Ankle Aide

Preventing and recovering from ankle sprains

Tuesday, November 1, 2005, 12:00 am

Alex McKay has the long, easy stride of a natural runner. That should be, "had"—last year. This year, McKay’s gait is stiff, with a one-sided limp in his stride.

Last winter, near the end of two back-to-back indoor soccer games, a sudden change of motion ended with McKay on the ground clutching a sprained ankle. Accustomed to the trail, sprinting up and down the gym had shocked and weakened him.


Most of us have felt McKay’s pain. The grimace-inducing shock of an ankle rolling further than it’s supposed to. The fear of serious damage.

"A sprained ankle means one or more ligaments on the outside of your ankle were stretched or torn," says Dr. Liza Grant, a soccer player, runner, and chiropractor. "If it is not treated properly, you could have long-term problems."

Most sprains happen with the toes on the ground and the heel up. This position puts the ligaments of the ankle under tension. A sudden force, like changing direction quickly, can turn the ankle farther than the muscles can support.

The American Orthopedic Foot and Ankle Society says ankle sprains are the most common running injury and one of the hardest to properly recover from. Every year physicians log 1.6 million visits for patients with ankle sprains in the United States, and half of those visitors will resprain their ankle. That’s probably because a mild sprain can be rested for a couple days and then ignored. But McKay will tell you that’s the wrong attitude.

"I’ve ignored sprains before, and that’s probably why this one is taking so long to heal," he says. "I’m rehabbing this one properly."

Proper rehab means different things for different people, says Dr. Allan Abelson, a rehab therapist, marathoner, and author of Release Your Stride, a guide to improved running performance and injury avoidance. "If I had six people with identical inversion sprains, my treatment might be different for each one, depending on their needs and strengths," he says. "With any injury, including the ankle, I would look at the whole body, the whole kinetic system—flexibility, strength and proprioreceptors. We don’t want to look just where it hurts. We want to look at the whole picture."

Sometimes, he says, the sprain is partially the result of a weakness elsewhere in the body, and if that weakness isn’t found and corrected, recovery will never be complete. After a thorough examination, Abelson will lay out a plan to get the runner back to trail running form.

As long as the sprain doesn’t require surgery (see below), the first step is to go running, but not on the ground. Deep water running can be done even in the acute pain stage.

"A mistake a lot of people make is to not move the ankle for the first few days. A non-impact activity, like deep water running, improves blood flow to the injury and displaces waste products," Abelson explains.

As the ankle starts to heal enough to carry weight, it’s time to work on strength and flexibility. Most of the strength work will be done on wobble boards to gain muscle support and exercise the body’s proprioreceptors at the same time.

Proprioreceptors are found throughout the body’s muscular system. Similar to little nerves, they react to stretching or pulling by telling the brain where a body part is, and what position it’s in. The proprioreceptors fire far faster than the eye can relay a message to the brain and the brain to the body, adjusting the body’s positioning almost instantly. Simply put, properly trained proprioreceptors can realign the body in the split second before a sprain. Wobble boards safely exercise them to fire faster.

No matter how fast one’s proprioreceptors, flexibility and strength recover, it’s important to move slowly. Healing should be gradual and continuous. "You don’t want to see peaks and valleys," says Abelson. "You always want to see the rehab going progressively forward."

If the body isn’t healed properly the first time, it will always be weak and susceptible to future injuries and chronic problems. Proper strengthening lays down different kinds of tissue than the weak scar tissue left behind by an untreated injury. "Tissues laid down without strength training are more susceptible to future injuries," Abelson says. The more someone works out, the more muscle tissue is laid down. Abelson adds, "If you rehab everything properly it shouldn’t happen the same way again."

Proper strengthening and flexibility around the joint can help prevent injuries as well, yet there’s always the accident factor. Abelson sprained an ankle stepping off a curb when he wasn’t paying attention.

McKay knows his injury was no fluke, and he’s doing all he can to keep it from happening again. "I would say to any runner: Get your body in shape to reduce the chance of things like sprained ankles. And if you get one, take care of it properly, because there’s nothing worse than not being able to run because you ran when you shouldn’t have."

Types of Sprains:

1) Mild tear or pull of ligament. Painful but can bear weight. These sprains can usually be self-treated.
2) Larger but incomplete tear of ligament. Pain is more severe and the ankle won’t support much weight. It’s a good idea to see a doctor.
3) Complete tear of ligament or ligaments. Very painful. Can’t touch or move ankle without pain. See a doctor, it may require surgery.



Flexibility Exercises

Trace the alphabet - With a heel on the ground, write the alphabet in the air with the big toe. Write as big as possible.

Foot flat rotate knee - Sitting in a chair, keep your foot flat on the ground while rotating each knee separately.



Strength and Proprioreceptor Exercises

Try these exercises sequentially as your ankle recovers. Or use them to strengthen your ankles to ward off sprains in the first place.

Deep water running - Running in the pool is a great way of getting the blood moving through a sore ankle without the impact of running or walking.

One-footed stands - Next to a wall, stand just on the sore leg, holding the wall if needed. When this is comfortable, close your eyes. Repeat.

Stair stepping - Stand facing a stair with the ball of your injured foot on the stair. Rise up on the ball of your foot. It may help to lean against the wall or hold onto the rail. Repeat 10–20 times.

Heel walking - Walk on your heels for about 20 feet, and then on your toes for about 20 feet.

Balance on the wobble board - A wobble board is one of the best recovery tools for sprained ankles, and a good way of strengthening ankles, too. Start by balancing on the board and work up to doing one-legged squats. Works on proprioreceptors and muscle strength. An IT band roller cut in half can be used as a balance tool, too.

Hops - Hop up and down with both feet together 10–20 times. Move on to side-to-side hops with both feet together, and eventually one-footed hops.

Straight line jogging - Restart your running by walking and jogging in intervals. Stay on soft but flat surfaces at first.