A twist on ankle sprains: all you need to know about what they are, what do to if you get one and how to prevent them in the future.

One minute you are cruising along minding your own business. The next you are hobbling to a halt clutching your ankle as it throbs with pain.

If you are a regular runner, be it road or trail, chances are you will have had an ankle sprain at some point. Whether it's a small roll that you have to rest up for a few days. Or a larger event that sees you on the sideline for a couple of months, we can all agree they are both annoying and painful.

This blog has been written so you can understand:

• What an ankle sprain is.

• What you need to do if you get one.

• How to mitigate the risk of getting one in the future.

What is an ankle sprain?

An ankle sprain refers to the stretching or tearing of ligaments around the ankle. This happens when the ankle twists, turns or rolls awkwardly taking the ligaments outside their normal range, causing them to overstretch. The severity can vary- from a mild overstretch of several fibres to a complete tear.

Ligaments are fibrous tissue that connect bone with bone, limiting movement and helping to create stability around the joint. Once damaged, if they are not rehabbed properly, the ligaments can have a reduced ability to stabilise the joint which in turn can lead to further sprains and related injuries.

There are two types of ankle sprain. An eversion sprain (ankle rolling inwards, foot outwards) or inversion (ankle rolling outwards, foot inwards.)

There are a variety of causes but typical ones are: an awkward landing, misplaced step during running, uneven surfaces, impact during sports.

Symptoms also vary but typical ones are: bruising, swelling, tenderness to touch, pain when weight bearing, restricted movement. 

Severity of sprains will vary depending on how bad the initial trauma was. Generally they are graded based on severity:

Grade 1- slight stretch and possible microtears. Some pain, minimal swelling and instability. Able to weight bear. Recovery will take anything from a few days to a couple of weeks.

Grade 2- partial tear of 1 or more ligaments. Moderate pain and tenderness. Noticeable swelling and bruising. Trouble weight bearing and some loss of movement. Some instability may be present. Recovery will be anything from 2-6 weeks. May be longer for some sports.

Grade 3- complete tear or rupture of one or more ligaments.. Severe pain, significant swelling and bruising. Inability to weight bear and instability of the ankle joint. Recovery time can be 3-6 months.

What happens if I sprain my ankle?

First call is always to go and see a physiotherapist or osteopath. They should be able to guide your rehab.

If you are unable to do so or can’t get an appointment for a while then I would follow the following steps.

1- reduce inflammation.

R.I.C.E (Rest, Ice, Compression, Elevation) will be your friend here. Whenever possible try to use this method to help with inflammation.

A low inflammatory diet coupled with high protein and plenty of sleep will also be useful to aid the recovery process. All these factors will influence your ability to recover faster.

2- improve range of motion.

Make sure you are still moving the ankle as much as possible. As soon as the pain and swelling will allow, try to get back walking on it and regularly mobilise it.

Ankle circles, moving your toes up and down and making sure you can move your ankle from side to side will all help.

A reduction in mobility is a common byproduct of an ankle sprain therefore you want to return your ankle to its previous ranges to help minimise future sprains.

3- building stability.

Once pain has reduced sufficiently and you are able to move your ankle and put weight through it I would begin working on rebuilding stability and strength.

Two big factors in ankle sprains are the reduction in stability and proprioception (your brain's understanding of where your foot is in relation to the rest of your body.) These are linked and therefore stability training will help to improve both.

This can be as simple as standing on one leg to begin with which can then develop into closed eyes balances or standing on a foam mat. The key to improving stability and also strength is to gradually increase the difficulty of the movements (making them less stable) as you adapt to them.

So while you may start simply standing on one leg you may finish landing on an unstable surface from a jump which is a much more challenging movement.

4- strength.

Further strength around the joint can be useful alongside other balance based strength movements.

So regular calf strengthening will help return mobility and strength to the ankle plus will further help with proprioception, which in turn will help with stability and injury mitigation.

Including movements like Bulgarian split squats will also help, in two different areas. They will help strengthen key areas you need within running but will also help develop stability and balance. So movements such as this are great to include in your programme over time.

How long will it take for me to recover?

Refer back to the grading lists above and this should give you an outline depending on the severity of your sprain. There are various other factors that will also influence it but this should give you a guideline.

As with anything, the more effort you put into your rehab, the quicker the recovery process will be.

Injury prevention in the future

It is impossible to remove the risk of injury altogether, however there are steps you can take to mitigate the risk of injury or re-injury.

1- continue your rehab. Everything you have done to rehab your ankle should be continued in some form in the future. Mobility, stability and strength training will mitigate risk of injury and help improve performance. So don’t drop them just because you feel you are back to running fitness.

2- follow a plan. So many people I see get injured just because they lack structure and do too much too soon. A good plan should see you progressively overloading your training over time and include weeks where you recover.

3-pick the right foot wear. Make sure you are wearing appropriate and supportive footwear for the task you are doing.

4- recovery. Make sure what you are doing is appropriate for your skill level and your fatigue. Trying to push through sessions for the sake of ticking a box and/or doing higher risk activity when under recovered, is an injury waiting to happen. 

For example, if you are a beginner on trails and decide to do a long run on them when tired, that could class as being higher risk. It’s unlikely you have built up the stability, strength and skill to be able to complete that in a state of fatigue so it may be better to do another day.

Final thoughts

Ankle sprains are annoying but hopefully this article has given you an idea of what they are, what to do if you get one and how you can help to prevent them in the future.

Although injuries are unpredictable and will be caused by a variety of factors, I have found following a structured training plan suitable to your ability alongside a solid strength training plan are two of the most effective ways to mitigate the risk of them. That or working with a qualified coach will help keep you running stronger for longer.

If you have any further questions on this blog then please drop me a message on any of the contact details below. If you have found it useful please give it a share.

About the Author:

Hi my name is Ollie McCarthy and I am a Running Coach and Personal Trainer in Tunbridge Wells. I help people to build fit, robust and capable bodies that look good but also perform well. This is done through a combination of running, mobility, strength and conditioning work.

E: Ollie@mccarthysf.com

T: 07828573920