Get back to running faster after a sprained ankle!
Ankle sprains are one of the most common traumatic injuries runners face and could potentially wreak havoc on your training whether you are just looking to get out for some mental clearing miles a couple of times a week or have a big half marathon or marathon goal race coming up.
Proper management is critical to getting back on pavement or trails doing what you love and that is what we are going to help you with today and if you stick around long enough I am going to share with you the most overlooked part of ankle rehab in runners!
The tips I am going to cover in this blog will help you prevent the next ankle sprain because preventative medicine is the best medicine!
Make sure you check out the blog resource from last week to make sure you’re going through the whole ankle sprain diagnosis and rehab! Click HERE to be directed to that blog!
Listen to the podcast episode or watch the YouTube video below!
Listen to the Podcast Episode during your next run!
Let’s Get into it!
The first phase of recovery and healing was dedicated to decreasing swelling, early protective motion and mobility, muscle activation and working surrounding muscles (the deep foot and hip muscles).
The main focus of this phase is to restore ankle mobility, specifically restriction of the flexed position of the ankle that we call dorsiflexion and to begin strengthening the muscles in and around the ankle which will be essential for proper healing.
Are you wondering why ankle mobility is important for runners? Well in order to properly run, you need at least 15 degrees of dorsiflexion for normal biomechanics to get your shin over your foot in mid-stance and into the propulsion phase or push off. You need even more when you run up a hill so if you run elevations, this will be key for you to restore while in recovery from an ankle sprain.
To assess ankle mobility, you can do what we call a weight bearing lunge test or the knee to wall test. You will need a standard tape measure and a wall. You place your foot so that it’s perpendicular to the tape measure imagining a line drawn through the heel and big toe. Then the participant will lunge forward until their knee touches the wall. The heel is required to remain in contact with the floor at all times. The foot is moved away from the wall to remain in contact with the floor at all times. The foot then moves away from the wall to the point where the knee makes slight contact with the wall while the heel remains in contact with the floor. This is what will put the foot into maximal dorsiflexion. The maximum distance from the wall to the tip of the big toe is recorded. The distance is measured in centimeters with each centimeter corresponding to approximately 3.6 degrees of ankle dorsiflexion.
If you find that you are restricted your ankle motion this with definitely prevent you from running without pain!
Check out the video below to see how to increase ankle mobility.
It is also important to think about the fact that decreased ankle mobility may come from soft tissue! This may stem from the achilles tendon being tight and preventing the ankle from being able to dorsiflex further.
Check out this video to follow a stretching program for the achilles and calf.
Ankle Mobility seems to be the most overlooked part of ankle rehab in runners. Many times, we see a runner in an aircast or a boot for 4 weeks, or even 6 weeks, and once they get out of that, they’re having lots of pain and stiffness and they can’t flex their ankle. Utilizing self mobilization techniques to help improve the ankle mobility is a huge part of this phase.
The other motion that may get locked up is the motion of inverting the ankle. This is because when we roll our ankle we can sublux our fibula bone forward or the tibia. You will know this has occurred if you go to point your toe down and it still hurts and feels stiff. The pain and stiffness is normal within the first 1 to 2 weeks of injury depending of the severity of the sprain, but if this is happening 3 to 4 weeks out then that is when it necessary to see a health care practitioner to help you restore the mobility in your ankle with specific manual therapy techniques such as manipulation or mobilization techniques. However, if you dedicate consistent work to self-mobility exercises then this may not be necessary.
The second part of Phase 2 is to strengthen the ankle musculature.
The following part of the blog will go through some great ankle strengthening exercises!
The overall goal for the second phase of rehab and recovery or the moderate protection phase is promoting full mobility of the ankle joint and strengthening the muscles in and around the ankle!
T-band Ankle Eversion & Inversion
Calf Raises With Tennis Ball (Click HERE for the video tutorial)
Achilles Strengthening Progression
Peroneal Mini Band Exercises
Multiplanar Cone Taps (Click HERE for the video tutorial)
Hip Stability (Hip Flexion in Standing)
Standing Clam Shell and Monster Walks
Reverse Lunge into Balance
This is our third and final rehab phase, known as our minimal protection phase. The main goal here is to strengthen the ankle and develop neuromuscular control of all of your leg muscles from the hip all the way down to your foot. We need to establish normal movement patterns and we want you to have the balance and strength to control your leg when you’re doing single leg activities like… RUNNING!
This is especially important so you can control your ankle when you’re landing from the swing phase of your running gait pattern especially if you run on trails. To restore this neuromuscular control we’re going to focus on more functional exercises. Everything you’re going to be doing in this phase is going to be on one leg and in a closed chain position, meaning your foot is on the ground.
At this point we’re not doing any exercises on the table and we’re progressing forward to those functional run specific exercises so we can ensure a safe return to running.
Specific plyometric training or jump training! It is one of our foundational SPARK Healthy Runner principles to run strong, fast and stay healthy and it is also critical in ankle sprain recovery!
Plyometric exercise helps to re-establish the dynamic neuromuscular control you need to have so your body can control your ankle in space. This is where you’re starting your jump training and you’re starting with two legs, progressing to one leg. You’re doing exercises in different planes, jumping forwards and backwards and side to side. This is going to be the last phase of rehab!
You should never be going from doing band exercises on the table to being back to running and especially back to running hard and doing races. You need this last phase to progress you through plyometric exercises so your body is ready to perform at the high levels you want to push it to again.
