Ankle sprains are a common occurrence among runners. Especially, trail runners. I recently sprained my ankle for the second time in ten years, not a bad record considering how much I run. I have lose tendons in my ankles anyway, so I can turn an ankle and not cause any damage 90% of the time. Two weeks ago, I was running down a mountain and another runner was coming up. I stepped up onto the slope of the mountain to avoid the runner and when I came down on my left foot it rolled over.
Pain shot up my leg and I heard it tear and said some choice words. I limped along for a bit, but was able to slowly run down the last little bit. I stopped at the first gas station, picked up ice and iburprophen. The swelling isn’t totally gone, but I think I’ll be back out on the mountain in another week.
True to form, I researched how to rehabilitate a sprained ankle and how long it takes to heal. During the acute phase injury to 3-4 days taking iburprophen, icing 4-5 times a day for 15 minutes each time, compression and bracing when you are walking on it.
There are three grades of ankle sprains. Grade one isn’t too bad maybe a minor tear and over stretching. It can cause some pain when walking and some swelling. This takes a week or two to get back to your activities. Grade two is a minor-moderate tear and over stretching. It causes swelling, bruising, pain, and imbalance. It takes 3-4 weeks before you’re back to your activities. Grade three is severe or complete tear of the tendons, which may make surgery necessary. You’ll definitely need crutches to get around. Recovery time on this one is going to be six to eight weeks at a minimum.
Rehabilitating any injury requires strengthening the muscles and tendons that were injured and then the surrounding and supporting ones, balance and proprioception and maintaining mobility. Physical therapy/rehab exercises should begin as soon as you can do them without zero to minimum pain (2 or lower on a 1-10 scale). Exercises should continue for three to four months.
Start mobility exercises about 4-10 days after. Move the foot forward and back, start ankle rolls and writing the ABC’s with your big toe, heel on the floor. You also want to stretch your Achilles and calf muscles. For strengthening, use an exercise band. Wrap it around your forefoot and pull it to the outside, inside and away from you. You can also do this against a wall. Calf raises are also good.
For the balance piece, start slow and work your way up: standing on one leg on the floor, then with your arms out and bent over, and finally using a balance board. To reestablish the brain body communication (proprioception) write the ABC’s with your whole foot while balancing on one leg.
Be patient in your recovery. Once you roll an ankle it is easier to do it again in the future, which is why continuing the exercises for three to four months is so important. When you do return to running, tape your ankle (youtube) each time you run for a week or two. You’ll have to reduce your miles and build them up to reduce the risk of overloading the healing tissues.
You can cross train doing things that don’t cause any pain. Getting out there as soon as possible is important, but keep in mind, going out too soon poses a high risk for re-injury and starting from square one or causing more damage.
Being patient with your body and allowing time to heal is difficult, but absolutely necessary if your goal is to run for a long time. I struggle with taking time off just to rest and recover; an injury is just as difficult for me. Usually, I continue running on it-telling myself I can run through it. And many times running through minor injuries is fine. It’s the not so minor ones that you can’t run through. Even some minor ones, get worse if you try to run through them. Knowing the difference, is the difference between an experienced and novice runner.
Injury and time off is unfortunately part of the running experience. Alternatives to running are just not the same. You don’t get that runners high. You don’t get that peace and sense of freedom. The longer it takes to heal the more agitated you become. It’s easy to fall into a pessimistic and defeatist attitude. You become an expert at positive self talk or you fall into a depression. The longer you are in the recovery mode, the farther off running feels.
You definitely go through the seven stages of grief: shock, denial, anger, bargaining, depression, testing, and acceptance.
Shock and denial are lumped together most of the time, “It’s not that bad,” “I can’t believe this has happened.” “It’s nothing to worry about,” “I can still run, it’s fine.” “It’s the shoes, I’ll just get a new pair.”
Anger is directed at pretty much everyone including other runners and yourself. You beat yourself up about not taking time off right when it happened. You decide you could have prevented it and were just stupid.
Bargaining-” Dear God, I’ll take time off right away next time, if I can just have my running back now.” “I’ll volunteer more and donate money, if I can just get back out there.” “I’ll do anything to get back out there!!” Anything, but take the time to heal that is. You begin doing research about the fastest way to heal. You spend hours looking at new training programs, super foods, stretches, miracle vitamins, and strength training.
Depression comes in the form of the defeatist. “I’ll never run again.” “this is going to take years to heal.” “It will always hurt to run.” “I can’t be happy without my running.” “I can’t live without my running (you think this is going to far until you’ve been there).”
Testing-“I’ve taken a few days off, I can go back.” “I know it still hurts a little, but a little run won’t hurt it.” “Just an easy three miles.”
Acceptance- “this sucks, but my goal is to run until I die, so I guess I’ll spend six months doing physical therapy and then I’ll take the time to get back to running in the right way because if I don’t, I’ll be back where I was when this started.”
