Don’t Let an Ankle Sprain Stop You From Running

Ankle sprains are an all-too-common injury, especially for runners. Many of us have experienced the pain and mistakenly believed that complete rest was the best solution. However, recovering from an ankle sprain takes more than waiting for the pain to fade.

An ankle sprain occurs when the foot twists suddenly, overstretching the ligaments. It’s the most frequent orthopedic injury, affecting around 20% of people, runners being even more prone to it. In fact, thousands of ankle sprains occur daily in the U.S., often sending runners to emergency rooms and even leading to orthopedic surgeries.

While not typically a severe injury, ankle sprains can have long-term effects. Up to 50% of people may not fully regain their previous level of function, and recurrent sprains can lead to chronic ankle instability.

1. Types of Ankle Sprains

Ankle sprains occur when the ligaments around the ankle joint are stretched or torn, usually as a result of sudden twists or turns. Depending on which ligaments are affected and how the injury occurs, ankle sprains can be categorized into different types:

1. Inversion Sprain
   This is the most common type of ankle sprain, occurring when the foot rolls inward, causing the ankle’s outer ligaments (lateral ligaments) to stretch or tear. Runners are particularly prone to inversion sprains when running on uneven surfaces or if their foot lands awkwardly.
2. Eversion Sprain
   An eversion sprain happens when the foot rolls outward, stretching or tearing the inner ligaments (deltoid ligament) of the ankle. Though less common than inversion sprains, eversion sprains tend to be more severe and take longer to heal.
3. High Ankle Sprain (Syndesmotic Sprain)
   This type of sprain involves the ligaments that connect the two bones of the lower leg, the tibia and fibula, and is typically caused by a forceful twisting motion. High ankle sprains are less frequent but often more difficult to treat, requiring longer recovery times compared to inversion or eversion sprains.

2. The 3 Grades of Ankle Sprains

Ankle sprains are categorized into three grades based on their severity, ranging from mild ligament stretching to complete tears. These grades help determine the appropriate treatment and recovery plan.

Grade 1 – Mild Sprain

• Slight overstretching of the ligaments.
• Mild pain with minimal swelling and tenderness.
• Slight difficulty with weight-bearing activities like walking or running.
• Usually heals quickly with rest and light rehabilitation.

Grade 2 – Moderate Sprain

• Partial tear of one or more ligaments, commonly the anterior talofibular ligament (ATFL).
• Moderate pain, noticeable swelling, and some joint instability.
• Bruising may occur around the ankle.
• Difficulty walking or performing weight-bearing activities, requiring more extended recovery.

Grade 3 – Severe Sprain

• Complete tear of the ligament, typically the anterior talofibular ligament.
• Significant pain, swelling, and bruising.
• Severe ankle instability, making it difficult or impossible to bear weight.
• Often requires a longer rehabilitation period, and in some cases, surgery may be necessary.

📌 If you’re uncertain whether you have foot or ankle pain, use Mayo Clinic’s Foot or Ankle Pain Symptom Checker for guidance.

Disclaimer: This post is not medical advice and is not intended to provide diagnosis or treatment for any medical conditions. Please consult a physician or other health care professional for your specific health care and/or medical needs or concerns.

The most common sprain is a lateral ankle sprain, also known as rolling the ankle.

3. Immediate Treatment for a Sprained Ankle: The R.I.C.E. Method

🔔 Before starting treatment, it’s important to seek professional medical attention if any of the following are present:

• An open wound
• Severe pain or intense swelling
• Visible deformity of the ankle
• Signs of infection include a fever over 100°F (37.8°C).
• Inability to put weight on the injured leg

If you’re unsure whether the sprain is Grade 2 or 3, it’s better to consult a healthcare professional for proper diagnosis and treatment.

R.I.C.E. Guidelines For Ankle Sprains

In the first few days after an ankle sprain, follow the R.I.C.E. method to reduce pain and swelling:

• Rest: Minimize walking or putting pressure on the injured ankle. Try to avoid bearing any weight on it, using crutches or a brace if necessary to fully offload the ankle and prevent further strain.
• Ice: Apply ice three times a day for 20 minutes. Always use a barrier, like a cloth, between the ice and your skin.
• Compression: Use an elastic bandage or compression ankle brace to reduce swelling and support the ankle. Make sure it’s snug but not too tight to maintain proper circulation.
• Elevation: Raise the injured ankle above your heart to minimize swelling.

While the R.I.C.E. method helps in the immediate aftermath, ankle sprains need ongoing care to ensure a full recovery. Early treatment with active exercises is key to speeding up healing and reducing the risk of future sprains.

Active Exercises for Recovery

For Grade 1 or 2 sprains, starting gentle weight-bearing exercises after about 3 days can:

• Reduce pain
• Speed up recovery
• Strengthen muscles and improve coordination
• Lower the risk of recurrent ankle sprains

A good example is the Heel/Toe Raises exercise shown in the video below.