Don’t get me wrong, if you’re a back of the packer and you have never done plyometric exercises before then these would not be appropriate for you but if you are a competitive half marathoner like myself or want to run a fast 5k or a marathon especially if you are doing fast trail and ultra-running then this will be necessary to strengthen those ankle muscles to provide you reactivate neuromuscular control so you can react to that root or that rock that you step on or that misstep when you are starting to fatigue at mile 12 of a half mile or mile 22 of a marathon.
We want to re-establish the resiliency of your body, strengthen your body and go through rehab properly the first time to prevent ankle sprains in the future!
Here are some exercises we like to program for runners during this last phase of recovery
Walking Marching with OverHead Press (Click HERE to be directed to the video)
2 Legs to 1 Leg Jump
Hop Scotch Warm Up Exercise
Side to Side Jumping Over Objects
Side to Side Jumps
Zig Zag Jumps | Single Leg Cross Hops
Running Level Plyometric Programs
The final topic we’re going to talk about is PREVENTION of an ankle sprain! If you’ve sprained your ankle once, unfortunately you are more likely to sprain it again. This is really focused around the strengthening and stabilization of the ankle.
This is what we call Neuromuscular control. So, not only utilizing the muscles in your foot and ankle but also your knee muscles and hip muscles. The outside hip muscles such as the gluteus medius and your rotator hip muscles will play a role in the movement of your foot.
The muscles help to control pronation and supination at the foot, or rolling in and out. We want to focus on strengthening the evertors on the outside of your ankle as well. We want to be strengthening these muscles with not only a TheraBand but with your foot on the ground with you standing so yo can actually work on that neuromuscular control and those muscles. This is going to be vital in helping retain the control of the muscles around the ankles. You also need to train your muscles in a plyometric fashion. These exercises are going to be very important for any type of running or jumping in your activity.
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Connect with Dr. Duane:
Dr. Duane Scotti, DPT, PhD, OCS is a running physical therapist, run coach, host of the Healthy Runner podcast, and founding owner of Spark Healthy Runner and has been a leader in the rehab and running community for over 19 years. He is passionate about helping runners feel strong and confident so they can stay healthy and become a lifelong injury free runner! Dr. Duane truly believes that anyone can run and that all runners should be treated differently as athletes. He is on a mission to change the traditional thinking that running causes “overuse injuries” and you must “take a break” in order to get better. Through run specific training (exercises and running progression) you can build your body to be a strong, resilient runner and stay active, stay healthy, and just keep running!
Duane received his Bachelor of Health Science degree and Master of Physical Therapy degree from Quinnipiac University in 2001 and 2003. He then went on to receive a clinical Doctor of Physical Therapy and a Ph.D. in Physical Therapy from Nova Southeastern University in 2017. Duane is a board-certified Orthopaedic Clinical Specialist, RRCA Certified Running Coach, Certified Mulligan Practitioner, certified in dry needling and has advanced training in spinal manipulation and rehabilitation for runners.
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Thank you (running friends) for taking the time to read and I hope you enjoy the podcast episode!
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You can teach an old dog new tricks!!! I have never considered myself a runner and I knew I needed to be smart about it because I am no spring chicken. Spark preached getting strong and healthy to be injury free and they practice what they preach. I am soooo glad I made the investment in me! I finished my half marathon last weekend and couldn’t be any happier! The program fed me all the steps I needed to essentially learn how to run long distance, build strength, nutrition help, a forum of other runners and probably most important was the 1:1 coaching. I had no idea how to tackle training for a 1/2 marathon and this program broke all of it down, had it individualized for me and we tweaked as we went to make sure I was staying healthy and strong. I had so many questions the week prior to my race and Coach Cat was always there for me and answering all the questions and issues I had-and believe me there were a lot! The biggest benefit I think I got was the strength. I am strong and fit. But most important was what I gained emotionally. I built confidence and strength I didn’t know I had, even at my age. Honestly could not have done this without Spark Healthy Runners!
My Healthy Runner journey started after I had battled bilateral achilles pain for a few months and was frustrated how it affected my running. As soon as I talked to Duane I knew I had made the right decision. His positivity, enthusiasm and genuine care are infectious. The training plan that was tailored to me included specific exercises to rehab my injury and I was so excited that I didn’t have to stop running. It took patience to only run slow for a few weeks but I trusted the process and it got me me to where I am now: running pain free. We made adjustments to the plan throughout whenever needed having someone in your corner that is always there with guidance and support throughout the process was invaluable.
I just ran my second half marathon, both with Duane’s coaching, and PR’d by over 9 minutes! I got all choked up in the last mile when I realized that I felt strong and could still kick it up a notch.
I’m so thankful for the Healthy Runner program, community and the entire coaching team for all the support!
Wanting to run more consistently, and to increase my long run distance and total weekly mileage, I was concerned about hip pain due to hip alignment issues. This is an issue I had when I trained for my first half marathon several years ago. Having listened to the Healthy Runner podcast for the past couple years, I knew Duane Scotti could help. I signed up for the four-month strength and running training program and am extremely happy with the results.
The program Duane and Coach Whitney developed for me was exactly what I needed. It was tailored to my needs and to my target race. Coach Whitney was very helpful, and with the biweekly coaching calls, we were able to fine tune the program based off my performance and feedback.
At the end of the program, I completed a 10K trail race feeling strong and pain free.
I highly recommend Duane Scotti and the Healthy Runner training programs.