If you have an ankle sprain, you’re likely to experience throbbing at night. However, you may not have been adequately informed about this – a common occurrence among my patients.
As a physical therapist, I will explain the reasons behind this phenomenon and what you can do about it.
Take home message: Nighttime throbbing after an ankle sprain is not a sign of a complication. It’s simply because the inflammation needed for tissue repair is more prominent at night. This will naturally improve over time.
Happy reading 🙂!
Last update: October 2023
Disclaimer: Affiliate links. Complete disclosure in legal notices.
Written by Nelly Darbois, physical therapist and scientific writer
Why Does Your Ankle Throb at Night After a Sprain?
That nighttime throbbing in your ankle following a sprain is usually due to inflammation.
Inflammation is a natural part of your body’s healing process.
When you get injured, like with a sprain, your body’s response involves inflammation. It sends chemicals and immune cells to the injured area to clean up and start the healing process.
This process can lead to swelling, redness, warmth, and pain – the usual signs of inflammation.
This increased throbbing isn’t a sign of a problem. Instead, it shows that your body is actively healing the sprained ankle. And, as your healing progresses, the nighttime throbbing should gradually fade away.
Why the Inflammation is More Prominent at Night?
Let me explain to you the physiological mechanisms, including anxiety, that can explain why your ankle inflammation is more important at night!
- Circadian Rhythms: Your body follows a natural circadian rhythm, which affects the functioning of many processes, including inflammation. At night, your body may produce more pro-inflammatory cytokines: xubstances that your body uses to repair damaged ligaments and other tissues in the ankle..
- Temperature Changes: Core body temperature drops during nighttime sleep. This drop can trigger an increase in inflammatory responses.
- Rest and Repair: While you’re at rest during sleep, your body can focus more on repairing tissues and fighting off inflammation!
- Cortisol Levels: Cortisol, a natural anti-inflammatory hormone, typically follows a daily pattern. Cortisol levels are lower at night, which may allow inflammation to flourish.
- Reduced Physical Activity: At night, physical activity decreases, and the lack of movement may lead to localized inflammation, such as in an injured ankle.
- Anxiety and Stress: At night, we often experience increased anxiety, which is a biological legacy from our ancestors. When you have an injury like a sprain, this anxiety can intensify, making you more aware of your sensations and potentially increasing your perception of pain.
- Immunological Changes: Your immune system’s activity varies throughout the day. It’s often more active at night, which can promote inflammation.
At night, your body’s internal rhythms and blood flow can make you more aware of these symptoms, particularly the throbbing pain.
Is It a Sign of Complication?
No, not at all.
Complications from a sprained ankle are rare, and nighttime throbbing is not a cause for significant concern.
An infection can also cause this sensation, but it’s an extremely rare complication after an ankle sprain. In such cases, you would likely experience symptoms like fever and other signs of infection.
And infection can occur only if you had an open wound or surgery.
How Long Do Nighttime Throbbing Last After an Ankle Sprain?
Since ankle sprains are a very common issue, there are numerous studies that track the recovery of individuals with sprains. This includes monitoring the evolution of pain, which, like swelling, is a reliable indicator of inflammation.
Inflammation is responsible for both swelling and pain.
So, what do these studies reveal about the duration of nighttime and daytime pain after an ankle sprain (van Rijm 2008)?
- Pain decreases rapidly within the first 2 weeks following the injury.
- Up to 2 out of 3 individuals will no longer experience pain after one year.
- Up to 9 out of 10 individuals will no longer experience pain after three years.
We also know that a ligament can take up to three months to fully heal if it’s torn or stretched, such as after a sprain (Hubbard 2008).
So, even though nighttime throbbing often subsides relatively quickly, the fact that it can last up to three months is not a cause for concern or a sign of complications.
The recovery time of nighttime throbbing after an ankle sprain may last for several days to a couple of weeks.
What Can Be Done to Relieve Nighttime Ankle Sprain Pain?
Time is your best ally to stop feeling these sensations at night.
Some people find relief with certain methods, but it’s challenging to identify one-size-fits-all solutions. Furthermore, there’s an ongoing debate in the research community regarding whether it’s truly beneficial to combat this inflammation or if it’s better to let it proceed for tissue repair.
If these nighttime sensations bother you too much, here are some things you can do.
- Elevate your ankle: Keeping your ankle elevated while resting can help reduce swelling and ease nighttime throbbing. Place cushions under your sheets to keep them from moving at night and position your foot on top of them. Alternatively, elevate the foot of the bed with wedges.
- Apply ice: Applying ice to your ankle can help minimize inflammation and provide pain relief. Make sure to wrap the ice pack in a thin cloth to avoid direct skin contact. There are ice packs that you can chill and use. Some of my patients also like to use frozen vegetable bags because they conform well to the area where you place them.
- Over-the-counter pain relievers: Non-prescription pain relievers can help alleviate discomfort and improve your sleep quality.
- Compression: Wearing a compression sock can help reduce swelling and pain.
Here’s what I wanted to tell you about this! I wish you a very good recovery! Do you have any comments or questions? Your comments are welcome 🙂 !
If you feel the need to learn more about the recovery period after a sprained ankle, I wrote this guide in eBook format:
You may also like:
van Rijn RM, van Os AG, Bernsen RM, Luijsterburg PA, Koes BW, Bierma-Zeinstra SM. What is the clinical course of acute ankle sprains? A systematic literature review. Am J Med. 2008 Apr;121(4):324-331.e6. doi: 10.1016/j.amjmed.2007.11.018. PMID: 18374692.
Hubbard -Turner, Tricia & Hicks-Little, Charlie. (2008). Ankle Ligament Healing After an Acute Ankle Sprain: An Evidence-Based Approach. Journal of athletic training. 43. 523-9. 10.4085/1062-6050-43.5.523.
Written by Nelly Darbois
I love writing articles based on my experience as a physiotherapist (since 2012), scientific writer, and extensive researcher in international scientific literature.
I live in the French Alps 🌞❄️, where I work as a scientific editor for my own website, which is where you are right now.