Ankle sprain:  These are almost always a trauma for runners; in more way than one.  The first trauma is when you sprain your ankle and you are further traumatized every day you cannot run.  Ankle sprains are almost never an overuse injury.

History:  Any misstep on a run may lead to an ankle sprain.  They are almost always an inversion sprain, where you turn your ankle inward.  They are a lot more common in trail runners and anybody getting off the concrete and asphalt.

Self-Exam:  Here are some things you can look for in yourself. 

1)      Most of the time you can tell the exact instant it happened.  Your ankle may have actually popped as you were falling and yelling. PH 

2)      Ankle sprains almost always have some swelling and bruising on the outside of your ankle just below the shin bone. VID . 

3)      It usually hurts to walk, especially when you are pushing off with the injured leg.  VID 

Treatment:

1)      Manage the pain:

a.      P.R.I.C.E.

                                                              i.      Protect yourself from further injury.  ACE wrap, ankle brace, etc.

1.      NOT an immobilizer or orthopedic boot. 

2.      At this stage you do not need anything fancy, just to keep your ankle from moving stupid and causing more injury.

3.      You should use a cane or crutches if you cannot walk without a limp.

                                                            ii.      Rest your ankle.  If it hurts, STOP.

                                                          iii.      Ice your ankle.  About 20 minutes and no more than 3-4 times per day.  If you do not have an ice pack, a two-pound bag of frozen peas or corn will do.

1.      Keep a of towel between your skin and the bag.

2.      I really prefer the frozen peas or corn to a chemical ice bag you break open.  Some of those get really cold and others don’t get very cold.  You are not sure how cold the pack will be.  Ice is 32o.  You know what you get.

                                                           iv.      Compression will help reduce the swelling.  Not a tourniquet, just moderate compression to reduce the swelling

                                                             v.      Elevate your ankle with your ankle above your knee and your knee above your hip.

b.      NSAIDS will help. 

c.       Kinesiology tape may help, but most ankle sprains need more support than kinesiology tape can provide.

d.      Don’t even think about running until you can run without a limp.

2)      Restore full motion. 

a.      Easy stretches with the sequential short-term stretches if it does not hurt to put weight on your leg VID

b.      Ankle alphabets

3)      Begin non-weightbearing exercises to restore strength without all the pressure on the joints

a.      Begin with isometric exercises to reduce the stress on the muscle.  VID  Put a packing strap around a chair leg and do isometric exercises.  VID

                                                              i.      Progress to tubing exercises in all directions for your ankle.  VID

b.      You will not be at this level very long; we just need to increase your strength while minimizing stress on your ankle.

4)      Begin body weight exercises with emphasis on control versus strength and power.

a.      Wear your brace when you start your weight-bearing exercises.

b.      These are done slowly, with a short range of motion, and STOP BEFORE IT HURTS.

c.       Wall slides VID

d.      Eccentric calf raises.  LIN

e.      Progress to double leg calf raises VID

f.        And then to single leg calf raises VID 

g.      You need to incorporate proprioceptive exercises in your recovery program.  There are a BUNCH of them included in the strength training for runners section.

5)       Correct running mechanics.

a.      Gradually return to your previous running.  Start on relatively flat ground or even on a treadmill.  The best part of returning to running with a treadmill is that you can actually hear your footsteps.  Also, a lot of treadmills are in front of a mirror so you can see your hands move and your feet move.  If your arms or legs swing weird, you may want to have a physical therapist complete an evaluation before you return to full running.  Listen and ‘feel’ how you run.  Is one leg hitting the ground harder than the other?  Does one arm swing differently than the other?  Until you can run without pain and with fairly symmetrical running mechanics, you are still at risk of reproducing your old injury or creating a whole new injury to another part of your body.

b.      As soon as you can run without pain and without a limp you can return to your normal running routine.

6)      Return to running speedwork and hills.  After you have been able to run on flat ground for a week with your with your normal training and have not had any pain, you can begin to add speed and hill training to your program.

7)      My favorite step, get back to full running!  Have fun.  Eventually you will bust something else and be back to the website to fix that. 

8)      If you follow the steps on the website for 2-6 weeks (depending on how badly you hurt yourself the first time and on how long you tried to ‘run through the pain’) and your problem does not resolve, then call our clinic for an appointment and we can do something Dr. Google cannot do.  We can complete a hands-on evaluation, in-person evaluation to determine the cause of your pain.