Ankle injury prevention for trail runners over the autumn and winter months

Posted by Sophie Leyland, 3rd September 2017

Transitioning from summer to autumn brings new challenges underfoot, with the added risk of running on wet leaves over undulating terrain…which inevitably leads to concern over picking up ankle injuries.

But whatever time of year you run, there are number of things you can do to ensure you stay strong on your feet.

**Preparation is key**

It is always best to be prepared. Prevention is better than cure right?

So here are a few exercises to help increase your proprioception (control and balance), joint position sense, reaction times and, of course, muscle strength of the lower limb.

All of which help prevent ankle ligament sprains!

 

Proprioception / joint reaction speed exercises (very important for down hill and technical training). 

1. Single leg jumps: A progression from 4 point jumps.

single leg jumps for Ankle injury prevention

 

  • Trace a cross on the floor.
  • Stand on one foot and jump criss-cross to each corner over the cross, controlling the knee and ankle at each jump (knee cap aligned with second toe and avoid any lateral movement of the knee).

 

 2. 4 Points Hops

4 points hops exercise for bad ankles

 

  • Place 4 markers on the floor so they create a zigzag.
  • Hop to the first one by crossing your legs and landing on the opposite foot. Absorb the forces by bending the knee and keeping it stable.
  • Then hop to the next by crossing again to land on the other leg and continue this way for all 4 points and turn around.

 

3. Proprioception Clock

exercise for proprioception and bad ankles when running

 

  • Stand on one leg and reach as far as possible forward, sideways and backward with the free foot.
  • Bend your support knee slightly for balance.

 

4. Single leg stand with eyes closed 

running ankle injuries

  • Stand on a firm surface.
  • Stand on one foot.
  • Close your eyes and maintain your upright posture.
  • Open your eyes, switch feet, and repeat with eyes closed.
  • Progress by standing on a folded towel then on a pillow.

 

Lower limb muscle strength exercises (for runners … not an extensive list !!!!)

1. Single leg squat

single leg squat for running ankle injury

  • Begin by standing upright on one leg.
  • Push your hips backward like you’re going to sit down and bend your knee into a single leg squat position.
  • Slowly return to the starting position.
  • Keep your knee aligned with the centre of your foot.

 

2. Multi directional lunge with / without weight

multi-directional lunge for ankle injury prevention

  • Stand up and take a step forward to go down into a lunge position, knee over the foot and heel on the floor.
  • Execute the first lunge going towards the inside.
  • The second lunge is straight.
  • The third lunge is towards the outside.
  • Keep your hips facing forward as much as possible.
  • To progress add weight.

 

3. Single leg bridge

exercises for ankle injuries

  • Start in crook lying.
  • Lift one leg off the floor and go up into a shoulder bridge, peeling one vertebrae up at a time.
  • Keeping the leg out straight and the thigh in line with the other thigh, lower yourself on the ground and lift yourself back up.

 

4. Side plank and leg raise. Because the Core is always important…especially in canicross!

ankle injuries in autumn

  • Lie on your side with your legs straight and in line with your body.
  • With your upper body supported on your elbow, make sure the elbow is directly under the shoulder.
  • Lift your pelvis, creating a straight line with your body.
  • Stabilise and then lift the top leg and arm upwards, keeping your body straight.
  • Maintain the position and repeat.

 

Plyometrics (there’s so many to choose from but here are a few easy ones to do at home)

1. Box jump down and lateral jump 

ankle injury exercises

  • Stand on top of a box ( I use the sofa) with your feet shoulder-width apart in a comfortable position near the side of the box.
  • Gently jump down to the side. Land on the floor with both feet at the same time and immediately jump laterally as far as possible upon landing, using your arms to assist.
  • The ground contact time should be minimal.
  • You can start with a low height that you can safely manage. Progress over time by increasing the height of the box.

 

2. Quick step ups

step ups for ankle injury prevention

  • Start behind the step with one foot on the step.
  • Quickly switch your feet, stepping on the step with one foot.
  • Keep the ground contact time minimal.
  • Lightly touch the step.

 

3. Power Skip

ankle injury exercises

  • You can start the skip with a light jog or from a dead start.
  • Lift one knee up explosively and lift both arms at the same time as you jump up and forward on one leg.
  • Land on the same leg and switch legs on the ground to skip with the other leg.

 

4. Partner workout especially for canicross

exercise for canicross

  • Start in a comfortable stance with enough space to jump laterally.
  • Put a band around your waist to provide resistance and have a partner hold it or attach it to a fixed object.
  • Load your jumping side by getting into your hip, then jump explosively as far as possible to the side.
  • Use your arms to assist the movement.
  • When landing and during the ground contact time, the support knee must stay inside the foot.
  • Try to land softly.
  • Reposition yourself at the starting position and repeat with the same leg.

