Don’t Be An Ankle Breaker

Disclaimer: An ankle sprain can come in all shapes and sizes. The guidelines below are intended for mild sprains. These general tips are in no way meant to replace the advice of a qualified medical professional.

We’ve all done it: You’re running along, feeling good, and suddenly a rock, root, pothole, or some errant beast, comes out of nowhere and… pop goes the ankle. Sometimes it’s just a little tweak, while other times it leaves you writhing in pain on the side of the trail, questioning every decision you’ve made up to this point in your life. Every time it ends in disappointment and a stream of worst case scenarios flooding your mind. We can’t help imagine the days of training we might have to miss or the susceptibility to greater injury in the future.

Rest easy. It doesn’t have to be this way.

Ankle injuries are a drag and can linger for a long time if not treated properly. Many are misled by the quick turnarounds professional athletes make after seemingly bending their ankles to unfathomable angles. We are led to think an ankle sprain is a little thing. However, what we are forgetting is that these athletes not only have super well-trained ankles to begin with, but also have the best trainers working around the clock to treat their injuries and get them back on the field of play.

Below are some tips to get you back on your feet as soon as possible following one of these unfortunate turns.

A Tale of Two Extremes

The most common mistakes around ankle rehab come in two forms: either too much rest or none at all. Some people underestimate the impact of a sprained ankle, tape it up, throw on a brace, and get back out there. No pain – no gain, amirite? Meanwhile they’re pounding away on a raw and swollen joint.

No good.

The other extreme involves keeping the feet up, and waiting around until there is no sign of pain or swelling, before resuming normal activities. This approach can sometimes take a week, or even longer, by which time the athlete thinks they’re good-to-go and starts pounding away on a tight and confused joint.

Also, no good.

Sprained Ankles are Amnesiacs

The problem is: once you pop an ankle, no matter how minor, it immediately forgets where it is and what it’s supposed to be doing. Like a person with an intense head injury, the ankle needs to be reminded of who it is and what it’s doing. Even though the stabilizer muscles in the foot and calf haven’t had a chance to atrophy in the 2-3 days it takes for the swelling and pain to subside, the biological mechanisms within the ankle need to be reminded of how and when to utilize these muscles before you can resume intense activity. Otherwise, you could be doing further damage.

The Middle Way

Successfully rebounding from an ankle sprain requires careful care and selective bravery. These are also the types of situations where having a coach can come in handy – to keep you honest. But ultimately, you have to be aware of your body and honest with yourself. The classic RICE approach (Rest, Ice, Compression, Elevation) works wonders in the first 24 hours, when there’s significant swelling and/or too much pain to apply any pressure. However, your actions immediately following initial triage is what will make the difference between a lingering problem and a quick return to activity. The goal is to reintroduce various forms of stress without further aggravating or even damaging the joint.

Crosstrain: Wearing a light brace or compression sleeve, gradually test the ankle by introducing non-weight bearing forms of cross-training: reclined stationary biking, rowing, etc. This will help stave of too much loss in aerobic fitness, while also giving you a window into how your ankle is doing. A little discomfort is okay, but be smart. Don’t be a hero your first time out. Call it quits as soon as you feel any consistent instability or sharp pain.

Recover: After each session return to your recovery routine, utilizing ice, heat and compression to ease the pressure on the ankle. If you still feel instability while walking around, then wrap the joint with an ace bandage, wear a shoe and try to stay off of it as much as possible between tests.

Ice helps reduce swelling. Compression aids in stability as well as improving blood flow. Heat also induces blood flow, which is crucial in a joint as narrow and far from the heart as the ankle. Continue with this self-care routine through each phase of recovery until you’re able to run pain-free.

I like to supplement the usual hot water bag and ice pack treatment with an evening contrast bath, either for the whole body or just the lower legs. Using two plastic storage tubs, fill one with ice water and the other with boiled water and Epsom salts. Alternate submerging the feet in each bath for five minutes at a time. The temperatures do not need to be extreme, since it’s the contrast that is doing much of the work here. I try to keep the hot tub around 95F.

Stabilize: As soon you’re able to tolerate downward pressure on the ankle without any sharp pain or a feeling of swelling (lateral movements may still be touch-and-go), begin loading it in a controlled manner. You can even wear your ankle sleeve and/or a pair of stability shoes to start. Balance on the ball of one foot, with the heel raised in a neutral position. Begin to introduce forward and lateral movements with the non-loaded leg. A great tutorial on Eric Orton’s foot strength exercises described in the book, The Cool Impossible, can be found here. Keep testing the ankle until you can stabilize without shoes, and finally without a compression sleeve.

• Note on stability shoes: I’m not generally a proponent of stability shoes. Sure, they have a role in helping some people with serious foot issues who wish to maintain an active lifestyle, but they tend to be overprescribed to people who simply require proper foot strengthening. My bias aside, this is one area where having a pair of stability shoes in your arsenal can come in handy. Whether your lower legs are just feeling overly fatigued from a particularly intense week of training or you’re recovering from a lower leg injury, stability shoes can help provide a temporary reprieve while allowing you to maintain your aerobic fitness in a specific manner.

Ease Back In: When you feel you’re ready, slide on an ankle sleeve, throw on a pair of your chosen stability shoes and get back out there for an easy shuffle.

The same principle around cross-training remains: don’t be a hero. Ten minutes of running with solid form and minimal pain, greatly outweighs 30 minutes with degrading form and increasing pain. Listen to coach Eric Orton: “I don’t say more is better. Better is better.” The goal is to be back out there tomorrow, and the next day. Frequency is key in neuromuscular training.

Recovery is hardly ever a linear progression. Just like training, you need to counterbalance periods of stress loading with recovery. Don’t set arbitrary deadlines for recovery. It’s tempting to throw all the deliberate care and treatment out the window once the ankle starts feeling a little better, but remember it’s probably not fully healed after only a week of rest and rehab. Be patient and remain aware of how it’s reacting to loading. Most of all, don’t be afraid to wrap it again for an afternoon, just to give it a break.

Conclusion

If you really tear up your ankle, hopefully you have the means (and insurance) to visit your doctor and have a PT properly guide your rehab. However, even though most of us can’t justify the cost required to rehab a minor ankle sprain, this doesn’t mean it shouldn’t be done properly at home. Minor sprains need attention too, or you’ll be left months later wondering why the dang thing still hurts. Take the time to do it right and you’ll be back to bounding up and down that trail before you know it!