Jan 7, 2006: 10k race, around hairpin downhill turn, rolled my left ankle. Hard. RICED my ass off for 72 hours. Visited urgent care clinic day of sprain and xrays negative for fracture. PT and podiatrist and 6 months off and I was running again. 12 months after original sprain, visit podiatrist for custom orthotics, does xray and finds a chipped piece of cartilage that wasn’t visible from the first xray and MRI (due to severe swelling?). No biggie, healed well enough and I was running and got up to 30 mi/wk (my most consistent) when…
Aug 20, 2007: training run after two long 6000+ yd AM/PM swim practices and full day of work at the refinery. I was tired and still wanted to get the run in. Paid for it as I sprained other (right) ankle on some tree roots. No xray/etc needed - missed ChesapeakeMan - major bummer (But still rocked the Aquavelo). 6 weeks off and I was just getting back into running when…
Oct 26, 2007: sprained the left ankle when running on dark soggy trails. It was dark and dumb of me to want to get the run in after a long frustrating day of work - i really wanted to get out there to blow some steam. I love running in the rain - it was the darkness that got me. Icing as I type this,on my back. This one doesn’t seem so bad and probably won’t need more than a few days of monitoring. But it got me thinking…
This was the 3rd time in < 2 yrs. After the first one, I learned all I could about this. I semi-religiously do ankle exercises before bed (usually not the night before I run). This is using PT bands and work each ankle 4 directions 3 sets of 15. I am very careful about stability anything.
I have flat feet, and run a constant 8 miler pace pretty much for all distances, so no big time runner here - only do it for the sake of tri. marathon pr is a hair under 4 hrs and do a blazing 1:50 half IM run - why do I keep doing it when I suck so bad?
What am I doing wrong that I am constantly spraining my ankles?!? Part of it is likely mental. Of course if you overthink it during a run, you’ll likely end up spraining it. Missing the IM 5 wks out was also a tough pill to swallow. Or is it I’m doing dumbass things like running after an intense 6000+ yd swim which is unusually long for me; or fitting it in after a tiring day at work, in the rain on the trail, and quite dark. Maybe I’m setting myself up for failure, but there is something I’m not learning from my previous mistakes. I’ve analyzed it to death, and maybe I just need to run and not think.
After a sprain the proprioceptive fibers to those structures are disturbed. Sof tissue healing is not the only repair that needs to happen. The big push now is to rehab those fibers. A good PT can help you with this.
this may not be your primary problem and you might want to also visit a sports med doc.
I quite easily hold a cadence of 85-90 and over time have gotten better at striking at the midfoot. I dont’ plod and have improved my form so that I ‘look’ like a runner (times say otherwise).
I wear Asics Foundation 7s, my first sparin was on the Foundation 6. I love these shoes though. I’m not one of those who can go to a less stable shoe for the feel, I’ve tried the asics 21xx series, even brooks adrenaline is not enough. The foundations are great for me.
Lateral ankle instability is a fairly common problem. You seem to fit the bill well, although it is more common in people with high arched, more rigid feet. Sounds like you went to PT, have been doing ankle rehab/proprioceptive excercises, etc.
Might want to Google “Brostrum” or “Brostrum-Gould” procedure and read around from there. Basically, this is a surgery to reconstruct/tighten the ATF (anterior talofibular) and sometimes CF (calcaneofibular) ligament(s). Rarely, a split peroneus tendon transfer is used for severe cases (Chrisman-Snook).
What he said, plus stop running on uneven surfaces for a while until things heal up very well. I had two 2nd degree sprains of the same ankle in as many seasons and it took me awhile before I could really do much on anything other than a nice smooth paved surface. When I did get to run trails I was very careful and also wore some extra supports.
My sports doc does the “drawer” test on me every time I step into his office, because he’s concerned that the degree I sprained the ankle twice, the ligaments will never go back to what they were. According to him the chance of recurrance is greater each time you do it because the support from the ligaments never goes back to its original length on its own.
