A twisted ankle is among the most frequent injuries a runner can suffer from. It can also be one of the hardest to fully recover from. With different grades of ankle sprain, there is so much conflicting advice available about what you need to do to get back out on the road, it’s difficult to know what approach to take. But without proper rehab you can easily end up in a viscous cycle of reinjury. So how do you break the cycle and give yourself the best possible chance of avoiding reinjury?
Firstly, lets look at why this is such a common injury and why it becomes a weakness for so many runners. Although you can sprain either side of your ankle, the majority of sprains occur on the lateral (outer) side of the ankle, with only about 5% occurring on the medial (inner) ankle. This is because the ankle has much less range of movement when everting the foot (tipping it outwards), as the fibula bone sits in the way. When inverting the foot (tipping it inwards) there is a much greater range of movement in the joint. So of course, if you land a bit funny your foot can easily roll inwards, and bingo! You have a sprained ankle.
A sprain refers to the over-stretching or partial tearing of a ligament (the soft tissue structure which holds two bones together). In the ankle you have three small ligaments on the outside, and one large one on the inside, so again, there is much better support on the medial ankle to prevent hyperextension. The ligaments which hold the lateral ankle together are called the ATFL (anterior talofibular ligament), the PTFL (posterior talofibular ligament) and the calcaneofibular ligament. The most commonly sprained ligament is the ATFL.
A lateral ankle sprain is characterised by pain around the lateral malleolus (the bony knobble at the side of your ankle), often accompanied by swelling, and possibly bruising. It can be painful to weight bear for the first few days. Short term treatment involves protecting the ankle from further inversion by avoiding certain activities like running or jumping, along with frequent icing, elevation and compression.
Unfortunately, as they are passive structures, it’s quite difficult to strengthen ligaments by themselves. The stability of a joint relies, not just on the ligaments but also the muscles around it. Once a ligament has stretched or become damaged, it takes time for it to heal. Constant stress, such as walking or running, can make the process even longer. It can take up to 12 weeks or more for a ligament to repair, depending on the grade of the tear. The joint has to rely even more heavily on the supporting muscles, in this case the peroneal muscles, to maintain it’s integrity. And if these have been injured as well, it’s easy to fall into the cycle of hyper-extending over and over again, whilst trying to repair, meaning for every step you take forwards in your recovery, you end up taking two steps backward.
How do you break the cycle?
Exercise and strengthening of the ankle support muscles is key to recovery, and often overlooked. Just taking a week or two off from running is not enough to provide the joint with the strength and stability it requires to function properly. These 5 exercises should help with recovery. Once the ankle is completely pain free on walking and all of these exercises, with no residual swelling and with full range of movement, then a slow graduated return to running plan can be implemented. We recommend following a walk/run plan to begin with, with short intervals of running with recovery in between, to give the ankle time to build up it’s resilience again, before tackling longer distances.
- Ankle ABCs – Seated comfortably on a chair, lift the foot off the floor, and use it to write the alphabet in the air. Try to move your foot in as big a range as pain allows. This is the first exercise we recommend doing in the early stages of healing, to help restore movement in the joint, in all directions. You can complete this exercise several times a day, always working within pain limits.
- Banded eversion – Loop a resistance band around the opposite foot, and gently press the injured foot into the band, turning the foot outwards as much as pain/swelling will allow. Start with 2 sets of 6 reps. Increase reps as the exercise becomes easier. You can also increase the tension in the band to progress further.
- Toe and heel walking – Once you can weight bear on the injured foot, try rising up onto your tip toes and taking 10-20 paces. Then lift your forefoot off the floor and do the same balancing on your heels. Alternate for 3-5 sets.
- Single leg balance – Practice standing on one leg, trying to increase the time you can balance. Once you are stable on one leg, you can progress the exercise by trying to challenge your balance, for example throw a ball against a wall, or to a partner, and try to catch it without putting your opposite foot down. Or you could try bending down to touch a line of cones placed in a semi-circle around you.
- Hopping – Once your injured ankle is as strong as the opposite side and has full range of movement you can start introducing plyometrics into your plan. Begin by hopping from one foot to the other, and then progress to staying on the same leg. This will encourage stability and balance, as well as strengthen your take off and landing. Start with 10 small hops on each leg, staying on one spot on the floor. Progress by trying to jump higher off the floor, or by moving around. You can hop forwards and back, or side to side, to challenge the stability even more.
Continuing to do these exercises regularly after you return to running will ensure that the muscles and ligaments continue to strengthen, putting you in a much better position of avoiding reinjury in the future.
For further instructions on completing these exercises please click on the PDF to download, or request a digital copy of the plan which includes detailed video instructions.