4. When to Seek Professional Help

While many ankle sprains can be managed with home care and self-treatment, there are situations where it’s crucial to consult a healthcare professional to ensure proper recovery and avoid complications.
Here are some red flags indicating that professional medical help is needed:

Severe or Persistent Pain

If you experience intense pain that doesn’t subside with rest, ice, and over-the-counter pain relief, it may be a sign of a more serious injury. Persistent pain could indicate a fracture or severe ligament damage that requires medical evaluation.

Significant Swelling

While some swelling is normal with an ankle sprain, excessive or rapidly increasing swelling can be a concern. If the swelling does not improve with elevation and compression, or if it seems disproportionate to the injury, a medical assessment is warranted.

Inability to Bear Weight

Difficulty or inability to put weight on the affected ankle, especially if it persists beyond the first 24-48 hours, suggests a more severe sprain or possible fracture. Seeking professional help is important to assess the extent of the injury and receive appropriate treatment.

Joint Instability or Loss of Range of Motion

If you feel that the ankle is unstable or if you experience a significant loss of range of motion, it could indicate serious ligament damage. A healthcare professional can provide a thorough examination and recommend appropriate rehabilitation strategies.

Signs of Infection

Symptoms such as redness, warmth, or fever around the injured area could signal an infection, especially if an open wound or the injury becomes increasingly painful. Immediate medical attention is necessary to address any potential infection.

Failure to Improve

Suppose you’ve been following standard self-care measures, such as rest, ice, and elevation, and you don’t see any improvement within a few days. In that case, it’s important to consult a healthcare professional. A delayed or improper healing process may require more specialized treatment.

Consulting a healthcare professional ensures that you receive an accurate diagnosis and an appropriate treatment plan tailored to your specific injury. Early intervention can help prevent complications and facilitate a more efficient recovery.

5. Sprained Ankle Treatment After a Few Days

After about 3 days, depending on the severity of the sprain, it’s important to begin gentle exercises to aid recovery. Follow these steps to gradually regain strength and stability:

Key Guidelines for Exercise:

• Perform within your pain threshold—avoid pushing too hard.
• Start slow, just a few minutes each day.
• Gradually increase difficulty: begin on both feet, progress to one leg, and eventually add an unstable surface like a cushion.

Step 1: Two-Legged Exercises

1. Weight Shift: Shift your body weight from toes to heels and back.
2. Pelvic Transfer: Move your weight side-to-side while shifting your pelvis.
3. Heel/Toe Raises: Raise onto your toes and then back down onto your heels.
4. Heel Transfer: Shift weight to your heels with your toes lifted.

Step 2: One-Legged Exercises

Make sure to practice on both legs, starting with the healthy one.

1. Balance: Stand on one leg for 7-30 seconds. Repeat for 3 sets.
2. Leg Swings: Swing your free leg back and forth 20 times while balancing.
3. Toe Raises: Shift your weight while raising your toes 20 times.
4. Balance on an Unstable Surface: Stand on a cushion or any unstable surface, and shift your weight to your heels while keeping your toes in the air.

You can also increase difficulty by closing your eyes or practicing on a balance board for an added challenge.

6. Effective Ankle Sprain Rehabilitation Plan

Rehabilitation from an ankle sprain should be approached systematically, with a focus on gradually restoring mobility, strength, and balance. Here’s a clear step-by-step plan based on the severity of the sprain:

Early-Stage Rehab (Mobility Exercises, Light Stretches)

Objective: Restore ankle mobility and reduce stiffness while minimizing pain.

1. Ankle Circles
   • How to Do It: Sit or lie down with your leg extended. Slowly rotate your foot in a circular motion, 10 times in each direction.
   • Frequency: Perform 2-3 sets, 2-3 times a day.
2. Alphabet Exercise
   • How to Do It: Sit with your leg extended. Use your big toe to trace the letters of the alphabet in the air. This helps to improve the range of motion.
   • Frequency: Complete the alphabet once or twice, 2-3 times a day.
3. Towel Stretch
   • How to Do It: Sit with your leg extended and loop a towel around the ball of your foot. Gently pull the towel towards you until you feel a stretch in your calf and Achilles tendon. Hold for 15-30 seconds.
   • Frequency: Perform 2-3 times, holding the stretch 2-3 times a day.
4. Dorsiflexion Stretch
   • How to Do It: Sit on the floor with your legs extended. Flex your foot towards you by gently pulling on your toes. Hold the stretch for 15-30 seconds.
   • Frequency: Repeat 2-3 times, 2-3 times a day.

Mid-Stage Rehab (Strengthening Exercises)

Objective: Build strength in the ankle and lower leg to support recovery and prevent future injuries.