 

Planning some of the above exercises into your strength and conditioning sessions once or twice a week should help build the the muscle memory intake for when the leaves start falling.

 

Typical Ankle Injuries and Treatment

Ankle sprains are typically the most common injury for trail runners in the autumn and winter seasons.

They range in severity, from mild ache to weakness and instability, even preventing sporting activity.

There are two main ways to sprain an ankle:

1. Rolling In ( Inversion Injury)

2. Rolling Out (Eversion Injury), less common

90 % of inversion ankle injurys affect the Anteriotalofibular Ligament (ATFL). Other lateral ligaments include the Calcaneofibuar ligament – when torn this can cause more instability.

Acute Phase

  • Check Severity

Firstly, it’s important to try to gauge the severity of the sprain. In the worse case scenario 15% of ankle sprains can also result in a fracture.

Signs of an ankle fracture could include:

  • Immediate, throbbing pain. Pain that increases with activity and decreases with rest. Swelling. Bruising. Tenderness. Deformity.
  • Difficulty in walking or bearing weight. However not everyone presents like this. This is only a guide and it is always best to get a professional to check it out. If you want to read more details on this look up Ottawa Rules.

If you’re struggling to walk it’s best to get to it checked out. On the positive front, the BJSM reported that if you are able to walk again within 48 hours after trauma it indicates good prognosis.

Grade 1 Sprain (Mild): Possible home management. Though, if in doubt get it checked out.

– Slight stretching and microscopic tearing of the ligament fibres

– Mild tenderness and swelling around the ankle. Most likely stability intact.

Grade 2 Sprain (Moderate): Get it checked out! Visit walk-in centre / GP / Physiotherapist.

– Partial tearing of the ligament

– Some tenderness and swelling around the ankle

– Possibly abnormal looseness of the ankle joint on passive movement.

Grade 3 Sprain (Severe). A&E. Get it checked out !! May require surgery and / or immobilisation.

– Complete tear of the ligament

– Significant tenderness and swelling around the ankle

– In certain movements, substantial instability occurs.

Treatment

Phase 1  POLICE  meaning

Protect Optimal Loading Ice Compression Elevation

A recent study by Bleakley, Glasgow and MacAuley 2012 in the British Journal of Sports Medicine has suggested  the acronym ‘POLICE’ should replace ‘PRICE’ (Protect Rest Ice Compression Elevation). The reasoning being continued rest may lead to de-conditioning of the tissues – joint stiffness, muscle weakness and tightness and reduced proprioception.

The right type of loading will stimulate the healing process and manage swelling.

In some cases optimal loading may be no loading. Unstable fractures, complete tendon ruptures etc are unlikely to benefit from loading and may require mobilisation or surgical repair. The treatment plan should be specific for each individual and their injury and is best prescribed under the guidance of a health professional.

Ice should be applied as soon as possible to keep the swelling down. It can be used for 15 to 20 mins, 2 -3 times a day. Don’t ice over a numb area or open wound. Do not apply ice directly to your skin.

Compression dressings, bandages can give temporary support but it is important not to use this for too long as it can affect the progression of proprioception.

Elevate your ankle above the level of your heart as often as possible during the first 48 hours.

Medication. Nonsteroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen and naproxen can help control pain and swelling. Discuss medication with your GP or pharmacist if you have any concerns.

Phase 2 includes restoring range of motion, proprioception, strength and flexibility.

Phase 3 includes maintenance and the progression of proprioception exercises as well as the gradual return to activities that do not require turning or twisting the ankle.

Healing Times:

This three-phase treatment program may take just 2 weeks to complete for minor sprains, or up to 6 to 12 weeks for more severe injuries.

After these stages it maybe possible to add in plyometric exercises to train for the trail, as well as start to gradually introduce running on the flat short distances. then progress this as able.

Returning to running.

Your health professional should help guide your return to running, follow their instruction as timeframes on when you can start running vary a great deal.

As mild sprain may see a return to running in 1-2 weeks, a very severe sprain may need 4-6 months. To return to running without risking re-injury you need full range of movement in the ankle, good muscle power (with equal calf strength) and good control of movement and NO GIVING WAY.

 

It’s important to remember that every individual’s situation is different. If you have any concerns about your health and running  please see a physiotherapist or health professional for advice and treatment specific to your needs.

 

QUESTIONS OR COMMENTS? FEEL FREE TO CONTACT ME AT: sophie@endurancefitphysio.com

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