Great, was hoping rroof would chime in. I pay particular close
attention to your posts about the ankles. Yes i do have very
flexible/floppy ankles. I guess I was thinking the proprioception exercises and ankle band exercises will strengthen them up and maybe make them less floppy and more controlled. I’ll look into those procedures to at least
learn more about it.
Hey Thunder. I was a chronic ankle sprainer for several years while playing HS and college soccer. After the first handful of sprains I started PT and they recommended wearing ankle braces (Swede-O brand I believe) whenever I ran. The braces were fairly comfortable though they slightly reduced my mobility. Most importantly they still allowed me to remain active and prevented future sprains while I was working to build up strength again. I haven’t had a sprain in years (knock on wood), but remain extremely cautious whenever I run on uneven terrain.
I guess the morale of the story is do whatever you can to prevent sprains while strengthening the ankle and you should be fine, but it’ll take some time (in my case several years).
VERY interesting study I was reading about where people stood on a platform and ine side would drop out of it, they measured muscle response in the ankle right as one side of theplatform gave way.
Some people who were chornic ankle sprainers would actually use muscles that would make their foot roll MORE to the outside rather than inside (which would stabilize the foot) so basically their foot feedback mechanisms were all screwed up.
This is why the PT guy has you stand on that funky blue stability thing that’s out of round. To get your stabilizing muscles not only stronger but firing in the correct pattersn.
If I was still having problems with sprained ankles I’d buy one of the consumer versions of it that are so popular at the power systems website. One thing that helped me get over it is a brace I wore for a whole three months when I ran in the woods. Kept me from reinjuring it. Another study I read said that best results are obtained form wearing the brace for an entire 6 months after the accident.
I know from way back in my high school days that if you turn it often enough, the ligaments get so loose that it doesn’t matter anymore. They are totally streched out so turning your ankle no longer hurts Well, maybe not exactly but it seems true to a point.
And why do ankle sprains make you nauseous? I need that explained, maybe Dr. RRoof can fill me in.
I’ve resisted getting one of those blue stability deals, but from the perspective of that study you mentioned, its worth a look. How did the paper discuss getting the muscles ‘firing’ in the correct pattern? Any particular brands/models you recommend?
And I do have very flexible ankles such that I have run off the side of a paved trail, fully rolled my ankle without incident. No pulling or swelling afterwards, I think I was able to sense it and roll/react according to avoid any damage -though i did watch it carefully. Another time, the literal LAST step of a 2.5 hr training run, I step off the curb and roll the ankle. No issues there either. I sound like a complete klutz, and with running maybe I am, I’m really not that uncoordinated!
First order of business when I run again is to stick to paved flat road as another poster suggested.
hmm… just signed up for an indoor soccer league for the offseason. Got a laced up/velcro strapped brace a few weeks ago for my other ankle, but maybe I’ll need to get two!
Not sure where you read about nausea and my sprains, but I do think about it. Like in a car accident, time ‘slowed’ down during my sprains so I recall them with great detail - does make me cringe…
The “nauseus” feeling is just a vagal resonse. The vagus nerve is a VERY powerful bugger and causes all kinds of interesting feelings, reactions, etc. Best, crazy example would be getting a phone call with a horrible message (like the death of a loved one) and then “passing out”. Nothing physically happened, but the catecholamine release from the vagus nerve slows the heart beat immediately, the baroreceptors in the neck and kidneys can’t respond, pressure drops, and out you go.
rroof,
Thanks for the info on the Brostrum procedure. Very interesting. Is it common to have this procedure done on both ankles?? Sounds pretty invasive and would require quite a bit of ‘reprogramming’?
Floppy ankle syndrome as I call it really seemed advantageous during my swimming days - kind of like a flipper. but perhaps a bit of background may help:
Just turned 29, 6’1" 176lbs, 6% or less BF. Background was swimming since i was 10, thru HS, not in college. Got into tri’s and running after college, so around 22, longer distance stuff only in the last 3 yrs. Never sprained before then.
