The Dreaded Ankle Sprain

So far, 2009 has been a year for ankle sprains. Prior to this year, it had been almost a decade since I had really torn up my ankle. Training for the Western States 100 in 2000, I stepped on a rock while bombing downhill and tore just about every ligament and tendon in my right ankle. It was a severe sprain that ended up keeping me out of Western States that year and took a long time to heal.

Since then, I'd been pretty much ankle sprain free until this year. Back in April I sprained my ankle bad enough to keep me from running home. No fractures were discovered and the ankle healed up quickly, allowing me to race a trail 50K two weeks after the sprain. Fast forward to last night: another ankle sprain on the same ankle (the right one that was sprained severely back in 2000). This time I was able to run home on the ankle and it doesn't seem to be as swollen. It does however hurt today and it feels a bit different than the last sprain.

I actually believe that my ankle is stronger since the first sprain I suffered in 2000. Perhaps "stronger" isn't exactly the correct term. From what I understand, the ankle doesn't really get stronger when you exercise it after a sprain. Since there aren't any muscles in the ankle, you can't really make the ankle "stronger." You can strengthen the muscles around the ankle (primarily the calf muscles), but this doesn't really make your ankle more stable. What you're doing when you do balancing exercises after a sprain is improving your proprioception. In other words, you're retraining those nerves that were also torn during your sprain to fire signals to your brain that your ankle is inverting and that you need to make an adjustment to catch yourself before it turns all the way over. Training these nerves to fire efficiently is critical to avoiding future sprains.

Since my severe ankle sprain in 2000, I've run almost exclusively trails. I believe that this has naturally made my ankles "stronger" by training them to adjust to uneven surfaces, up, down and around rocks and roots. Trail running naturally improved my proprioception helping me to avoid ankle sprains.

So, now that I have the sprain, what do I do? With the last sprain, after icing for the first 24 hours, I believe contrast baths helped the injury heal much more quickly. Contrast baths involve immersing your foot and ankle in alternating hot and cold water. The water should be as hot and as cold as you can tolerate. Basically what you do is fill two buckets with water, one with cold and one with hot. Start by dipping your injured ankle in the cold water for 30 seconds to 1 minute. Immediately transfer the foot into the hot water for 1-2 minutes. Then back to the cold water for 30 seconds to 1 minute. Repeat this procedure for 5-10 transfers or about 15-20 minutes total. Always end your contrast bath in the cold water. While your foot is in the water, keep it moving, rotate left and right and spell out the alphabet with your toes. Try to do this at least two times per day. The contrast of hot-cold creates a pumping of the blood in and out of the body part to promote healing.

It's also important to remain active on the ankle when the pain and swelling subside. Active recovery is much more effective that just sitting around doing nothing because it also promotes blood flow through the injured limb.

To protect my ankle on trail runs as soon as the pain subsides enough for me to run, I often use an ankle brace for a couple of weeks after the sprain. My favorite ankle brace is the ASO brace. This brace locks the ankle in tightly yet is small and light enough to fit easily into a running shoe. It's definitely the most comfortable and effective ankle brace I've ever used.

Once you're comfortable running trails again and the ankle is healed, get rid of the ankle brace and start naturally "strengthening" the ankle and improving proprioception with trail running. Pay attention to where your foot lands and don't daydream too much. It seems my ankle sprains occur when I'm daydreaming and not paying attention to the trail. And, it's usually those places where the trail is less rocky and technical that you sprain your ankle because you're not paying as much attention.

Why did I sprain my ankle this year after nearly a decade of ankle sprain free running? I'm not really sure other than I may be daydreaming more lately. Run carefully out there!