Ankle Sprains:
Treatment and Avoidance of these Aggravating Injuries As cross country season is rolling around quickly and more people in general are taking to trail running, it is time to talk about one of the few "acute" injuries that runners face: the ankle sprain. As you all know, most running injuries occur gradually over time and are typically in the category of "overuse". However, ankle sprains occur in response to a sudden, significant stress to the ankle joint. There is a relatively high incidence of ankle sprains in runners, especially those that run on trails or uneven surfaces. But certainly this injury can occur just by a misstep when on the treadmill. Most people think of this injury more in terms of twisting or rolling their ankle. The key with this injury is recognition and proper treatment, and most of all prevention. The worst thing that can happen after this injury is that it could turn into a chronic situation if not properly treated. Hopefully this article can give you some pointers on how to avoid that.

The majority of ankle sprains occur when the runner rolls onto the outside of their ankle, this is called an inversion injury. Typically this causes a stretch or tears to the ligaments on the outside of the ankle. These ligaments give the ankle stability. Thus, repetitive ankle sprains can lead to chronic ankle instability. Typically only one of the outside ligaments is damaged, but in the more severe injuries, two are damaged. Ankle sprains are classified according to the degree of severity: grade I, II or III, with III being the worst. If you twist your ankle, typically you will feel a sudden sharp pain, followed by swelling on the outside of the ankle. When running on uneven surfaces, such as cross country, one can easily misstep, step in a rut or small dirt hole and then roll the ankle.

The severity of your pain and symptoms will depend on the degree of your injury. The grade I sprains are characterized by mild swelling, pain, and tenderness on the outside of your ankle. Typically there is no bruising and little loss of function. A grade II sprain is often accompanied by a tearing sensation or pop when the runner rolls their ankle. There is more pain and swelling and difficulty walking. The bruising develops about 3-4 days after the injury. A grade III injury is the most severe, with a significant amount of swelling, pain and often an inability to walk on your ankle. It may feel "loose" and unstable and a large amount of bruising can develop around the entire ankle and foot.

The treatment and recovery is also based on the severity of the injury. RICE is the cornerstone of treatment for all sprains. Rest, ice, compression and elevation are all important aspects of treatment. Tylenol or ibuprofen can help alleviate some of the pain. For the milder sprains, once the initial swelling and pain decreases(usually 24-48 hours), you should start a rehabilitation program. However, with the more severe sprains, in particular if you are unable to bear weight on your ankle, medical attention should be sought. An x-ray is typically necessary to assure there are no broken bones. Sometimes the severe sprains need a half cast or a fracture boot. Let your doctor be the judge.

For all degrees of ankle sprains, once the initial pain and swelling have decreased, the rehabilitation program is the key to your full recovery and also to preventing a recurrence. Those that tend to have persistent pain and instability after the initial injury often did not rehab their ankle completely. Non-impact cardio can be started as soon as your pain allows you to keep up your conditioning. Ankle stretches and flexibility should be aimed at the calf muscles and heel cord (Achilles) especially to prevent a stiff ankle. Focus on the ability to dorsiflex your ankle at least 15 degrees above a neutral position. Strengthening exercises should be focused on the group of muscle on the outside of your calf, the peroneal muscles. These muscles allow you to evert or hold you ankle out to the side. These muscles must be strong to resist your ankle from rolling in. Make sure a trainer, coach or therapist guides you in progressing your exercises if you are unsure.

With proper treatment, most grade I and II sprains can return to running as soon as they feel comfortable, although it may take a few weeks. Continue the exercises the entire time, especially the strengthening aspect. A grade III sprain may take much longer, up to 3 months to return. These are the injuries that place you at highest risk of recurrence, so don't skimp on proper rehab. Some do benefit from a low-profile ankle support or brace when they return to running, so explore this option with your trainer. This is often a more comfortable and easier option than taping your ankle before running, so see what works best for you.

As always, prevention is the best medicine, so try to adopt a regular strengthening program for your ankles and wear good, supportive shoes if you run trails or cross country regularly. Be especially careful when running these surfaces after a heavy rain. The slick grass and mud can certainly cause you to slip and twist your ankle. If you do have a tumble though, follow the above principles and hopefully you can avoid a long hiatus from your beloved sport!