Ankle sprains are annoying, but if treated correctly, this doesn’t have to mean several weeks without running. Here are some top tips to recover faster and stronger.
More and more runners are discovering the benefits and joys of off-road running, but some of us also discover the hard way that the uneven terrain, quick directional changes and sudden obstacles do increase the risk of an ankle sprain. Of course, ankle sprains can also occur on road, with curbs, uneven pavements, errant dogs and small children all providing potential risks. Going over on your ankle can be very painful and in the beginning often leaves you unable to put any weight on the leg at all, but despite the immediate frustration, it doesn’t have to mean weeks off running, as long as you treat it correctly.
DOES PAIN REFLECT THE SEVERITY OF INJURY?
Even though ankle sprains can hurt a lot and swell up in just few minutes, it’s important to remember that both pain and the inflammatory response are part of the body’s extremely sophisticated system of responding to perceived threat of damage, not actual damage.
Your brain is constantly receiving and interpreting information from receptors in the body regarding sudden changes in position, pressure, temperature, and so on. Doing so, it can take the necessary steps if the threat of possible danger arises.
Think of a time when you have stepped on what you thought was glass, but in fact it was a harmless piece of plastic. Your brain responds by making you jump away and may even send out some pain, but once you examine the item and realize no harm has been done, your system relaxes and the pain goes away. Sometimes the opposite can happen – we wake up with a bruise and don’t know how we got it because at the time the brain didn’t feel there was enough danger to inform us about it.
What modern pain science is telling us is that we should try not to freak out if we have sudden pain or swelling because this isn’t a completely accurate injury report. If you have little or no swelling within the first two days and can weight bear then you may just be okay, but even if you do have a lot of pain and swelling, don’t worry. Just go to see your doctor and let them assess it so they can give you an appropriate rehab plan.
DO YOU HAVE A BROKEN BONE?
One of the biggest fears among runners – we all know fear can increase the brain’s perceived level of threat and therefore the protective reaction – is whether a bone has been damaged during an ankle sprain. In reality, the chances are low and as a general rule if you are able to walk four steps then it’s very unlikely you have a broken bone.
When performing the four-step test, keep in mind that during the first 24 hours, much of your pain and inability to weight bear may be resulting from your body’s natural protection system.
Twenty-four hours of R.I.C.E. (rest, ice, compression and elevation) together with gentle attempts to test how much weight you can place on the ankle could see a considerable decrease in pain and increase in ability to weight bear. That said, if you still can’t walk after 48 hours you should definitely go to see a doctor. During the assessment, a doctor will apply gentle pressure to areas of the foot and ankle where fractures could occur; in the unlikely event that something is broken you’ll soon know about it.
GOODBYE R.I.C.E., HELLO P.O.L.I.C.E.
The traditional acronym R.I.C.E. (rest, ice, compression, elevation) has been changed to encourage people to move away from the idea that only resting will help speed up recovery. No matter if you’re a supporter of ice or not, the idea of avoiding anything that causes pain (which actually means total rest) doesn’t comply with modern studies.
Research has discovered that mechanical loading (weight bearing) actually encourages cellular responses that in turn stimulate change in the tissues. Even though we still have to be careful not to put too much load through an injured area, it looks like that in many cases total rest isn’t the right answer and can in fact slow down healing and recovery.
The ‘P’ of the modified acronym P.O.L.I.C.E. stands for ‘protection.’ If you aren’t able to weight bear at all then it makes sense that you wear some form of support or use a crutch. However, as soon as you can weight bear and protection is no longer needed, that’s when ‘optimal loading‘ comes into play. You have to experiment with how much load your ankle can take; use a chair or desk for support and don’t forget that pain is a response from the brain, a warning of perceived threat not actual damage so you shouldn’t be worried by anything less than 4 out of 10 – where 10 is the worst pain you’ve ever felt. In fact you should seek 3/10s or 4/10s as they’re signs that you are loading enough to promote the desired strengthening. And if you do hit a 5 out of 10, don’t worry – just pull back slightly, change the angle, do what you can to bring it back down to a 4/10 or less. A successful rehab programme is based on the gradual increasing of load and neuromuscular demand so that the body is encouraged to adapt accordingly.
WHEN CAN I RUN AGAIN?
In case of severe ligament injuries, healing may take up to 12 weeks. For this reason professional assessment is certainly recommended in the early stages. That said, in many cases the actual damage to the ligament is minimal so by understanding pain and reacting accordingly, you may find yourself back running long before that. As long as you follow a suitable rehab plan (including appropriately graded strength and co-ordination exercises), running will over time appear as part of your rehab. Continue climbing the rehab ladder sensibly and you may find yourself back to your former level of running sooner than you imagined.
Understanding pain is the factor that often helps explain why some runners are still limping after six weeks, while other are comfortably performing hops and start running after only two weeks.
WHAT HAPPENS WHEN IT COMES AN ANKLE SPRAIN?
Ankle sprains are caused when you are trying to place your weight on a foot while the sole is either excessively turned inwards (inversion) or outwards (eversion). Because of the bony shape of the ankle, inversion sprains occur more often, particularly when the foot is pointing downwards (plantarflexed – e.g. stepping off a curb) as opposed to pulled back (dorsiflexed).
Inversion ankle sprains leave structures on the outside of the ankle open to stress. Depending on the severity of shock to your system, swelling is usually immediate as your body automatically responds to the threat by diving into protective mode. The pain is also part of this protection, which is why something that won’t actually be that serious in terms of structural damage, can however still be very painful.
WHAT LIGAMENTS ARE AFFECTED?
If a ligament on the outer ankle is affected due to an inversion sprain, it tends to be the anterior talofibular ligament (AFTL) towards the front because this is the one dealing with the most load during plantarflexion. It’s smaller and thinner than its neighbours, the calcaneofibular ligament (CFL) and posterior talofibular ligament (PTFL). Now all of this might be very interesting from an anatomical point of view and forms a vital part of a doctor’s assessment, but as far the runner is concerned, the road to recovery is usually more about understanding pain rather than getting bogged down with what has occurred to what particular ligament, tendon or muscle.