Today on the Doc On The Run Podcast we’re talking about the three biggest mistakes runners make with ankle sprains.
I was just on a call with a patient. It was a telemedicine visit. We were doing a webcam call and she had been running on a trail, rolled her ankle, and had a really bad ankle sprain. Her ankle was black and blue. It was really swollen. It was really painful. She was having trouble walking. In fact, she could really only walk with her heel on the floor and couldn’t really walk through the whole normal gait cycle.
This is somebody who’s a really active runner who really wants to get back to running as quickly as she can. Not surprisingly, she wants to get back to running on trails. Well, running on trails is obviously a little more difficult and puts you at a little more risk of having another ankle sprain just because it’s an irregular, undulating, unpredictable surface.
So in my discussion with her, when we talked about what she did initially, right after the sprain, what she had been doing since the time that she had that initial sprain, and what she was currently planning on doing, I really realized that there are three major mistakes that runners often make when they roll an ankle running on a trail and want to get back to running after they heal.
It may not surprise you to hear that there are really three broad phases of ankle sprain treatment. The first one is first aid, what you do immediately afterward. Protecting it, resting it, providing compression, elevation, all of those things that we know that can actually decrease the swelling and prevent it from becoming overly inflamed. The second phase is the healing phase. And then the third phase is the rehabilitate phase.
And she was actually discussing and had talked about mistakes in each one of those particular phases, and we were just going through the call trying to help her work through that and make sure that she didn’t make these same mistakes and could get back on track. So when you roll your ankle and you get an ankle sprain, you basically have a partial tear or a sprain of one of the three ligaments in your ankle on the outside of your ankle.
The most commonly sprained ligament is called the anterior talofibular ligament. You probably see it described most of the time as the ATFL, but it doesn’t really matter what it’s called. What you really need to understand is that when you roll your ankle, you basically stretch, strain, and irritate, not just the ligament, but the joint capsule that is attached to those ligaments as well as the tissue that lines that joint.
The tissue that lines the inside of your ankle joint and your subtalar joint is actually called synovial tissue. Synovial tissue is soft and squishy that basically makes the synovial fluid that lubricates the inside of the joints and nourishes the cartilage. So the outside of the joint capsule though is fibrous, it’s tough, it doesn’t expand very well.
When you get swelling of the synovial tissue on the inside of your ankle joint when you sprain it, that tissue can swell inward. When you’re walking, it’s then painful because you’re basically squishing this soft irritated tissue, and that makes it more and more painful and it actually stimulates more inflammation. So the first mistake that people make when they roll their ankle on a trail and they’re out on a run is that they most often, truthfully, just don’t do enough to control the swelling.
In that first aid phase, a lot of people ice you. You’ll kind of protect it, you’ll kind of take it easy, but most of the people that I see are really not doing what is really needed to control the swelling. So the first thing is that if you sprain your ankle when you’re out on a trail you really want to try to do everything you can to control that swelling.
The more it swells, the more it balloons up, the more it swells up, the longer it’s going to take to move on to the next phase of healing. So doing things like an ACE wrap or wearing compression socks, doing legs up the wall pose, really icing it aggressively, all of those things can really help to decrease the inflammation in those early stages so you can move on to the next phase a lot quicker.
Now, the second phase is where you actually get healing taking place, and this means that you get collagen forming to repair that damage, the collagen that actually creates and forms the ligaments in your ankles. The first thing is that the mistake that I see people make, believe it or not, is that a lot of runners believe that waiting is a plan. They think, “Well, if I just wait a few days will be better. If I just wait a couple more weeks, it will be better.” Waiting is not a plan. For all athletes, you have to remember, if you want to be an active athlete, you need an active treatment plan.
That means that you have to do something to try to get the tissue to heal as quickly as possible. That does not mean just sitting and waiting. You need to do things that are going to stimulate blood flow and help avoid an accumulation of excessive inflammation that can delay your healing.
There are lots of different things you can do in the healing phase that you can talk about with your doctor. A lot of is explained in the Ankle Sprain Treatment Course For Runners. But you’ve got to do something. You have to come up with a plan. Waiting for things to heal doesn’t make any more sense than waiting to get fit for a marathon. You have to take action. Now, the third phase is the rehabilitation phase, and this is where you actually get your strength, your stability, and your balance back.
This is where most runners actually really go horribly wrong. Just this weekend, I was lecturing at a medical conference about running injuries and one of the talks I was giving was specifically discussing the fact that when runners sit still for a long period of time they develop what we call a sensory-motor dysfunction where the sensory motor dysfunction is where your muscles and your brains are not really connected as efficiently with your nervous system as they used to be.
When you roll your ankle, you actually tear some of the nerve fibers that actually tell you positioning in space. You can’t get those back. But what you can do is you can actually retrain the stretch receptors in the muscles in your legs to overtake that function and give that same input to your brain so that your brain can tell the position of your foot underneath you when you’re running on a trail. But that’s what proprioceptive training is.
Most of the runners I see who are really at risk of a sprain, I have them do some simple tests, all that stuff’s in the Ankle Sprain Rehab Course. But I have them do these tests and they often don’t believe me. They say, “Well, it feels okay. It calmed down. I got the swelling out. I went for a run. It felt okay when it ran in my neighborhood. Can I go run on a trail?”
And I’ll do these simple tests for them and then they actually see that they can’t really balance with their eyes closed. They can’t really do some of these really simple tests that show whether or not you’re really at high risk of re-injury. And the problem is that as soon as you feel like you can run and you go do a test run, you feel like you’re okay. But you really have to check and be sure that you’re not really at risk in terms of having this lack of balance and proprioception that will make it a lot easier for you to actually sprain your ankle. There’s an incredibly high incidence of recurrent ankle sprains, and usually they get worse. Each one you have, it’s already weaker, it’s already less stable. So when you’re out on a trail and you roll it again, it gets even worse.
But those are all things you can control. Just make sure you control the swelling initially, come up with a plan to get it rehabbed, and then make sure that you start that rehab as soon as you’re ready, and keep ramping up your activity so you can keep running, keep training, and run as much as you want on trails. But you have to take action. Don’t just sit and wait and think that it’s just going to happen magically.
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