An ankle sprain is a common injury and involves injury to the ligaments that support the ankle joint. 

Approximately 2 million incidences of ankle sprain injuries will present to A&E each year. 

Most ankle sprains will heal within a few weeks but it is important to follow a few simple rules to aid this process and help prevent further injury.

The ankle joint is supported by ligaments which help to keep the joint stable. These ankle ligaments could be injured to varying degrees when you sprain your ankle.

These ligaments could be stretched or torn when you twist or roll your ankle.

Following injury, your ankle may be swollen, bruised, painful or stiff. In order to help the natural healing process, follow the advice on this page.

During the first 24-72 hours

Initial treatment is to calm inflammation and control the swelling and pain. This can be managed with:

• Rest. Reduce your activity but try and walk as normally as possible. Avoid forceful or strenuous activities, like running or jumping, until the pain and swelling has settled.
• Ice or frozen peas in a damp tea towel can be applied to the injured area. Apply for up to 20 minutes every 2 hours. Cold can burn so remove if uncomfortable.
• Painkillers are important to help you keep moving around. Paracetamol and ibuprofen are effective pain killers when taken regularly and can be taken together. We do not routinely dispense these as they can be bought cheaply over the counter from a chemist or supermarket. Read the packet instructions for the doses.
• Elevation of the ankle with the knee supported will discourage swelling. 

We no longer offer compression bandages for sprains as they appear not to have an effect on the speed of recovery. But some people find them comforting to wear and you can purchase them from a pharmacy if you want to try one.

Avoid HARM

• Heat can increase inflammation during the first 72 hours
• Alcohol can also increase the blood flow and swelling and also reduce healing.
• Running or impact exercise can make the injury worse or cause re-injury.
• Massage during the first 72 hours can increase bleeding and swelling.

After 48-72 hours

Once the ankle feels less hot and painful, it is essential to start simple flexibility exercises to prevent stiffness. The exercises suggested should be performed slowly and thoroughly, moving into discomfort but short of pain. They can be repeated hourly through the day.

Exercise 1

• Move your foot up and down at the ankle, moving as far as possible in each direction. Repeat 10 times.

Exercise 2

• Place your foot on a flat surface (on a towel) so that you can slide it forwards and backwards.
• Keep your foot flat on the floor and move it as far as you comfortably can.
• Repeat 10 times, 4 times a day.

Exercise 3

• Move your foot in and out at the ankle, so the sole of the foot turns inwards and then outwards. Repeat 10 times.

Exercise 4

• Combine all the above movements by moving the foot and ankle in as large a circle as possible. 
• Compare the movements of your injured ankle with those of your other ankle. They should eventually be the same.
• You can also place a towel or belt looped around your foot, using it to help move your ankle up and down. Repeat 10 times, 4 times a day.

General exercise

As soon as you are able to put some weight through your injured ankle, start to get up and about more, gradually disregarding your crutches if you have them. Short walks are good for the healing ankle. Steadily build up your walking distance.

Please remember to return your crutches to the Emergency Department when you have finished with them.

Progress your exercises to include the following as soon as you can take full weight comfortably on your injured ankle.

Exercise 5

• Time how long you can stand on your injured ankle without overbalancing. Then practice on your injured leg until it as good as your other leg.
• Once you can do the above for 1 minute, practice throwing, catching or bouncing a ball whilst balancing on your injured leg.
• Try balancing on one leg and closing your eyes. You should eventually be equally good on each leg.

Exercise 6 - for strength

• Hold on to a firm support with your feet slightly apart. Then rise up onto your toes and down.
• Repeat until tired, 3 to 4 times daily.
• Progress to performing the exercise on your injured leg alone until it can do the same as your other leg.

Exercise 7 - to regain essential movement

• Lean forward on a firm surface, placing the injured foot flat in front of your other foot. Lean slowly forward, pushing your knee over your foot whilst keeping your heel flat to the floor
• Hold at the point of tightness for 15 seconds.
• Repeat 4 times.

Evidence shows that the sooner this exercise improves, the more likely your ankle is to fully recover.

If you are keen on keeping fit, then swimming and cycling are suitable forms of exercise. If you are aiming to return to sporting activities, you must build up progressively and be able to complete all of the above exercises prior to starting impact exercise and sport. 

Train so that you can complete all of the different elements of your sport/activity with confidence before you participate in the activity fully. If you play a contact sport, you may require a higher level of rehabilitation than the scope of this information leaflet.

It can take 8 – 12 weeks to recovery from and ankle sprain, and even longer with severe sprains or high ankle sprains. It is worth knowing that following a sprain, the ankle can look thickened or swollen for some time.

