Thursday, August 20, 2009

Avoiding Ankle Sprains

In keeping with our recent discussion on ankle sprains, here's an article from Trailrunner magazine which addresses ways to prevent and cope with ankle sprains. Add this information to yesterday's post.

Get Twisted (or Not)
How to prevent and cope with ankle sprains
By April Rose Ferrentino

You're cruising along a beautiful singletrack, enjoying your elevated heart rate and a great view, when suddenly you lose your footing. Ouch! Along most trail runners' favorite routes lie such potentially ankle-turning hazards as roots, rocks and quick descents. A brief moment of not paying attention to where you're stepping is all it takes to disrupt the ankle's delicate balance. Even worse, injured ankles remain weakened for an average of six months.

And up to 80 percent of all ankle sprains stem from previous injuries. Athletes who have an injury-weakened ankle joint are about 10 times as likely to suffer a repeat injury than those who don't. Twelve to 20 percent of all sports injuries are ankle sprains.

The ankle's physiology is one reason why inversion injuries are so common. The inside of the ankle is much more stable than the outside, especially when the toe is pointed (plantar flexed). The good news is that you can quickly and easily determine if your ankles are weak, and take precautions to keep them healthy.

Are You at Risk?

According to head athletic trainer at Boston College, Bert Lenz, "The most common type of ankle sprain seen in sport involves the ligaments on the lateral [outside] aspect of the ankle. Injury to these ligaments most often occurs with a 'rolling' of the ankle inwards, or an inversion mechanism, such as simply stepping on a rock while running. This type of inversion action to the ankle can damage one or all three of these ligaments in differing degrees."

Sports medicine professionals define dysfunction resulting from ankle inversion injuries as a reduction in proprioception, or knowing where your ankle is in space and what it is doing. If your brain isn't aware of how your ankle should react, you're much more likely to trip over a log or roll your ankle in a downhill divot. So how do you know if you have a weak or "dysfunctional" ankle? According to a study published by T. H. Trojan and D. B. McKeag in the British Journal of Sports Medicine, the simple "single-leg balance test" is a reliable way to predict the possibility of future ankle sprains.

To perform the single-leg balance test, stand barefoot on a flat surface. Stand on one foot with the opposite leg bent and not touching the weight-bearing leg. Focus the eyes on a target, then close them for 10 seconds. If you sense any imbalance, the test is failed. If the foot moves on the floor, the arms move, the legs touch or a foot touches down the test is failed. A failed test suggests the individual is more susceptible to ankle sprains and injuries. Further, according to Trojan and McKeag, athletes who failed the single-leg balance test but taped their ankles were less likely to sustain ankle sprains than those who didn't.

An Ounce (or Two) of Prevention

So here's the damage control. If you have a weak or dysfunctional ankle, you can reduce the likelihood of injury, and re-injury, by taping, bracing, stretching and strengthening the joint in question. If you're planning on taping your ankles, see a physical therapist or an athletic trainer who can show you how. Ankle braces are easily found in your local drug store and can effectively fortify vulnerable joints.

Another ankle-saving consideration is in selecting the proper shoes. Jason McGrath, USATF Level 2 Track Coach, decorated ultra trail runner, and shoe expert suggests trail-specific shoes that are neutral and low to the ground. Most running shoes suitable for pavement are well cushioned; however, a thick midsole means that your feet are farther from the ground, causing less stability and increasing the probability of rolling an ankle. McGrath also warns strongly wearing "stability" shoes, common on the road-shoe market. These shoes contain medial posting, or a separate material lining the instep that prevents overpronation of the foot. When running on uneven terrain these shoes place more stress on the physiologically weaker lateral (outside) portion of the ankle, making it more likely to roll. In the meantime, you will also want to add ankle strength and flexibility exercises to your workout regimen.

Stay Supple

Stretching the ankle is important to restore and maintain its range of motion. The following exercises will get you back on the trail.

1. Calf stretch–Sit on the ground with both legs straight out in front of you. Loop a jump rope around one foot and pull the toes back toward the knee as far as you can without the rope's help. Make sure the knee remains straight. Then gently pull back on the rope to assist the stretch and hold for approximately two to three seconds. Perform this stretch another six to 10 times on each leg.
2. Tibialis anterior stretch–Sit down on a chair with your left ankle resting on the opposite knee (the actual ankle bone should be about two inches off the thigh). Point the toe as much as you can on its own, then grasp the toe with your right hand and gently pull it toward you on your right side. Hold this stretch for two to three seconds and repeat six to 10 times for both legs.
3. Ankle everter stretch–In the same position as the previous stretch, grasp the forefoot with your hands and from the ankle, rotate the foot inward towards you so that the sole of your foot is pointing up. Assist with the hands at the end and hold for two to three seconds. Repeat six to 10 times on both sides.
4. Ankle inverter stretch–In your chair, raise one leg so that one foot remains on the floor and the heel of the other foot is in your chair in front of your buttock. Rotate this foot outward and gently assist it with your hands placed on the forefoot. Hold for two to three seconds and repeat six to 10 times on both sides.
5. Range of motion practice–Lift one foot into the air and draw circles with your toes for 30 seconds in each direction on both sides.

