What are the three biggest mistakes runners make with ankle sprains? Well, that’s what we’re talking about today on the Doc On The Run Podcast.
Ankle sprains are probably the most common musculoskeletal injury that affects runners. It happens all the time, it’s really easy to do. You might have sprained your ankle tripping on a root or rock when you’re out running on a trail, or you could have just been wearing some fancy shoes going out to dinner and you stepped on a little reflector on a crosswalk, or something, and rolled your ankle. Either way, if your ankle is painful and swollen it is definitely going to interfere with your running.
Now, there’s a couple of important things that you need to understand with ankle sprains and I think a good place to start is with the biggest mistakes that runners make when they roll an ankle and they still need to train and they still need to run, because of course, just because you get an injury, doesn’t mean that your training should stop.
The first thing, the first big mistake I see, is that runners will often just let it swell out of control on day one. So you have to realize there are three phases of wound healing, and this is true for a cut on your arm, it is true for a sprain in a ligament, it’s true for a stress fracture. It’s true for all kinds of tissue healing, you have the inflammatory phase, you have the proliferative phase, and you have the remodeling phase. Now the inflammatory phase is when you get increased blood flow in an area because you have tissue damage. So you roll the ankle, and what happens? It starts to swell, it turns red, it hurts. Well, that’s the inflammatory phase. Now that could go on five to seven days, but it depends on what you do. The longer you let it go, and the more swelling you have, the longer it takes for your body to actually remove all of that fluid in the tissue where you’ve had the ankle sprain.
You have to control that swelling if you really want to get out of the inflammatory phase sooner. So yes, some inflammation is good, but letting it go completely out of control, that’s going to get you out of whack, it’s going to make it swell longer, it’s going to make it hurt more, and it’s more likely to cause swelling inside the joint that you feel that causes chronic pain afterward if you don’t get it under control. So you got to do something to control the swelling right away, it’s really important.
Second mistake is not getting x-rays. Now this is the thing I talk about in great detail in the ankle sprain master class, and I talk about this over and over with physicians when I go to medical conferences. Part of the reason for this is there’s a set of rules that most doctors use to decide whether or not you need x-rays. I’ve got a video that’ll show you exactly how to check that yourself, to see, based on what doctors normally do, should you get x-rays or not? So you can get it for free, the link should be there at the bottom of the show notes for this episode, or you can get it if you go sign up for the masterclass on ankle sprains, you can get that at docontherun.com/anklesprain. It’s free, it’s a deep dive a take into everything about ankle sprains.
But in short, if you have a fracture that gets missed, which does happen a lot when you actually roll your ankle, well, that’s going to hurt more, and it’s going to take longer to heal, and you’re going to have to do some things differently to make sure you can get back to running without pain, so you do not want to ignore it. If you think you might have a fracture you definitely should get x-rays immediately, sooner rather than later. Now you can get that really easily, if you go see any podiatrist they’re going to basically do x-rays in their office almost all the time.
If you called me and we did a webcam visit and you need x-rays and you’re in California, if you’re in Texas, if you’re in Florida, if you’re in one of the states where I’m licensed to do telemedicine, no problem, I would just write an order for your x-ray, I would send it to your facility, you get the x-rays, you send me the disc, and I would do screen share and I would actually show you what’s on your x-rays, and I would show you whether or not you might actually have one of these fractures. But that’s easy to do, x-rays are fast, x-rays are cheap, and it should not be a big hassle for you to get them. There are lots of ways to get them. But if you’re concerned you might have a fracture you do not want to skip this step, so make sure you get that checked out appropriately.
Third thing, this is the biggest one, and I really don’t know why, but many times when runners call me and they’ve had an ankle sprain, they have not appropriately rehabilitated the ankle. Now trust me, I get it, it’s mundane. You want to get back to running, you want to get back to training, you want to be back on the track doing speed work, or doing long runs on trails, I get it, I do too. But if you sprain the ankle and you actually tear some of the little nerves in the joint capsule that tell you positioning in space, it makes you very, very unstable. And if you have that instability, and then you don’t do some specific retraining that we call proprioceptive retraining. By the way, proprioception just means your ability to tell position in space. If you close your eyes and I pull your thumb up, you know that your thumb went up because the stretch receptors actually feel that. If I pull your thumb down, the stretch receptors notice that.
When you roll your ankle and you damage those nerve fighters, you actually can’t tell and you become very unstable. That instability puts you at tremendous risk of another ankle sprain later, and most often, because it’s already a little weaker, the sprain is more severe the next time. This is really demoralizing, think about it, you’re training, you have an ankle sprain, it sets you back, you’re bummed out, you get back to training, you’re a little bit behind on your training, you’re trying to catch up, you’re finally getting better, you start feeling like you’re making some progress, and then you roll it again and it’s even worse. It’s black and blue, it’s swollen, it’s really bruised, and your doctor’s telling you you need crutches or a fracture walking boot, completely avoidable, but you have to rehab it appropriately.
So I’ll talk about all that stuff in the master class about ankle sprains. You can get it for free, you can come join me, it’s docontherun.com/anklesprain is where you go, you can sign up, it’s free, it’s a deep dive into all these topics. But make sure you don’t make these mistakes, you’ve got to keep the swelling under control, you’ve got to get it checked out appropriately with x-rays if needed, and you have to do something to make sure that you rehab it and do not get another ankle sprain later. So come join me in the master class docontherun.com/anklesprain, and I’ll see you in the training.