If you are concerned about the progress of your ankle, then contact your GP or the Emergency Department that you originally attended.

References and Further Information

References | Sprains and strains | CKS | NICE 

© North Bristol NHS Trust. This edition published April 2024. Review due April 2027. NBT002629.

This page is for adult patients who have have been examined, and the doctor or nurse is happy for you to go home. For your safety, you should have a responsible adult with you, who has read this information, for 24 hours or until you have recovered.

What symptoms to expect

It is normal after a head injury to experience the following:

• Mild headache
• Sensitivity to bright lights
• Feeling sick (without vomiting)
• Mood changes - feeling angry, anxious, irritable, or struggling to rest are common symptoms
• Difficulty concentrating and retaining information.
• Feeling tired or needing to sleep more

Your recovery

These symptoms should resolve over the next two weeks. If they persist or you have concerns please visit your GP.

You can take simple over the counter analgesics (painkillers) such as paracetamol to help.

• Do rest.
• Do keep well hydrated and avoid stress where possible.
• Resting includes avoiding strenuous activity or rough sports.
• Avoid reading small text or screens such as computers, phones or TV as concentrating on these can make your symptoms worse.
• Do not have alcohol or any sedatives (medicines that help sleep) following your head injury for at least 48 hours.
• Do not drive until you are fully recovered. 
• Do not return to work, college or school until your symptoms have improved. 
• Do not participate in contact sports for at least 3 weeks.
   

Red flag symptoms (when to call for help)

Most head injuries resolve without any serious complications. However, if you experience the following symptoms please call 999 and return to A&E immediately.

• Severe or worsening headache (despite painkillers)
• Vomiting (being sick)
• Dizziness or a lack of co-ordination 
• Increasing confusion or memory problems
• Weakness or numbness
• Excessive sleepiness during normal waking hours
• Fits or seizures, convulsions or collapse.
• Change to your eyesight
• Deafness in one or both ears
• Neck stiffness
   

© North Bristol NHS Trust. This edition published April 2024. Review due April 2027. NBT002438
 

Coping with nosebleeds

This information is designed to help you cope with any nasal bleeding you may suffer and to suggest ways that may help prevent further episodes.

Why have I had a nosebleed?

Often the cause is unknown. However, some causes can include:

• High blood pressure.
• Picking your nose.
• Recent colds resulting in strong nose blowing.
• Recent sinus or nasal surgery.
• Anti-coagulation therapy.

Where does the bleeding come from?

The nose has a rich blood supply. Blood capillaries all converge in the nasal septum (the thin piece of cartilage separating the nostrils). 

The area of the septum which contains all these blood vessels is known as the Little’s area. Most nosebleeds arise from this point and can be stopped by applying pressure.

Occasionally they can arise from further back in the nose - which makes them more difficult to stop by simply pinching the nose.

What are the first aid procedures to stop the bleeding?

1. Remain calm. Most nosebleeds stop with simple first aid measures.
2. If you are alone, summon help if possible.
3. Sit upright with your head slightly forward. Breathe through your mouth.
4. Apply firm pressure with the thumb and forefinger at the level of the nostrils. You will need to do this for approximately 10-15 minutes. Do not feel tempted to let go sooner, as all the good work done by the compression may be undone by 10 seconds curiosity to see if the bleeding has stopped.
5. Ice packs can be applied to the forehead or bridge of the nose (a packet of frozen peas or similar makes a good ice pack). Sucking a small piece of ice can also assist in stopping the bleeding.
6. Try to spit out any blood going down your throat.

It may be helpful to measure the amount of blood loss. We realise that this is difficult, but try to catch any blood in a bowl. 

What at happens if I cannot stop the bleeding myself?

If after 10-15 minutes the bleeding continues attend the nearest accident and emergency department or call an ambulance.

Sometimes very severe nosebleeds may make you feel faint or dizzy, so make sure you are sitting down. (Standing up may lower and already low blood pressure).

What to do after a recent nosebleed?