I’ve read about POSE, read Chi running, and understand the push to go to a minimal shoe. But I do have some very flat feet and used to heel strike. I’ve vastly vastly improved my running stride but still go w/ the Foundations. I do understand they are very supportive. I did get pricey custom orthotics, so I will seriously look into ‘flatter’ shoes. But I’ve tried Nike Frees, 21xx asics, etc, but always felt I needed more stability.
So what ‘flat’ do severe overpronators use to feel the road (using custom orthotic)?
The study was either in peak performance newletter or the sports coach newletter and I no longersubscribe to either of them and I also don’t have the saved copies.
SO, to the best of my recollection, just by standing on the wobble board for a few minutes a day you can get the muscles to fire correctly again. I have no recommendations on a type because I never used one except for in the PT’s office. But this one looks nice enough. https://www.power-systems.com/nav/closeup.aspx?c=109&g=2950&Eco/Pro/Wobble/Board
THe one in the pt’s office is not circular and is wonky shaped to perfectly go along with normal range of motion in your ankle.
I was talking about my own nausea after “good” ankle sprains. Last one was on labor day of 2004, went something like this. “Boy these new trails sure are nice to run on, and I can really open it up and run down these hills, this is great… Tumbletumbletumble, wow my ankle is already swollen out of my shoe.”
I had a similar recurring issue. Learned that the problem wasn’t the ankle, but the lack of functional strength in the entire lower limb (hip, knee and ankle). Started working on functional exercises for the lower limb. These days when I unexpectedly step on a hidden tree root or other object on the trail, my entire body responds rather than the muscles and ligaments around the ankle. Sometimes recurring problems are the result of something bigger gone wrong. Good luck.
As others have mentioned, sometimes frequent lateral ankle sprains is just luck, sometimes just a muscular imbalance. If so, the BAPS (wobble) board can be very useful. However, if you have a postive anterior drawer sign or ATF disruption on MRI, then no amount of muscle strengthening will help if the ligament is disrupted or healed back so long as to cause the chronic instability. You probably saw some lateral tilt X-rays with your Brostrum research as well.
As for shoes - no way to make any recs without actually seeing your foot function, but in general, I like my “flat footed” (as you described) runners who wear orthotics to use them in a good, neutral to slight stability shoe with a good full length last. Most good running stores should be able to help you as you are certainly not alone and an unusual customer for them.
rroof,
Thanks again, but could you please explain what this is? I have no idea what a drawer/ATF has to do with my ankle. Maybe I can go back and have my podiatrist look at the MRI for this?
“However, if you have a postive anterior drawer sign or ATF disruption on MRI, then no amount of muscle strengthening will help if the ligament is disrupted or healed back so long as to cause the chronic instability.”
An anterior drawer test is a simple maneuver that is done to assess if the ATF is ruptured, or weakened. It is not usually a good test in acute ankle sprains (because of patient guarding since it would HURT), but I find it better for chronic instability.
Here is a short video if you want to see. Yes, look at the MRI again (but I’m sure the radiologist already commented on your ATF)
I’m not a doctor, and I haven’t stayed at a Holiday Inn Express in a while, but I used to sprain one or another ankle at least once a year. Sometimes stepping on a big piece of gravel when running was enough to do it.
A few weeks after a pretty bad sprain, I started doing wobble board exercises, and even though I have only been doing them 2 or 3 times a month for the last couple of years, absolutely no more sprains or even strains. I think it was a combination of strengthening and improvements in balance that did it. When I started, all I could do on the balance board was “fall” from one edge being on the floor to the other edge. Eventually I could stand on it, and even rock it back and forth without the edges hitting the floor.
I think trying to be more of a forefoot striker and keeping my feet more underneath me may have helped, but I’m not all that good at it and still tend to fall back into being a heel striker.
I’m still surprised that after years of ankle sprains they have been “cured” for the last 4 years by some simple work on a balance board.
Well, maybe not exactly but it seems true to a point.