When you’re ready to start your epic return to running make sure it’s slow. Review my return from injury training program found above under the 5k and 10k training program link.
It’s a shame that we can’t start with acceptance. Maybe that should be our goal for our next injury because if we’re honest with ourselves, the next injury will come.
At the suggestion of my boyfriend, I’ve decided to try bikram yoga (hot yoga). The reasons I came to this decision were: I need heat and humidity training for the Hawaii 100 in January and I need to do something about a nagging hamstring injury.
My cousin is a Bikram Yoga instructor and has always suggested I start practicing…but I only have a limited amount of time in the day to train, so I’ve never done it. I decided to research the benefits of Bikram Yoga for runners.
Here is what I’ve found out. Yoga increases your flexibility and strength particularly in your core, quads, hamstrings and hip flexors (and if you’ve read any of my past articles you know how important hip strength is to preventing injuries from hip to toe). Increasing your strength and flexibility increases your running efficiency. The breathing exercises can expand your lungs allowing for deeper and more effective breathing. I can see how this would be helpful at higher elevations especially for those runners who are coming from anything under 3500 feet.
It makes you sweat, a lot which flushes toxins out of your body allowing it to heal and recover more quickly. It has the same cardiovascular benefits as running. It’s a great alternative for injured runners and for those coming back from an injury. It can help with old injuries by improving circulation and cleaning out scar tissue that hinders flexibility.
Bikram yoga is mentally challenging, but reduces stress and the risk of heart disease. It also restores balance in your body helping prevent illness.
Bikram yoga benefits your mental strength and focus. Yoga teaches you to deal with discomfort and to focus. It teaches you to let go of troublesome thoughts that get stuck in your head regardless of where they come from or what their content is. It could be questioning your ability to cross the finish line or dwelling on a poor decision or incident earlier in the race.
I’m looking forward to this new challenge and diversity in my training program. If the only benefit I get out of this is healing up my hamstring it will be well worth the change in routine. I do expect to get more out of it than that, however. Changing your routine and challenging your body in new ways helps you reach new levels and break through training plateaus. I will keep you posted on how it goes, you never know, maybe it will become a permanent part of my training.
I’ve written about foam rolling before, but it’s an essential element in my training/recovery routine and it merits repeating. Over the last week, i’ve been reminded, by my body, how important foam rolling is. After I finished the Bear 100 three weeks ago, I jumped right back into training mode, after one week off, because I have the Pony Express 100 in more 8 days. I skipped rolling for a few days in a row because I was busy and tired. My ITBand began tightening up in my left leg and my quad in my right leg. Both of which pulled the tendons guiding my knee caps resulting in tension and aching. I knew right away what it was and made sure I didn’t miss anymore days.
I get a lot of questions about when and how to stretch. My response has always been the same. If you’re going to stretch, stretch after you run not before. Muscles must be warmed up before you stretch them or you risk straining or even tearing them. You can also “freeze” your muscles, causing them to go into defense mode and reduce your range of motion. Since the idea behind stretching is to help recovery and prevent injury you sure don’t want to cause injury.
How to stretch is a more complicated question. There are so many different ways to stretch and it’s hard to know which muscles/tendons to stretch in the first place. Of course, if you’re going to stretch, it’s important to stretch big muscles you use for running: quads, hamstrings, glutes, calves, and ITBands. Stretch to the point of it feeling tight and not super tight, just when it first starts feeling tight. You should hold the stretch for twenty to thirty seconds and then release it completely. Go through your stretches two to three times depending on how tight they are.
Why do I keep saying “if” you stretch? Because using a foam roller is better than stretching. A foam roller will do everything stretching does and more. It lengthens your muscles and tendons and also increases your flexibility. The “more” of foam rolling is its ability to break up the tension in your myofascial layer (deep connective tissues).
Here are the basics of foam rolling: relax the muscles you are rolling, but keep your core tight and stable. If you let your core sag, you’re not going to get the right angle and pressure on the tendons and muscles you’re trying to hit; roll slowly over the area, going back and forth for one to two minutes. Rolling isn’t all fun and games. It hurts at times. In fact, it can hurt pretty bad when you hit a knot. If you roll on a regular basis, you develop less knots.
Stress can be good and stress can be bad for our running. Stress forces our body to adapt and get stronger, but too much stress can wear us down and not allow us to recover. Too much stress plus to many miles or hard workouts can lead to injury which then causes more stress and thus the cycle goes on and on my friends.
Stress can come from many different places in our lives leaking into our running, impacting our performance, and syphoning our energy until we dread getting out of bed in the morning resorting to smacking the snooze button half a dozen times.