• Do not drink very hot fluids for or have hot showers for 24 hours. This can cause the blood vessels to dilate, which can lead to rebleeding.
• Avoid blowing your nose for a couple days to allow the healing area inside the nose to settle down.
• If you feel as if you are going to sneeze, cover your mouth and sneeze through your mouth. Do not try to hold back a sneeze, as this may cause a build up of pressure in your nose which can cause bleeding in the healing area.
• Avoid constipation and straining when going to the toilet, as again this increases the pressure inside your nose. Lots of fibre in your diet may help.
• Do not pick your nose or try to clean it with buds. Doing so will dislodge any healing crusts. It is normal to have bloodstained mucus discharge from your nose for approximately a week.
• Stay away from very smoky places for a week.
• Your nose may feel blocked for up to 10 days following a nosebleed. It will gradually clear.
• Mouth washes may help if your mouth feels dry due to constant breathing through the mouth.
• Drink plenty of cool fluids.
• If your nose is very sore the doctor may prescribe Naseptin cream which will help soothe the nasal mucosa and prevents crusting.
• If you smoke, try to give up or at least cut down. Smoking can irritate the sensitive nasal mucosa, leading to bleeding.

What to do after a severe nosebleed?

Severe nosebleeds can arise higher and further back in the nose. These nosebleeds sometimes do not respond to pressure alone and may require insertion of nasal packing to stop the bleeding. The packs place pressure on the bleeding vessels and so stop the bleeding.

Occasionally the doctor may cauterise the bleeding vessels, which means silver nitrate sticks are inserted into the nostril for a few seconds to seal the bleeding vessel.

What happens if I am admitted to hospital?

If you have had a nasal pack inserted you will need to stay in hospital. This is usually for 24-48 hours to ensure the bleeding will not recur (packs usually remain for up to 24 hours).

In Bristol the ENT department is based at the Bristol Royal Infirmary - and you will be transferred here if you need to stay in.

What to do about anti-coagulant medication?

If you are on anticoagulant or aspirin the doctor should have advised you what to do regarding taking this medication after your nosebleed. If you have not been told what to do with your anticoagulation medication please do ask the emergency department team or your GP.

© North Bristol NHS Trust.  This edition published April 2024. Review due April 2027. NBT002300.

Children’s Activities and Talk in Their Everyday Routines (CHATTER)

Background

Children who are delayed starting to talk compared with other children of the same age are sometimes called ‘late talkers’. Many late talkers go on to ‘catch up’ with their peers, but some children continue to have difficulties understanding and using language into school age and beyond. This is called a developmental language disorder (DLD) and research shows it affects 2 children in every primary school classroom. To help children who are at risk of DLD, speech and language therapists often work with parents of children who are late talkers using parent-child interaction (PCI) approaches. This includes giving parents advice about how to adapt their interactions in ways that support children’s language development in day-to-day life.

However, there are concerns that this type of approach might not be a good fit for all families. PCI approaches are mostly based on studies of mothers and children talking in clinical settings, not at home during everyday routines. Also, many research studies have only included limited, non-diverse groups of families. Because of this, some families have said therapy strategies are hard to fit into their daily routines or are culturally inappropriate.  

Aims of the study

The CHATTER study is being run by Caitlin Holme as part of her PhD at the University of Bristol, and is funded by the Heather van der Lely foundation.

Through this study we want to find out more about how parents and children with typically developing language talk to each other on a typical day. We want to understand how talk varies at different times of day and during different activities, and what parents think about their child’s everyday interactions and activities. If we understand more about diverse interactions between parents and typically developing children, we will know more about what advice to give to parents whose child is struggling with language. We will also be able to think about how advice can be useful, culturally appropriate and fit better with families’ everyday lives.

The research aims are:

1. To understand variation in daily opportunities for interaction in typically developing children from a diverse range of backgrounds, through exploration of activities in their everyday lives and how these relate to interactions on a typical day.

2. To combine observations made in (1) with family perspectives on and explanations of the interactions identified in relation to their context and daily routines.

3.To explore how the findings and methodology used in (1) and (2) could be used to impact clinical practice and improve ecological validity of parent-child interaction therapy.

What will happen in the study?

We hope to recruit a small number of families with a child aged 2.5 to 4 years.

The study will have 3 main steps of data collection:

1. Families will be given a ‘LENA’ device to record their child’s interactions over a ‘typical day’ of their choice. This is a small audio recorder which fits in a pocket worn over the child’s clothes. The recorder then gives an automatic analysis of times when the child uses and hears language during the day.
2. We will ask families to take photographs of the different activities they and their child were doing on the day.
3. Then we will meet for an informal chat about their daily routine and their child’s language and do some activities together like making a timeline of their day.

Information from the LENA recordings, photographs, timelines and conversations will then be explored in depth to build a rich description of different family contexts and communication environments.

How can I find out more?

If you are interested in finding out more about the study, please contact Caitlin at caitlin.holme@bristol.ac.uk or 0117 4143951.

