The Clinic: Ankle sprain return to running

Question: I'm a 62-year-old male who has been running for 45 years. I tripped running and sprained my ankle, in addition to pulling a calf and upper leg muscle too. It's been about two weeks and most of the swelling is down.

What exercises should I do to return to my workouts? I have a stationary bicycle, weight machine, elliptical trainer, cross-country ski machine, stair climber and various free weights.

Answer one: Ankles tend to be chronic swellers, so be sure to continue with the ice until all the swelling is gone. I recommend you spend some time on the exercise bike to restore range of motion; the ski machine will serve the same purpose. Just be sure your activity is limited to getting range of motion back -- don't go all out yet.

If the weight machine has ankle attachments, that can help you strengthen. Check to see if you can stand briefly on your toes without pain before getting too aggressive.

Once you have normal range of motion and minimal pain (below a five on a scale of one to 10), begin running at half speed in straight lines. Don't cut or run circles for four or five weeks, and keep icing that ankle!

Answer two: First try exercises without your body weight on the foot, gradually progressing to full weight on both feet, and then to your body weight on only the injured foot. Begin by drawing the alphabet with your foot on the floor while sitting.

Next try balancing on both feet, then just the injured foot with eyes closed. Try heel raises next, again on both feet, until you can do them on the injured foot alone without holding on. Pool therapy with a kick board will help restore mobility. Progress to deep water running, and then to speedwalking. Progress gradually to jogging, then running, outside.

Remember the four parts to any safe and successful workout regimen: warm-up, stretching, the activity, and stretching/cool down.

Answer three: Once pain and swelling are reversed, runners often short change the rehab process involved with ankle sprains. Range of motion and strength of the ligaments around the ankle, which have been stretched or partially torn, is essential or another sprain may well occur. In addition, improving your positional awareness (proprioception) will help prevent future injury.

Rubber tubing can help strengthen the outside (lateral) ligaments by placing the tubing around your forefoot, anchoring it to the leg of a sturdy table, and turning your foot so the resistance is on the outside of the ankle. Hold this position for a count of five for a set of ten repetitions, and repeat this exercise two or three times a day.

Often ankle sprains compromise the ability to pull up your foot (dorsiflexion). Try wrapping a towel around your forefoot and pulling up on the foot. This isn't a strengthening exercise, but a stretch, therefore perform this two or three times, holding for a count of 15 to 30.

To stretch your calf, stand with your forefoot on the edge of a step and slowly allow your heel to drop down. Again hold for a count of 15 to 30, and repeat several times.

Balancing drills will improve your proprioception. Walking on your tiptoes and then on your heels will help. Try these eventually with eyes closed. Next, attempt one-legged hopping. You can return to running once you're pain-free, have full range of motion, and normal strength and balance in your ankle. Start gradually, increasing your distance and speed over time.

American Running Association, Running & FitNews 2005, Vol. 23, No. 5

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