Maintaining a balance in all aspects of our lives is a very lofty goal and impossible to maintain on a consistent basis making ebbs and flows the standard. That is standard procedure in my world. Sometimes my life blows up and nearly every facet of it becomes a hot mess pressuring me to not get out and run at all, but focus on putting Band-Aids on everything to stem the catastrophe.
Our bodies are interconnected systems. If one system is overwhelmed with stress, it impacts others. Most people divide their lives into seven different facets: physical, emotional, social, environmental, occupational, intellectual, and spiritual when one of these is out of wack, another picks up the slack. This is not a bad thing as long as it’s doesn’t become the norm, in fact, we see it when we have a physical injury. Our supporting muscles take on the work of the injured muscle or tendon allowing it to persist in that way will eventually lead to additional injuries and imbalances.
Chronic stress reduces your body’s ability to recover by compromising your body’s immune system. Breaking your body down too much is not going to produce performance gains. You need to allow your body time to adapt and get stronger. It can’t do that when you’re putting it under high levels of stress on a regular basis even if it’s from different angles of your life.
How should this change the way we train? If you know you have an especially difficult day, make your training for the day easier. When you are planning your training for the season, look at the things you know are coming, which could cause some extra stress. Schedule a rest week during those times. By reducing your miles you will reduce the risk of over training. Schedule your intense workouts such as speed work and long runs for days where you are least likely to be high stress days. Prioritize your workouts. If you have to skip a workout or change things around, dump the easy days and keep your high quality workouts like speed work and long runs.
As some of you know, I fractured my foot at the end of November 2015 and I have been working my way back into running since then. It’s now a little less than three weeks until the Buffalo 100 mile endurance race. Coming back from an injury is a huge challenge for most runners. Especially, one which is going to keep you from the sport you love for months.
You don’t have a lot of choices when it comes to a fracture either. You can choose to continue to run on it and hope that it heals (very very slowly) rather than completely fracture and require surgery. Or you can choose to follow your doctor’s instructions and live to run another day.
I’ve never been one to follow my doctor’s instructions about taking time off running. I’ve pulled and sprained all kinds of things. I’ve run through shin splints, ITBand syndrome, plantar fasciitis, sprained ankles, and pulled pretty much everything.
In fact, I find doctors who are endurance athletes and then as soon as they walk into the room I tell them, “I’m not going to stop running, so we are going to have to do what we can with me running.”
Some of them are not very happy about it, but are glad I’m up front about it. The one thing I don’t mess around with is a bone injury. My goal is to run until I’m 100 years old and not taking care of a bone injury will compromise my goal (yes, I know other injuries can too).
So how’s the stress fracture in my foot? I ran 20 miles on my full body weight last weekend without any pain. It has taken me fifteen weeks (almost four months!!) to get back to running at my full body weight.
And I’m so glad I took my doctor’s advice building up my miles and tolerance for impact slowly. If I hadn’t I would not be planning on running the Buffalo 100 on March 18th.
How did I do it? I started with running in the swimming pool, swimming laps, and riding a bike as much as I could while my foot was in that acute phase where it hurt to even walk on it. Then I maintained my aerobic fitness by using the stair climber, elliptical, and other machines at the gym as soon as they didn’t cause any pain to use. I maintained my same schedule, so if I was supposed to run for 2 hours, I did aerobics for two hours or three hours or four hours.
The other thing I did was add in a lot of functional strength training, an hour and a half, three days a week. Since my muscles and bones were going to lose their impact conditioning I had to make sure they stayed strong in another way. Strength training was the only way I could do this without causing more injury to my foot.
Once I had the all clear from my doctor, I began using the anti-gravity treadmill. This allowed me to run at only 40% of my body weight. I started by running an hour every other day and increased that to five days a week. Once I was running five days a week to keep my miles up, I increased the weight on my foot by 5% each week. It was very slow and sometimes I increased the weight on my foot to quickly and would have to back up because it hurt my foot.
Running is my go to coping mechanism, but what do you do when your go to is broken? So the other essential component of my treatment was the support of my friends and family. There were many days were I would be near tears because I had to go backward or because it was beautiful outside and all I wanted was to feel the ground under my feet. Seeing other’s running made my heart ache.
Alright and I have a little bit of determination, stubbornness, and ambition.
Many injured and healthy runners use an elliptical machine to reduce the impact on joints, muscles and tendons while maintaining the running motion as closely as possible. An elliptical is a practical alternative and available to most people. It’s purpose is to do just what these runners are looking for. Long term use of an elliptical can have a negative impact on your running, however.
If you’ve ever used an elliptical for over an hour, you’ll notice it starts to make your toes feel numb. The position of your body is different on the elliptical compared to when running.
What are the body position differences?
First, on the elliptical both feet are always making contact with the “ground.” When running one foot is in the air while the other is stabilizing you.
