A sprained ankle is a very common injury sustained through sports and also daily life. It is sometimes also known as a twisted ankle, as usually this is how the injury occurs.
A typical sprained ankle injury occurs suddenly through a twisting or turning motion at the ankle. There is immediate pain and swelling usually develops pretty quickly too. It may be difficult to bear weight on the ankle, or just impossible in severe injuries. The majority of ankle sprains are due to rolling the ankle outwards and so swelling and often bruising appear on the outer ankle. Bruising may also develop anywhere around the ankle joint and foot.
What is it?
A sprain of any joint refers to ligament damage. In this case, it is the ligaments which attach your Fibula (outer shin bone) to your Talus (ankle bone) and Calcaneus (heel bone) which are damaged. There are three of these which are typically injured –
- ATF – anterior talo-fibular ligament – the most commonly injured
- CF – calcaneofibular ligament
- PTF – posterior talo-fibular ligament
Whilst ankle sprains aren’t that common in road running due to the straight line nature of the sport, they can still occur, for example when treading on an uneven paving stone or off a curb. They tend to occur more frequently in trail and off-road runners.
The severity of an ankle sprain, like all sprains, is graded 1, 2 and 3. 1 is a minor tear with only stretching and maybe a few ligament fibres torn. Grade 2 is a wide grade with anything from 10-90% of fibres torn! Sometimes this is further divided into 2- and 2+. Grade 3 is pretty much a full rupture. But remember, this can be in one ligament (usually the ATF), two or even all three. Full ruptures of all three ligaments can cause a dislocated ankle.
As with all acute injuries, the first thing to do is take the weight off the ankle, elevate it and apply some ice. This will immediately help to reduce the swelling and bruising that develops. Keep ice on the ankle for 10-15 minutes at a time, no longer, but repeat this every 1-2 hours initially. You can also apply a compression bandage to help reduce swelling. In severe cases, crutches may be necessary to help you rest the ankle.
In moderate to severe cases, it is well worth a trip to A & E to get the ankle x-rayed. It is not uncommon for a small piece of bone to either chip off during the accident, or for the ligament to pull a piece of bone away – known as an avulsion fracture.
Maintain the resting, ice and elevation procedure for 2-5 days, again depending on severity. Worse cases will require longer. In this time, if it is comfortable to do so, start ankle mobility exercises, such as simple ankle circles which will help to reduce swelling and stiffness and also align new ligament fibres as the injury heals.
Once you can weight bear comfortably, start calf stretching exercises. Tightened calf muscles is a natural response to an ankle injury in order to protect the joint from further damage, however if the muscles do not return to their pre-injury length, this can lead to further problems. Tight calf muscles can contibute towards developing other injuries including achilles tendinopathies and plantar fasciitis.
There are two muscles in the calf which need to be stretched and many people forget one of them – the Soleus. This muscle can be stretched by simply bending the knee slightly in any standard calf stretch position. This relaxes the overlying Gastrocnemius to allow you to stretch the Soleus underneath. You’ll know you’ve got it right as the stretching sensation will feel lower in the leg, around the achilles tendon.
Ensure you hold stretches for a minimum of 20 seconds and repeat each stretch 2-3 times to thoroughly stretch the target muscle. Stretching like this should be performed at least 3 times a day to really see the benefits. But remember, stretching should never be painful.
As well as stretching, balance exercises can begin in the early stages. After an ankle sprain it is common for the balance (sometimes called proprioception) to be affected. This is due to proprioceptive sensors which are located in the ligaments being damaged. These sensors send messages to your brain regarding the positioning and movement of the joint. Failing to re-train this sense of positioning can result in future injuries which is why many people suffer recurring ankle injuries.
Initially it may be enough to simply practice balancing on one leg only. Tie this in to doing a daily task, such as cleaning your teeth or washing up! This will remind you to do it. Once you can stand unaided for 30 seconds on the injured leg alone, add in something to challenge your balance. This can be numerous things, from a small knee bend, to twisting your upper body, to closing your eyes! wobble boards and cushions are also great for proprioception training.
The final part of rehab following an ankle sprain is strengthening. There are lots of exercises you can do to strengthen the muscles which surround the ankle. Start with heel raises and toe raises in a seated position and when ready advance to standing and then single leg. These are pretty safe exercises to start with as they don’t involve the inversion movement (twisting the ankle outwards) which caused the injury.
Eversion is the next step. This is the opposite movement of turning the ankle in, so the sole of the foot faces outwards. This can be performed isometrically (statically) against the resistance of a static object like a table leg, followed by rehab band resistance.
The final step is adding inversion into the mix. Again, start with isometric inversion where the ankle is turned in against resistance (sole of the foot in). Then progress to rehab bands.
Returning to Running
Ensure the ankle is completely pain free before returning to running. You should gradually build up the demands on it from walking, to skipping to jumping etc, making sure you allow enough rest time inbetween exercise to know if any of these exercises flare the injury up.
It is also vital that you ensure you have regained full ankle range of motion before running. If not, this could lead to other injuries rearing their ugly heads! If you need a little extra help, some sports massage can be really beneficial.