I would wait and see how things go. If you dont have to make a decision now, dont. Wait until you have to make a decision, then test the leg and see what you think.

I sprained a knee ligament about 4 weeks before my 'a' race.

It stopped running entirely and ramped up the bike and swim until it felt good again. It took 7 days and was 100%. I was fine in the end, I didn't feel like i lost anything at all

Can't say for your severity of course. Your call there. Good luck!

At least it's 4 weeks out not 2 weeks. I rolled my ankle really really bad 3 years ago. I think it cleared up in 7-10 days at most. I bet your jogging in 3-4 days. Just take it really easy at first. Walk only, then work back into running. Only run on reliable surfaces so you don;t roll it again. Forget anything speedy. Its' not that importation anyway. Back fill a little with biking and swimming to maintain overall fitness.

You only had 1-1/2 weeks of build left anyway. You can build the bike a little harder instead. Actually it will be fun because without running to fatigue your legs you'll find you become superman on the bike and can do longer, harder workout on sucessive days. My biggest improvements on the bike was during a run injury in mid Feb. I raised my FTP by 5% and mt CTL went form 51 to 75 over those 4 weeks peaking at an ATL of 123. I also killed it on the swim at hte same time. In a strange way, it was a really good thing. When I came back I was really focused on conservative, consistent running. I nailed 1/2 marathon PR in early May.

I'll put it this way, your base if deep enough that you could not run a single step for 2 weeks, then work back into it to dust off the co-weds for 2 weeks just doing slow easy runs then do a short 3-4 day taper and you'd probably run very well...and have solid bike fitness to go with it. Actually you'd do so well, that you might even to rethink you run training strategy. It took me about 5-7 days to feel like I got my run form back and 2 weeks to build the mileage back up where I felt like I had descent durability again. But I had an achillies injury, which I think is much worse, because it never heals 100% until you take a LOT of time off.

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A few options to consider....

* RICE - if you haven't been resting, icing and elevating it, do it ASAP.

* After a few days rest, try some exercises on a balance pad or BOSU ball. Will help strengthen the weakened areas.

* ankle brace for support.

* water running - boring, but effective.

* elliptical work

As motoguy noted though, you are probably close enough to your IM that this won't have a dramatic effect. A little rest now to recover and then a few runs to sharpen everything back up.

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Rest it up over the next couple of weeks and you should be fine. Friend of mine was sidelined from running for almost 6 weeks before his IM and he PR'd focusing on swim and bike.

Give it some rest, regain the motto, then get the stability and then try it out little by little in a few weeks. Keep your head up, you should be good to go.

Thanks for the encouragement and words of advice. It's nice to know ST community is really supportive.

It just concerns me that it's getting worse with time but I have been fu*@ing around with it trying to run. I even ran 16 miles on Saturday so I'm sure this didn't help. But I was able to run Sunday (5miles without too much discomfort). I took yesterday off and tried to run but I only got 0.25 miles.

Do you think I should use elliptical as well increase my bike and swim? Or just take the time I'm planned to run and add it to swim/bike?

I would not run at all until things heal. If you keep re-injuring it, you will not gain anything. If it is pain free biking and swimming, do those workouts and substitute bike workouts for run. Revisit the ankle in a couple of weeks. I am taking off 3 weeks for a calf strain and will probably just get in a couple of runs before IMWI. I have to say that I actually feel great doing this. My bike is strong, I am spending a bit more time in the water, and I do not expect my run to suffer.

I wouldn't mess around. Heal it now (stop running. I really think after 4-5 days you'll feel good then take a couple more to be sure).

Put the extra time into your weakness, assuming it doesn't cause ankle pain (careful with flip turn pushoffs etc). You can still get some very high quality work in. Turn it into a positive

After this week of running rest, re-evaluate.

I'm hoping this is a blessing is disguise. Maybe it will benefit me in the long run. Maybe I can get my FTP up.

Oh... don't worry, ST can turn on people pretty fast too if you do something stupid or unapproved.

Resist the urge to put any weight on it until it doesn't hurt. No walking, elliptical or running. Might mot even be able to bike for a couple day and won;t be able to push off the wall of kick swimming. Don't aggravate it, it will take longer to heal. The longer it takes to heal, the more fitness you lose and you make the situation worse. Doing nothing for 5 days is WAYYY better than training at 1/3 the training load for 3 weeks. Especially if you can get back to even 90% of normal load for even just one week before shutting it down.

Honestly, this is where something like a PMC is great for plugging in some different scenarios to determine quantitatively the impact and how late you should shut it down to still taper a little.

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Well it still a little stiff so still no running for me. Its getting a little better but not as fast as I want it to be. My friend who is an ortho doc looked at it yesterday and thinks there are no torn ligaments, etc. Its still a little swollen so he told me to take scheduled NSAIDs and ice a lot. He also said I'm at the point where it should start getting better since 4-5 days out after initial injury is when its the worst. As of right now, I think I'm looking at another 3-5 days of not running. So this would total 7-9 days off running. How much run fitness will I lose? Also, I will need to ease back in the 1st week I start running. So that leaves me 2 weeks before race of real run training. How much should I do in the 14 days leading up to race?