1. Resistance Band Exercises
   • How to Do It: Sit with your leg extended. Loop a resistance band around the ball of your foot. Push your foot against the band (plantar flexion), hold for a few seconds, and then slowly return. Repeat 10-15 times.
   • Frequency: Perform 2-3 sets, 1-2 times a day.
2. Calf Raises
   • How to Do It: Stand with your feet hip-width apart. Slowly raise your heels off the ground, balancing on the balls of your feet. Lower back down slowly. Repeat 15-20 times.
   • Frequency: Complete 2-3 sets, 1-2 times a day.
3. Toe Taps
   • How to Do It: Sit with your leg extended. Tap your toes up and down against the floor or a wall. Repeat 15-20 times.
   • Frequency: Perform 2-3 sets, 1-2 times a day.
4. Heel Walks
   • How to Do It: Walk on your heels for 30-60 seconds, keeping your toes off the ground. This helps strengthen the front of the lower leg.
   • Frequency: Complete 2-3 sets, 1-2 times a day.

Late-Stage Rehab (Balance and Proprioception Exercises)

Objective: Improve balance, proprioception, and agility to return to running safely and prevent re-injury.

1. Single-Leg Balance
   • How to Do It: Stand on one leg, aiming to balance for 30-60 seconds. Progress to doing this on an unstable surface, such as a BOSU ball or balance pad.
   • Frequency: Perform 2-3 sets, 1-2 times a day.
2. Wobble Board Exercises
   • How to Do It: Stand on a wobble board or balance disc. Try to maintain balance and perform gentle movements to engage ankle stabilizers. Start with basic balancing and progress to more challenging exercises.
   • Frequency: Perform 2-3 sets, 1-2 times a day.
3. Agility Drills
   • How to Do It: Incorporate agility drills such as ladder drills, cone drills, or side shuffles. Focus on quick changes in direction and maintaining balance.
   • Frequency: Include 1-2 agility sessions per week.
4. Dynamic Balance Exercises
   • How to Do It: Perform exercises like standing on one leg while moving your other leg forward and backward or side to side. This mimics the dynamic movements of running and helps improve proprioception.
   • Frequency: Complete 2-3 sets, 1-2 times a day.

If that feels too easy, try performing the exercise on a cushion or another unstable surface for added challenge.

Check out this video for more guidance on ankle sprain exercises:

7. Getting Back To Running After an Ankle Sprain

When you’re ready to start running again, using an ankle brace during your runs can provide extra support and help reduce the risk of re-injury.

Warm-up

Before any run, a proper warm-up is crucial to prevent injuries. Focus on dynamic stretches that get your joints moving and blood flowing to the ankle.

Gradual Return to Running

Ease back into running gradually. Start with slow walking, then slowly pick up the pace as your ankle allows. Once you’re comfortable, introduce short running intervals, alternating with walking or slow jogging.

Recovery takes time, often several weeks or months, so be patient and listen to your body. Never push through pain or discomfort. If you notice pain, swelling, or instability, stop immediately and consult a healthcare professional.

Finally, keep up with ankle strengthening and stretching exercises to ensure continued improvement in stability and flexibility.

Cross-Training

While you’re easing back into running, consider incorporating low-impact activities like swimming, cycling, or elliptical training. These exercises keep your cardiovascular fitness up without putting stress on your ankle, helping you stay in shape during recovery.

Ankle Bracing and Taping

In addition to an ankle brace, you can also consider ankle taping for added stability during the early stages of your return to running. Speak with a physical therapist or athletic trainer to learn proper taping techniques or decide if an ankle brace would be more beneficial for your specific situation.

Listen to Your Body

It’s tempting to return to your usual running mileage or speed but pay attention to how your ankle feels after each session. If you experience any recurring pain or stiffness after a run, give yourself additional rest and adjust your training load accordingly.

8. The Role of Footwear and Running Surfaces

Proper footwear and being mindful of running surfaces are key to preventing ankle sprains. Here’s how to protect your ankles:

Choosing Supportive Shoes

• Fit Matters: Wear shoes that fit well and provide ample ankle support. Shoes that are too loose can cause instability.
• Arch Support: Choose shoes that match your foot type. whether you have flat feet or high arches, proper support is crucial for balance.
• Cushioning: Look for good shock absorption to reduce impact and strain on your ankles.

Being Aware of Running Surfaces

• Avoid Uneven Terrain: Running on uneven or rocky surfaces increases the risk of rolling your ankle. Stick to smooth trails or well-maintained roads.
• Change Surfaces Slowly: If transitioning from a treadmill to outdoor running, gradually adapt to new surfaces to avoid sudden stress on your ankles.

➤ Running Ankle Sprain Frequently Asked Questions