Ankle Sprains

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.

Time to Heal…

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.