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Ankle injury help - getting back to 100%?
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Grade 2 ankle sprain during 10k race this weekend threw a wrench in the off season run focus plans (downhill full weight bearing ankle roll). Minor emergency Dr. took x-rays, no fracture, and no complete separation of ligaments (no surgery), and in a splint on crutches for 3 weeks. However he says PT is not necessary(?!)

Iced 20 min on/off four times, compressed, and elevated - everything by the book and will continue with cold/warm alt baths in a day or so. I'm not dumb enough to try to push it, as my #1 goal is to get back healthy and on course like I was to make serious gains on the running.

From reading all I can on the topic, I hear over and over that you never get 100% back to where you were.

Current stability exercises (hip ad/abduction, flexors) did not focus on the ankle, but were proprioception exercises from balancing on one foot - may have saved me from further damage.

My plan: long pool sets with the pull buoy after swelling subsides; Strengthen lower leg muscles using elastic bands due to time in cast; Start biking when no pain is present; Move on to stability exercises listed above; Resume light running. I think I can bounce back, I'm 27 and 2 yrs of base volume of training; but I realize it may take months to recover physically, and years to recover mentally.

My questions:
What else can I do to get as close as I can to back to normal? what can I do about the stressed ligaments that were traumatized and presence of scar tissue in a sensitive area? PT/friction massage?
How do you 'retrain' the affected muscles and ligaments?
How about nutrition, what kind of macronutrients and vitamins should I make sure to cover?
Experiences from those who had bad sprains but did not need surgery?

Thanks, I might be down, but I ain't out.
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Re: Ankle injury help - getting back to 100%? [thunderoadie42] [ In reply to ]
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No magic vitamin in an otherwise healthy 27 yo! I highly discourage "friction massage" of a partially torn ligament! Simple inversion ankle sprains usually do very well. BTW, there is no way an ER doc can tell you what "kind" of ligament damage was done via an X-ray. Textbook anterior drawer test is almost impossible in the acute setting because of pain/patient guarding. By definition: a strain is a stretch of a ligament beyond it's normal. A sprain IS a partial tear of the ligament (usually the ATF ligament, and occasionally the CF ligament). These usually heal well. The main problem is that there are nerve endings in the ligaments (Golgi apparatus) that are supposed to signal the brain when the joint/tendon/ligament is being "stretched" to that your muscles fire, stabilize the joint, etc.

PT is often important to gain this proprioception back. It is not always necessary, but I usually encourage my patients with an inversion ankle sprain to start their own gentle rehab as quickly as possible once the pain and swelling subsides (in about 3-5 days).

Simple things to do at first (besides what you mentioned already). Draw the alphabet in capital letter with your big toe during commercials while watching TV. It is important to "think" of the letters while drawing them. When able, get a soccer ball or basketball. Place a flat, wide board on it (about the size of a chess board). Hold the wall. Stand on the board/ball combo and gently roll the ankle around with some pressure, slow increasing pressure and rolling action (PTs call this a BAPs board and charge lots for this :)

Good luck!

____________________________________
Fatigue is biochemical, not biomechanical.
- Andrew Coggan, PhD
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Re: Ankle injury help - getting back to 100%? [thunderoadie42] [ In reply to ]
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You are way overthinking this.

You're doing everything right. Add the proproreception to the end of your training and you'll be all set.

One thing you didn't mention was an ankle brace. 6 months of running with an ankle brace will be helpful in keeping the next ankle sprain from really knocking you out of the action. I find the aircast braces the most comfortable to run in, although my physical therapist says the ones he wants to sell me are better. The ones he is trying to sell me are blister making devices so I stay away.

The same physical therapist says that the therapy will help the collagen rebuild in an orderly manner rather all willy nilly. Not sure if I buy that part, but boy my anle was absolutely huge when I saw him and he knocked out the swelling in two visits.

Playing basketball coming up we all had sprained ankles. It was pretty much a constant management of that injury. We all made it out relatively unscathed.
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