Injury Focus – Sprained Ankle

Sprained ankles – the bane of the fellrunner, general annoyance, occasionally (and unnecessarily) the end of a running career.

What happens?

You run along minding your own business when all of a sudden you go over on your ankle. We’ve all done it – your foot inverts, pain blossoms at the junction of your ankle and your foot, normally on the outside, you scream, sometimes fall over, and then attempt to keep running on it.

inverted ankle

Sometimes you can keep running on it, but sometimes it is so bad that all you can do is hobble to the nearest road, call you Dad and get a lift home. (This may or may not have happened to me in 2007).

Technically, you invert the foot because the muscles on the outside of the leg are overwhelmed by the amount of force going through them, they inhibit themselves in order not to get damaged, and the structures that stop your foot from going all the way over are your ligaments. Needless to say, it gets stretched beyond where it normally likes to be, and that overstretch of the ligament tends to be the injury.

Other stuff can happen with really bad sprains, it can affect the capsule around your ankle, you can have avulsions, lots of bruising might occur, but for the moment, we’ll continue on with a bog (ha) standard fellrunning ankle turn.

If there is no bruising, cool – there might be a lot of pain and some swelling, but nothing bled. If there is some bruising – ok, this is might take a bit longer to heal, but generally is not something to panic about.

 

Aha – the difference between ligaments in your ankle (in green) and the muscles that try to stop you from spraining you ankle – (blue and red).

What to do?

If you’re on a hill – get off. Generally speaking if it is “just” an ankle sprain you should be able to get off under your own steam. If, after a few minutes you genuinely can’t put weight on it, or it is visibly deformed, you might have to make alternate plans involving Mountain Rescue.

For most situations, though, dunk it in a stream, make it cold, and when you get home, if you feel it necessary, ice it.

Personal experience…..

The time scale from here is very dependent on just how bad the sprain is. Personally, if it is pretty bad and I find it hard to put weight on it, then running is obviously going to be a bit of a no-no for the time being.

For the first couple of days I try to stay off it, and then as time goes on, I put more and more weight through it. I begin to work on mobility by holding it in the air and drawing the alphabet with my foot – making sure the articulation is coming through my ankle.

Slowly but surely I’ll start walking faster. I’ll practice 2 footed jumping and landing. If there is little or no pain, I’ll go onto lunging and hopping.

Getting back to running off road takes a while. I hate it when I think I’ve got over a sprain, go out for a nice stomp around Bleaklow and then go over on it AGAIN! Argh.

So I start out running on the road for a week or so, making sure that I’m really emphasising foot placement and making sure I’m stable through the ankle. After that I’ll work onto trails with loose stones, introducing a bit of ankle movement as I run. I’m not looking to keep my ankles locked, I want them to flex, to move around, and to make my muscles wake up to stabilise my ankles as I run.

It’s probably telling that the only photo I have of anyone running on the road are fell runners

Trail running… like road running, but with a bit more ankle pertubation

Fellrunning. Ankle stability is necessary

After that, I’ll start running on easy fell routes that I know well, paying close attention to what is going on under my feet – making sure that I can see where my feet are going… no ferns or heather or crazy unstable moorland underfoot.

Finally, when I’m back to that and my ankles feel like they are working normally and can take sudden changes in direction, odd cambers and surprising surfaces do I consider it ok for me to head off into wherever without even thinking about my ankles.

It is the reintroduction of fellrunning when I am at my most vulnerable. A couple of years ago I went through a phase of 7-8 months where I thought I had glass ankles. Hopefully I’m through that now. Keep running, keep challenging yourself.

Note – this is a BLOG. It is not a peer reviewed article, it does not purport to be such. It is based on the authors experiences of being a fellrunner, having a sprained ankle and the various physiotherapeutic measures he tends to take in such a situation. That being said, if you go to a physio with a sprained ankle from fellrunning and they tell you to a) stop fellrunning b) take up another sport c) only run on road from now on. Find another physio.

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