Sprained Ankle in Runners
It’s true that most of us don’t want to stop running when we are in injured. How often have you heard someone say their ankle injury was just a twisted ankle? As Physiotherapists in a busy sports injury clinic, we hear this quite a bit, but unfortunately, it is often well after someone sprains their ankle. Sometimes it is months down that track that help is sought by patients as the sprain has not healed and may still be causing pain or there is difficulty getting back to preinjury running form. This article discusses the sprained ankle in runners and highlights that there is often more going on than simply a twisted ankle.
Ankle Sprains can be divided into three categories. A Grade I is a minor sprain or twist. Ankle ligaments are overstretched, but there is usually no other damage. Grade II is a more severe sprain with marked ligament tearing and Grade III involves a major rupture of the ligament away from the bony attachment that may need surgery to repair it.
A severely sprained ankle in runners sometimes involve small fractures of the foot or ankle bones and it is imperative for future health of your foot and or ankle joint that if a fracture is present, that the appropriate treatment is provided. At City Physiotherapy your physiotherapist is qualified to refer you directly for an X-ray or MRI if we feel it is required.
A simple rule to remember is if you can’t put weight through your ankle then you must get an X-ray, especially if your pain is felt near-certain foot bones. If you hear a popping or cracking sound or your ankle swells up rapidly and you have a lot of bruising or discolouration of your skin then these are also signs that you should get an X-ray to check for any signs of a fracture.
There have been many research studies performed over the past 20-30 years on ankle sprains and the evidence all points to receiving professional assessment and rehabilitation as the key to a successful recovery. Even for a Grade II sprained ankle in runners, failure to rehabilitate could delay return to full activity by several months.
One research study from 1999, undertaken by Barbara Braun of Health System in Minnesota, examined 467 sprained ankle patients. The study revealed that most of the participants still had pain and weakness in the ankle and foot from six to eighteen months post-injury. Approximately one-quarter of these participants couldn’t even walk for 1.5kms without pain, and almost twenty per cent of the participants had managed to re-sprain the same ankle, some people did this more than once!
With the right kind of rehabilitation, most ankle sprains can be helped. Luckily for runner’s and athletes alike, rehab involves getting back to weight-bearing activity as soon as your ankle will tolerate it. This doesn’t mean getting back to running straight away though.
What we do know is that the quicker you begin your ankle rehabilitation, the more quickly you can get back to your preinjury condition and running. At City Physiotherapy your physiotherapist your treatment may consist of hands-on treatment, soft tissue and joint mobilisation, dry needling, taping and support and rehab exercises.
We no longer use RICE or PRICE as current research has shown us this is not as helpful as we used to think it was and some aspects of this may actually delay healing. Nowadays the initial treatment follows the new acronyms of PEACE and LOVE. PEACE is to Protect, Elevate, Avoid Anti-Inflammatories, Compression, Education and then after the first few days we apply LOVE which is Loading, Optimism, Vascularisation and Exercises. For more information on current treatment and management of soft tissue injuries using PEACE and LOVE read our blog article by clicking on the link : https://cityphysiotherapy.com.au/rice-soft-tissue-injury-treatment/
Some of the well-known exercises such as drawing the alphabet in the air with your ankle and using theraband (elastic bands) to strengthen your ankle muscles are still good ankle rehab exercises. Don’t forget to stretch your Achilles tendon and calf muscles as these can tighten up quickly with a sprained ankle. Further down the track, we start with some basic weight-bearing exercises, like leaning against a wall whilst squatting. At City Physiotherapy your physiotherapist will guide you with which exercises are right for you and when to progress them.
This is the point where most runners stop rehab and treatment but it is important to follow through from here as simply getting back to running can lead to recurrent ankle sprains or weakness in your ankle muscles.
In order to stop yourself from spraining your ankles repeatedly, also called chronic ankle instability, you will need to perform specific strength rehab exercises.
Your peroneal muscles, which are situated on the outer side of your lower leg, need to remain strong and with good reflex action as these can stop your ankle from rolling. Your foot muscles also need to be strengthened as running is actually a single leg activity – think about how you propel yourself forward whilst one foot takes the impact the other foot is in the air.
In order to have good reflex action, your muscles need to have good proprioception. Proprioception is your body’s internal sense of its position and ensures you can balance. When you sprain your ankle, you not only get weaker muscles from the injury, but you interrupt the nerves that provide you with good proprioception. Both of these factors together can lead to your balance remaining poor, which in turn can lead to chronic ankle instability and recurrent ankle sprains. There are loads of balance exercises we can undertake. One of the more common balance exercises is to try and stand one foot with your leg slightly bent. Your physiotherapist will guide you as to which balance exercises are best for you and how to progress your ankle rehabilitation. It is important to be patient as your proprioceptive ability can take quite a few months to recover. If you persist then you will improve your proprioception, balance and foot strength. Now you are ready to get back to running safely.
If you feel your ankle sprain recovery isn’t progressing quickly enough, you might have bruised a bone, developed chronic ankle instability from repeated sprains or developed a stress fracture, which can show itself with the same symptoms as a strain or sprain. If your ankle ligaments have been overstretched one too many times your recovery will be slow you should seek the assistance of your physiotherapist if you haven’t already done so by this stage. They will devise a personalised strategy and treatment plan to improve your ankle instability and get you back to running pain-free.
Give City Physiotherapy a call on 8212 4886 Monday – Friday between 8am -6pm and Saturdays from 8.30am- 2pm or book online 24/7 at https://healthengine.com.au/book/46470
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