The second difference is your hip extension. When you are running your back leg straightens out more than on an elliptical and it is farther back pulling your hips back as well. On the elliptical, your knee stays bent because your foot continues to be in contact with the ground. This is problematic because a lack of hip extension leads to injuries and inefficient running. Thus, the elliptical does not develop the neuromuscular connection required for a strong efficient form when running.
Another issue is it doesn’t require you to use the stabilizing tendons and muscles of your ankles causing them to become weaker and damaging the neuromuscular connection here as well. Then there is the hamstrings, because the elliptical limits hip extension it doesn’t engage your hamstrings very well. Weak hamstrings impact your ability to climb and cause an imbalance of muscles. The hamstring works to balance your quadriceps. They slow down the forward movement of your leg.
Wow with so many disadvantages, why use an elliptical when injured? Because it lowers the impact. There are other advantages as well. It burns close to the same number of calories as running. It maintains your cardiovascular fitness, and gives more of a total body workout if you use your arms. There is the options of both forward motion and backward motion with your legs, giving you some cross training due to the different muscles used.
Many people work harder on an elliptical than they do when running because the perceived exertion is less on an elliptical. Finally, it’s easy and safe to use.
The take-away? An elliptical is a good alternative to running when injuries or to be used as cross training in addition to running. However, exclusive use of one to train for running, especially long term will compromise your form and lead to injuries.
I have to apologize for not posting any blogs last week. I couldn’t find the motivation to write about running when I can’t run due to the stress fracture in my right foot. It’s been five weeks since I have been for an actual run. Over the last nine years of running, I’ve never taken more than one week off to rest after a race or to rest a minor injury. I am running in the swimming pool and on the anti-gravity treadmill, which lifts a portion of your body weight off your feet.
Last week my mind was empty of possible topics for blog posts. In fact, I have been trying not to focus on running or the lack thereof in my life currently. I continue to spend the same amount of time doing aerobic exercise as I was running, but now I’m doing it all at the gym… on machines.
So how do you cope with being injured and unable to participate in your sport for an extended amount of time? First off, you remember what your goals are long term not just the next week or month or even the next year.
My long-term goal is to run until I can’t draw breath. I remind myself of this when I’m at the gym for four hours on Saturday and another three on Sunday. If this doesn’t get me past my pitty party, I try to remember how it feels to cross the finish line of a one hundred mile race.
Another way to stay motivated is to focus on your short-term goals. My short-term goal is Buffalo 100, which is in eleven weeks. I’m determined to run the race, even if it means I’m coming right out of the gym to do it. Because I am going to run Buffalo, I want my fracture to be as healed as possible, so I don’t refracture it by going out to run too soon.
Having a secondary sport you use as cross training or just another sport you enjoy in addition to your running is an excellent way to keep active and stay off the discouragement train.
A supportive family and friends who can keep you laughing and active will also help.
Keep your heads up, the sun always rises, you just have to hold on long enough.
Taking time off running is never an easy thing to do, but sometimes it is a necessary thing to do. I have never been good at taking time off. I struggle with rest weeks every four weeks and a rest day each week. So when my doctor says, Nicole, you’re going to need to take a few weeks off of running.
It hits me like a frying pan in the face.
Anger, frustration, disappointment, and heartbroken, I felt them all wash over me. Running is my outlet and my balance.
Why do I have to take time off? A stress fracture in my forefoot.
I’ve never had a stress fracture before and it has always been my greatest fear as a runner because I know it takes you out for an extended period of time.
So now what? I don’t want to lose any more fitness than is necessary, and I want to be able to run the Buffalo 100 at the end of March.
The best way to maintain running fitness when you are injured is through pool running. Running in the pool is not fun. It is monotonous. To run in a pool, you use a flotation belt. You are not supposed to be able to reach the bottom of the pool nor do you move very quickly. The faster you move the more out of running position you are. You can sprint all you want, you’re still not going to go any faster. Running in the pool allows you to continue to work your running muscles without the impact, which will aggravate your injury, whatever it may be.
Other things you can do to maintain at least aerobic fitness are cycling and swimming. Depending on the type of injury you have, weight lifting is also a good option. Take advantage of the downtime by working on things you, “don’t have time for,” because running takes up all of your spare time.
Forced rest depression is something all injured athletes have to be aware of and constantly assess themselves for. Exercise floods your body with endorphins that make you feel good and when you lose those, you can fall into a bad place emotionally. It’s easy to do when you are already feeling heartbroken.
The fastest way back to running is by following your doctor’s advice (I’ll admit, I am not very good at this). If you don’t, you will likely make the injury worse or heal much more slowly. You also run the risk of making a soft tissue injury turn into something chronic that will flare up on a regular basis at the most inopportune times.
A stress fracture heals much faster than a full fracture of the bone. No promises here, but I’m committed to being mostly good and to follow my doctor’s advice.