Stay Strong
Strengthening the ankle muscles (NOTE: the muscles around the ankle, these exercises help primarily with proprioception which will help you avoid ankle sprains) will provide greater stability and reduce the likelihood of re-injury. The following exercises can be easily performed anywhere.

1. Towel scrunches–Sitting in the chair, place a hand towel underneath your forefoot and your heel placed firmly on the floor behind it. Use your toes to scrunch the towel as far as possible. Repeat three times on both sides.
2. Towel scoops–Again, in your chair, keeping your heel on the ground and your forefoot on the towel, scoop your forefoot toward the midline of your body, straighten and repeat until you have passed the towel from outside your foot to the inside.
3. Towel push-aways–In the same position, with the heel on the floor off the towel, push your forefoot away from your body, straighten and repeat until the towel has moved from the inside of the foot to the opposite side.
4. Calf raises–Stand with the ball of your foot on a step and hold onto a railing for balance. With a straight knee and the non-exercising leg bent at the knee, raise yourself by pointing the toe of the exercising leg. Repeat 10 times on each leg.
4. Heel walking–raise your toes in the air and walk only on the heels of your feet for 15 to 20 yards.
5. Wobble board-An oval-shaped board that pivots freely over a hard cylinder or ball, the wobble board works great for training proprioception. Stabilizing on the board may feel difficult at first, but most people progress quickly. Stand on the board and try to rotate it three times around in each direction. Then try to tap down in the four directions North, South, East, West consecutively. Try to balance on the board with no parts touching the ground for as long as you can. This will strengthen ankle muscles, and improve proprioception.

Recovery Road
In the event that you do sprain your ankle on the trail, here are a few tips to get yourself back in action fast. Everyone's doctor suggests RICE immediately following an ankle. RICE stands for Rest, Ice, Compression and Elevation and is the old standby for athletic injuries.

In the article "Management of Ankle Sprains," authors Michael W. Wolfe M.D., Tim L. Uhl PhD., ATC, Carl G. Mattacola PhD., ATC, and Leland C. McKluskey M.D. emphasize the importance of stretching and exercises (see sidebars) to maintain range of motion during the initial icing stage immediately after injury. Compression using an elastic bandage alleviates swelling in the area.

According to a study by Bleakley, McDonough and MacAuley in the British Journal of Sports Medicine, the best way to ice an ankle sprain is in 10-minute intervals, alternating with gentle stretches. This procedure may be repeated every two hours, and was shown to significantly reduce the pain felt on activity within the first week of injury. Non-steroidal anti-inflammatory drugs (NSAIDs) also alleviate swelling and pain. After pain and swelling are gone, begin a stretching and strengthening routine, taking care to tape or brace your ankle before hitting the trails.

Support Group
Ankle braces, which both compress the ankle and improve joint stability, are easier to use than traditional taping methods, generally comfortable to run in (although they may not fit well in all running shoes) and washable. A couple of proven products are:

Body Glove Ankle Support (
Stromgren Supports Double Strap Ankle Support 325 (
EDITOR'S NOTE: Definitely include the ASO ankle brace mentioned in the previous post here.

RICE 101
: Stop running immediately after ankle injury occurs.

ICE: Apply ice for 10 minutes, stretch for 10 minutes, re-apply ice for 10 minutes and repeat every two hours until swelling subsides.

COMPRESS: Cut a U-shape out of a wad of gauze. Place the bottom of the U underneath the bone on the outside of your ankle ("ankle bone," or malleus) so that the bone is surrounded on both sides and underneath by gauze. Hold this in place and wrap an elastic bandage toe to mid calf around the ankle. Otherwise use an ankle brace.

ELEVATE: Lie or sit down, relax and place the injured ankle no lower than six inches above the heart until swelling subsides.
EDITOR'S NOTE: And...contrast baths!


  1. Exercise is totally essential for everyone, be it as a daily routine or as a preparation for long-distance running to prevent injuries. I once had an unfortunate event while jogging around the park, I re-injured my ankle that left me sidelined for many months. Thankfully, the doctors there had my past electronic health records, which makes it easier for them to diagnose my injury.

    Getting my ankle fixed again, I increased my warm-up time and watched my every step to prevent any more injuries. Also, my recovery became faster, all thanks to the electronic medical records system they employed.

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