Trailrunner Mag: Prevent Ankle Sprains on the Trail

Thanks to our friends at Trail Runner magazine for this helpful article about preventing (and coping with) ankle sprains on the trail. It contains some great advice, including stretches and exercises to strengthen your ankles, how to know if you’re at risk, and how to treat a sprain if you happen to get one…

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.

Read the rest of this great article.