Discussion: Ankle Injuries

We already discussed in one of the previous threads blisters so I thought it is time to look at the ankle injuries and what can be done before and after the fact.

Personally I had my both ankles sprained (one after another) and that put me out of the season for a year or so. It took me another year before I got my ankle strength back to the acceptable level. However, during WMOC in Italy I sprained my right ankle (thankfully, it was not big one - just got my speed decreased ~2 minutes per hour).

Generally, I use soft ACE ankle braces during forest runs and try not to use any ankle protection during regular trail/road runs. Looks like using braces gives stability to the weakened ankles and prevents injuries from re-accuring.

After ankle spraining Rest, Elevation, Icing, and Anti-inflamatory drags help a lot. Key here - no runs for 2-3 weeks at least before ankle healed more or less, and no serious running until you feel completly ready. Meantime you may do some stationary bike, stairs, and aqua exersises to keep your cardio-vascular system in shape.

What is your experience and advise?

Thanks,
Sergey

I can only speak for myself. Playing soccer I destroy my ankles all the time. In fact I rolled my ankle last thursday. The biggest saver is to avoid putting weight on the ankle once you start twisting it. This avoids the worst damage and cuts down the healing time significantly. This works for most orienteering/running sprains. I don't know how you train for it other than sprain your ankles all the time :)

Tape them!

I am currently recovering from my most serious ankle injury that I suffered about a quarter of the way into Day #2 of the COC Classic. R.I.C.E. is essential then physio. My physio therapist (also a team mate of mine on my adventure racing team) has been awesome. It is great having a person that knows what orienteers do and what we run over, etc. Now that that swelling has almost gone (10 days later) I have started her strengthening exercises (wobble board, toe raises, etc.). Holger Hott Johansen suggested to me that the wobble board is the most important and that taping is essential (all the time).
I guess the idea is to strengthen the ankle indoors but protect it outdoors. My PT suggests tape AND a brace. BUT the key is that I am not to run on ground for 6 weeks post injury (not great prep for WOC so that is in doubt at the moment). HOwever, I have a grade 2-3 sprain on one ligament and a grade 2 sprain on another so those 6 weeks is likely greater than for most ankle injuries.

I have been able to start biking and paddling but getting into the pool is key. Ted de St Croix is a big fan of pool running. Pool running (without the float) is a key to not losing too much running specificity while injured. If done right you can gain while doing pool running. Of course, you can not do forest running O technique and pool running requires a great deal of motivation.

I completely agree with the idea of taping them. I injured my ankle seriously about 3 1/2 years ago (my doctor and physical therapist said it would have been better for me to break it) and the one that thing that I do to keep from making it worse is tape it. I also have to wear an ankle brace when I do anything physical (orienteering, running, even when I play frisbee). Prevention is definitly key, and a simple taping job can do wonders to prevent injury!

I also noticed that most of the elite runners tape their ankles during racing. Unfortunately it is not an option for me due to my hairy legs and easily irritatable skin. I tried hard brace once and didn't like the feeling (plus I developed immediately blister) so I settled on the ACE soft brace. It is like a sock with cutouts for heel and toes. It works fine for me. I might try this wobble board to strengthen my ankles.

After many years of XC running and many ankle turns I had resigned myself to "bad ankles." Once or twice a year I would be off my feet (RICE) for a few days, at the least, after a bad turn. It was very frustrating and I thought I was stuck with a genetic defect.

A few years ago I started doing yoga. After some time, I was surprised to find that when I did roll my ankle it wasn't as bad. It might still be painful and I would not be able to run as efficiently for a short time, but I wasn't losing any training time the next day. For me, this bordered on being a miracle! It was a completely unplanned and unexpected benefit.

I haven't lost time due to an ankle turn in about 4 years. I can run trails and do regular running training w/o any protection. For O, I still wear an Active Ankle or tape.

Thus, in addition to strengthening and the proprioceptive exercises (balance board, etc), I would add flexiblity. If you have a yoga guru around ask them about "foot poses" and "hero's pose" (kneeling). For balance I practice the "tree pose."

By the way, one aspect we are missing is psychological effect of being injured. Very important to understand since the very beginning that you need time (3-4-5-6 weeks) to recover to the stage when you can start doing regular training. There are no miracles to happen. It is work, work and work. Your results will suffer for a year or so. Keeping this in mind, lowering your expectaions. and keeping yourself motivated should be with you in addition to doing recovery work. Of course, your training process should be altered accordingly.

I have learned from experience (also having a grade 3sprain) and in my degree Exercise Science that after the initial injury phase (ie. the swelling is gone and you can stand/walk on it without pain) it’s very important to regain proprioception. That is, you want to train the damaged nerves to react again. If this is not done, it can become an ankle that turns easily, and you have care to and protect more, especially in orienteering. The wobble board is good, but may be too aggressive right in the beginning (or you may simply not have one). Balancing on a pillow is really good and hard too. If it becomes too easy, do it while turning you head from side to side, and when that becomes too easy do it with your eyes closed. Of course you may want to do this near a wall, so you can catch yourself if you loose balance.

I also agree that you should protect your ankles, especially if you have had a prior injury. Taping is great for races, it’s light and small. I tape almost every time I orienteer, only sometimes not for trainings (the thought is that I also want to strengthen them, and I may not be going race speed, so there is less risk).

Mike, I think that you can keep your form for WOC if you can start pool running (sometimes the resistance of the water is uncomfortable, but it will help strengthen you ankle again). I am however a supporter of a floatation device, at least in the beginning. It helps you keep accurate “running” form. Granted, it’s harder to keep your heart rate up, but there are all sorts of different strides you can do in the water to get your heart rate up for a while. I personally do a set of intervals (meaning different stride which are harder to do than simply running) every time I pool run to get my heart rate up. I can just imagine that if you start without a vest with such a severe ankle injury, that it could cause too much stress on the already damaged ligaments, it is quite a bit harder to do without a vest. Good luck and I hope you can still keep WOC in your plans! You can do it!!

FYI, the best way to search online for information on pool running is to use the term, deep water running (DWR). This is what is used most often in the research literature.

Just to add to what has been said about pool running, I do pool running as a regular part of my training even when I`m not injured. I think it is good to give your body a rest from the impacts of running while still doing something that has some specificity. (A break from the cold and slippery trails and sidewalks of winter and possible other injuries, too)If you use an HR monitor, keep in mind that your HR will be lower in the pool with the same level of effort. I just saw that in Runner`s World.

Oh yeah, Sergey, you could shave your ankle area. I know it looks weird when you are walking around with sandals but we`re a weird bunch anyway:)

The hair isn't going to be there after he takes the tape off the first time!

That is why I settled on the soft brace first hand :)

So it hair or the ankle that matters?

Ankle for me, hair for girls :) Soft brace saves for all sides.

my own experience:
when running seriously i had long string of ankle injuries, despite taping an exercising.. This injuries repeatedly put me out of training and competing for anything between one and four weeks

in last year of my competiteve orienteering i started using Mueller braces (model ATF). I haven't had injured ankle ever since.

now i run less active, meaning my ankles are weaker and my weight higher. still no injuries.....

except in training when i have some slight sprains from time to time...

I'm also taping my ankles but I'm having problems finding a good tape here in the U.S. In Switzerland I've been using a brand called 'Leukotape' but all tape I've tried here in the U.S. (Mueller and an other one from Wallgreens) seems to get loose once it's wet. I hate the feeling of he tape loosening once I start to sweat...

Can anyone recommend a special brand/source or does have a way to make the tape more sticky?

hockey tape. it's cheap, comes in several widths and it works well. That was a very Canadian answer, eh?

I