Ankle sprains are often one of those underestimated injuries, both in how long they can take to heal, or in how they affect injury risk down the road. I ask all of my patients about previous ankle sprains, and no matter if it was a year ago or from playing soccer in high school, I’m paying attention to see if that is contributing to their current injury.
So, why are ankle sprains so pesky? What do you do to prevent future occurrences? How do you minimize the effect that an ankle sprain has on your running gait? Here are some things you should know before (or after) you roll.
First, let’s discuss what happens in an ankle sprain, and how chronic recurrent ankle sprains change your ankle. As you may know, a classic lateral ankle sprain is what happens when your ankle suddenly turns inward. This can happen when running on uneven ground or concrete, or in my case, when you’re running on flat ground inattentively (I have stepped on the tiniest pine cone on the road and sprained my ankle rather significantly). We have three main ligaments and the peroneal tendon that prevent this inward motion, and these are what are usually injured when you roll your ankle
There are different severities of ankle sprains, utilizing a grading system of I-III, based on the extent of ligamentous and soft tissue damage.
Grade I- overstretching of the ligaments, microscopic tearing. Mild swelling and stiffness.
Grade II- More significant ligament damage, potential partial tearing. No sense of instability of the joint. Moderate swelling/bruising, may be painful to walk and weight bear.
Grade III- Severe ligament damage with a possible full tear. Significant instability of the joint. Large amounts of swelling, difficulty walking.
In a severe acute ankle sprain, it is important to rule out fracture, either of the 5th metatarsal or fibula (bone on the outside of the ankle). If you are unable to bear weight on your injured foot, are having extreme difficulty with mobility, or have point tenderness along the 5th metatarsal or fibula, an X ray is appropriate. It is important not to skip this step, as the recovery will be different and there may need to be a period of non weight bearing or partial weight bearing to facilitate healing.
When there is injury to a ligament, the ligament will only heal to about 97% of its original length. Therefore, even one ankle sprain can result in loss of stability in the ankle joint, and every recurrent sprain will continue to lengthen the ligaments, which are the “guide rails” for the ankle’s many planes of motion. Within the ligaments are sensory receptors called proprioceptors, which tell our brain where the joint is in space. So, in the scenario of stepping on a root during a trail run, and a quick inward motion of the ankle, the sensors within the ligament send information to the brain that instigates a muscular response to attempt to prevent injury or falling. The stretching that occurs with chronic ankle sprains disrupts this mechanism, dampening the muscular response and increasing the risk of future sprains.
Another consequence of ankle sprains is glute inhibition, which occurs as a protective mechanism to limit weightbearing and forceful movement following injury. As a runner, you know that glute activation and strength is important, and this inhibition can linger if it is not addressed. Lastly, an ankle sprain is often accompanied by a loss of ankle dorsiflexion, a key important of running and walking gait. If we don't have sufficient dorsiflexion, the body is likely to compensate through other parts of the body, potentially leading to knee, hip, or even back strain.
So, what is a runner to do when a sprain strikes?
Keep the ankle moving, completing ankle circles and gentle calf stretching. Early movement is key to getting the collagen in those ligaments to heal back to their full potential. Manage swelling with ice within the first 48 hours and use a compression sock to assist further, especially when sedentary. If there is any suspicion of fracture, get it ruled out.
Delay returning to running until you have nearly full range of motion and are not limping with walking and/or running. If your running gait feels “off”, stop and wait to return to run.
Once the sprain heals, and assuming a typical Grade I or II ankle sprain, complete single leg and balance exercises to help with proprioception and the joint sense mentioned earlier. The good news is that while the ligament may be a different length, you can train your body to compensate. To make balance exercises even harder, you can perform them with your eyes closed. This takes away visual feedback and forces you to rely on your proprioceptors more. You should be doing glute exercises to begin with, but if you aren’t now is a great time to start!
Continue to do balance and single leg exercises even once fully healed. Yes, that means forever!
I hope you have a better idea of how to get off the “sprain train” and reduce your risk of recurrence. Of course, not all ankle sprains are preventable, but exercise is your best defense. Utilizing trail shoes or kinesiotape for extra support can also help provide some external stability. If you need help with a rehab program, see your favorite Physical Therapist, and they will assist you every step of the way.
Keep going, you got this!
Kacy Seynders, PT, DPT