hydroxyproline) plus vitamin C as a critical enzyme cofactor. (Without vitamin C, the enzymes that cross-link and stabilise collagen fibres cannot function properly.)

A clinical trial using hydrolysed collagen peptides (dosed at 5 grams daily) combined with vitamin C supplementation showed significantly faster collagen synthesis and pain reduction compared to no dietary intervention in tendon injuries.

Research points to this combination being even more effective at accelerating healing when we are older, but without conclusive evidence yet.

What this means for you ... Targeted nutrition supporting the specific biochemical process your body needs for healing works:

Collagen peptides: 5 grams daily (unflavoured dissolves in water, coffee, or tea; no taste)
Vitamin C: 500–1,000 mg daily (excess excretes; no harm)
Protein: ensure adequate dietary intake (1.2–1.6 g per kg body weight daily; critical for ages 70+)
Duration: 8–12 weeks covering the entire remodelling phase

Start these immediately if injured; they're particularly important weeks 2–8 when collagen remodelling accelerates.

⇒ However, all this is not a magic cure - it only works alongside appropriate rehabilitation - see the next item.

//
04 Light Exercise Accelerates Healing

Should you immobilise, or try to keep moving, if you've a sprain or strain?

Obviously you should not push hard or try to work through bad pain. Take it slowly.

However validated research has shown that people who focus on early mobilisation recover strength up to 60% faster and return to activity weeks earlier than those to stay immobilised.

In fact the Sanford Health evidence-based MCL rehabilitation guideline now prescribes immediate pain-tolerated walking and stationary biking beginning day 1, with progressive resistance as swelling decreases.

Why? Because controlled movement stimulates fibroblasts (the cells rebuilding ligament tissue) to lay down collagen in organised, load-bearing patterns.

IF YOU HAVE A COLLAGEN enhanced diet, as above, this will boost the effect of your early mobilisation exercises.
On the other hand immobilisation produces disorganised, weaker collagen that remains vulnerable to re-injury.

Additionally, early mobilisation prevents the vicious cycle of deconditioning, muscle loss, and proprioceptive loss (sense of knowing the orientation of the joint) that plague completely immobilised joints.

What this means for you ... If you’re over 50 and injured, your instinct to “rest completely” is outdated.
Progressive weight-bearing - starting with gentle walking and progressing to stationary biking (5–10 minutes initially, advancing to 20+ minutes as tolerated) - accelerates tissue healing and functional recovery.
For moderate severity sprains, this translates to the restoration of near normal functional capacity at around 6–8 weeks instead of 12–16 weeks.

⇒ The prescription: Week 1–3: normalise walking (pain-free gait without limping), biking 10–20 minutes daily. Week 3–6: add hamstring curls, double-leg leg presses or squats that you can tolerate, and step-ups; introduce pain-free running if 75% strength is achieved. Week 6+: lateral movements, sport-specific activities.

Read your body. Find movement that suits your stage of recovery and keep doing it.

The Big Picture
If you’re over 50 and fit (running, strength training, kettlebells), your injury recovery follows the same principles as younger athletes - with one key difference: slower kinetics. Masters athletes over 70 achieve comparable long-term functional outcomes to younger cohorts, but each recovery phase extends approximately 1–2 weeks longer. For example, a moderate severity (Grade II) MCL sprain that resolves in 4–6 weeks for a 35-year-old may require 6–8 weeks for you. If it is a repeat injury then it will take longer.

Thanks for reading!

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