To find out more you can watch this video of Caitlin explaining the project:

https://www.youtube.com/watch?v=DzOKphACBOw

Location: 

The Macmillan Wellbeing Centre is located next to the Breast Care Centre at Southmead Hospital. It is alongside the Brunel main hospital car park. 

Address:

NGS Macmillan Wellbeing Centre

Southmead Hospital
Southmead Road
Westbury-on-Trym
Bristol
BS10 5NB

Contact us: 

Email: wellbeingcentre@nbt.nhs.uk

Telephone: 0117 414 7051

Opening Hours: 

Monday - Friday 8.30am - 4.15pm excluding bank holidays

Cancer Support Team Services:

• Dietetics
• Physiotherapy
• Psychological support
• Breast Prosthesis fitting
• Macmillan - Citizens Advice Bristol

If you would like to know more, please contact the Macmillan Wellbeing Centre for more information: Telephone: 0117 414 7051 or email: WellbeingCentre@nbt.nhs.uk

Cancer Support Workers

Cancer Information Session Videos

Cancer Booklets

Patient Drop-in

Macmillan Cancer Support Macmillan Cancer Support.

Cancer Research UK pioneer cancer research Cancer Research UK.

Penny Brohn provides care and support to people living with cancer before, during and after treatment. Penny Brohn.

Shine Cancer Support provide support and information to people in their 20s, 30s, and 40s who have been diagnosed with any type of cancer, at any stage Shine.

Cancer Equality provide support and information and address the needs of ethnic minorities. Cancer Equality.

Live Through This supporting and advocating for LGBTIQ+ people affected by cancer Live Through This.

Macmillan Advice Helpline: 0808 808 0000

8am-8pm, 7 days a week for financial, emotional and practical advice

Veterans Covenant Hospital Alliance (VCHA)

North Bristol NHS Trust is an accredited member of the Veterans Covenant Hospital Alliance.

VCHA members are committed to the twin underlying principles of the Armed Forces Covenant. The Armed Forces Covenant covers the whole UK armed forces community, including those in the Armed Forces, whether regular or reserve, those who have served in the past, and their families. The two underlying principles are:

• The Armed Forces community should not face disadvantage compared to other citizens in the provision of public and commercial services.
• Special consideration is appropriate in some cases, especially for those who have given most such as the injured and the bereaved.

Please let a member of staff know if you or your spouse/partner has ever served in the UK Armed Forces so that we can best support your care needs.

Recording you as a veteran in your health care record will help to ensure you are able to access specific veteran’s health services, such as those for mental health and hearing loss.

It also means that where you have an illness, injury or medical condition that has been caused by your time in service you are not subject to any disadvantage from your service (compared to local people).

Veterans and Families’ Directory of Services (VFDS)

The Veterans and Families Directory of Services (VFDS), also known as the Veteran Gateway helps you to locate services that are available in their area. These have been grouped into categories such as Education and Training, Employment, Finances, etc.

Transition out of the pandemic offers an important opportunity to capitalise on increased awareness of the impacts of communication barriers, anxiety, and social isolation on those who stammer.

The COVID-19 pandemic has resulted in many changes to our behaviour and communication. Whilst these changes affect us all in different ways, little is known about the specific effects on people with communication disabilities. This study addresses the impact of COVID-19 related lifestyle changes on the communication of people who stammer. From the findings, we have generated guidance and recommendations to better support people who stammer during and following the COVID-19 pandemic, and to plan for future events of this type.

Our full report provides more information on the project and our findings. We have also produced the above animation about the project.

The executive summary (overview) of the project:

The full report of the project:

What we did

What we found

Our Recommendations

If you would like to get in touch to discuss the project or to provide feedback, please email Yvonne.Wren@nbt.nhs.uk

We will share further work from this project here, and on our Twitter account @Bristol_SLTRU

• We would like to thank our involvement group of people who stammer and speech and language therapists, for their valuable contribution to developing the survey.
• Policy Bristol provided support to develop our briefing document and hosted the consultation event where we shared our preliminary findings.
• Thanks also to all who attended the consultation event and provided useful comments which we have integrated into this report.
• We worked in collaboration with Clare Williams, University of Bristol, on the animation. Ronan Miller, at BeneTalk, and Kirsten Howells, at STAMMA, co-developed the animation script and provided the narration. We are very grateful to Clare, Ronan, and Kirsten for their valuable contributions.
• This project was funded by the Underwood Trust for research, and the Principal Investigator was Dr Yvonne Wren. It was led by Dr Jen Chesters, with co-investigators Jenny Short, Deborah Mason, Anna Prince, Dr Sam Harding, and Dr Rosemarie Hayhow.