Ankle sprains are a common yet frustrating injury for runners, often derailing training plans and hindering performance. These injuries occur when the ligaments that support the ankle are stretched beyond their normal range of motion, leading to pain, swelling, and instability. For runners, particularly those who enjoy trail running, the uneven and unpredictable terrain significantly increases the risk of ankle sprains. Understanding the causes, methods of self-diagnosis, and effective self-management strategies can help runners recover more quickly and reduce the likelihood of recurrence.

Ankle sprains typically occur due to a sudden twisting or turning (also referred to as rolling) motion of the ankle. This is common in activities that involve running, jumping, or any rapid change of direction. For trail runners, the risk is exacerbated by uneven surfaces, rocks, roots, and sudden changes in ground elevation. These factors make it easy to misstep, leading to an inversion injury where the foot rolls inward, overstretching the ligaments on the outside of the ankle.

One of the most significant concerns with ankle sprains is the high rate of recurrence. After the initial injury, the ligaments often remain weakened and less stable, making the ankle more susceptible to future sprains. Without proper rehabilitation and strengthening, a single ankle sprain can lead to chronic instability and repeated injuries.

Recognising the signs of an ankle sprain is the first step towards effective management. Self-diagnosis can involve several simple tests as explained below and in the attached video:

Gently press around the ankle to identify areas of tenderness and swelling, around the torn ligaments as shown in the image above. Compare both ankles to assess any differences in pain and sensitivity.

Stand on the affected foot and attempt to raise your heel off the ground. Compare this to the uninjured ankle. Difficulty or pain in performing this movement indicates a potential sprain.

Perform a knee-to-wall test by standing in a lunge position with the injured foot back. Attempt to touch your knee to the wall while keeping your heel on the ground. Measure and compare the range of motion to the uninjured ankle.

Single Leg Balance: Stand on the injured foot with your eyes open and then closed. Time how long you can maintain balance and compare this to your healthy ankle.

IMPORTANT! In some cases of ankle sprains the severity of the injury can cause potential fracture in the ankle and rear foot. This would subsequently require a referral for an X-Ray. It is essential that you seek a medical opinion on the diagnosis and management of your ankle sprain to ensure you’re on the right track.

Effective management of an ankle sprain involves several stages, from immediate care to rehabilitation and return to running.

While complete rest from running is necessary, maintaining some activity is beneficial. Engage in non-weight-bearing exercises, such as swimming or cycling, to maintain fitness without stressing the injured ankle.

Apply ice to the injured area for 15-20 minutes every 2-3 hours during the first 48 hours to reduce pain. Elevate the ankle above heart level whenever possible to decrease swelling.

1. Range of Motion: Gentle exercises like ankle circles, alphabet writing with the toes, as well as the exercises shown in the video will aid restoring range of motion which is essential prior to progressing your rehab.

2. Strength: Incorporate heel raises with progressive overload from double to single leg and the addition of weights will help restore the calf-achilles complex to full capacity. This is crucial to ensure you can return to running at the same level prior to your injury. The addition of compound movements like split squat variations are a great way to get the entire kinetic chain restoring strength as well as challenging stability and balance.

3. Plyometrics: Incorporate plyometric exercises, such as box jumps, single-leg hops and Pogo hops, to improve explosive strength and agility. These exercises help prepare the ankle for the dynamic demands of running.

4. Stability: Progress to dynamic balance exercises, such as single-leg stands on unstable surfaces, to improve proprioception and prevent future sprains.

Gradually reintroduce running with a structured programme that starts with short, slow runs or intervals of running and walking on flat, even surfaces. Gradually increase the distance and intensity as your ankle becomes stronger and more stable. It’s important to follow a structured plan that is tailored to your running history and goals.

Be mindful of the terrain as you return to running. Start on flat surfaces before progressing to more challenging terrains like cambers and trails.

Achieving optimal rehabilitation requires careful implementation of all the factors mentioned above, all working in harmony with each other.Remember, ankle sprains don’t always play by the rules. Listen to your body, always seek professional guidance, and prioritise your rehabilitation.

For expert help and management please feel free to contact my team at The Running Room (www.therunningroom.net)