I would seek a CAM Walker to immobilize it for a week or so, then an Air Cast to begin movement. Running through pain is completely wrong. You've already 'done the work', don't be afraid to rest it.

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Dr Jay
http://www.Tri-Pod.net

Do I run with the air cast initially?

I've heard that some with shinsplints do water running ...non contact. Perhaps the same can work for you?

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If you can, without pain. You should be able to walk without pain before running.
If you have morning stiffness or pain, try tracing the alphabet with your foot before getting out of bed. Sometimes this is a big help.

The water running is a good idea, too.

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Dr Jay
http://www.Tri-Pod.net

Yes, ankle passive ROM is crucial with any return to activity. You need the temporary immobility to rest the involved structures but that also leads to some adaptive shortening, and a shortened tendon/ligament is not a strong one. Its a basic rule of rehab, regain mobility before starting aggressive strengthening or tasks. Improved motion will also help restore proper joint lubrication and blood supply.

As mentioned you should be able to walk pain free first. Then you should begin with balance on stable and unstable surfaces then basic low level plyometrics (running is the end goal) because running is essentially a series of one legged hops in the saggital plane. This progression will ensure the safest return to your distance goal.

Can it be done faster and without these steps? Maybe, but you've got a lot more to risk than to gain by being too ambitious with only a few weeks till IM. Its a far better bet, at this point, to err on the side of caution to ensure your ability to race.

Where can I get an air cast? Pharmacy?

I'm able to balance on one leg without any pain (and can do it quite well). What do you recommend for unstable surfaces? Should I try this now if it doesn't hurt?

Yea local pharmacy should be able to provide you with one, but in all reality I usually don't have people use one unless walking around (for a few days) causes significant soreness. That means the injury is to the point where even a basic function is too noxious for the injury. The concept of "optimal loading" is often left out of rehabbing and it should be the included ASAP in the subacute phase. Optimal loading meaning challenge the involved structure as much as possible following a logical progression without reaggravation. So if you don't have discomfort or increased soreness after walking then begin slowly adding more activity.

Walking around and loading the ankle joint is necessary and the more you do it, the more you will strengthen the ligament and tendons (swelling will affect the tendons and joint mecanoreceptors).

Start with balancing on one leg, then do this barefoot, then try maintaining balancing barefoot while doing something (brush teeth, make a sandwich, catch a ball, etc.). Then try standing on a folded towel or pillow. This creates an unstable surface and challenges your ankle in all planes. Then repeat with doing some activity standing on the soft surface. Then progress to side stepping, then wider, then faster, then forwards, bigger and faster. Then if this is all ok I usually try gentle hopping in place and progress to more dynamic motions in multiple directions.

Movement and balance is important before starting dynamic movement in order to strengthen the mechanoreceptors. Without that, you still have compromised stability.

High or low ankle sprain?

I got a very bad high ankle sprain in November...it didn't heal for 6 f*^king months however I was able to run on it with the help of an ankle brace and ice it 2-3 times a night. I couldn't run for about a week and then was able to get out there and run. It would really hurt for about 10 minutes then loosen up. After 15 miles or so, it would begin throbbing but for the most part was bearable, just very annoying. Ran a marathon on it with no adverse effects. Sometime in May the ankle pain finally went away.

You will know a lot more in a week after the initial swelling goes down. If you can get through some long runs on it, you will likely be fine. During my marathon, with the help of some Tylenol and adrenaline, I never once noticed the ankle (that was the only run it didn't hurt on).

Yup walking around causes no pain. Its a little tight but no pain. I'm walking much better today than yesterday! And its getting better as the day progresses. I will try some of your pylo recommendations. Thanks for your help!

I have been working with endurance athletes for over 20 years, teaching them how to self-treat the muscles that limit their ability to play their sport. During those years I've worked with many Ironman Triathletes (who were actually the reason I wrote one of my books titled The Pain-Free Triathlete, which is currently being totally updated and revised. Recently I wrote a blog with pictures of self-treatments for sprained ankles. The treatments work, and could make all the difference as to when you will run again without pain in your ankle. The URL for the blog is http://www.triggerpointyoga.com/...ned-ankle-treatment/.

This treatment has quickly helped many endurance athletes get back on the road within a week, it's definitely worth the time and effort to give it a try.

Good luck with your race,
Julie Donnelly

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Excellent post!

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Dr Jay
http://www.Tri-Pod.net

This is my thought too. I think tomorrow I'm going to work on strengthening it since I can walk fine now without feeling anything. I also can stand on the injured ankle with one leg and balance with no pain and it seems pretty stable.