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Ankle sprain occurs when a person stumbles and the supporting foot twists inwards or outwards, causing ligaments to stretch beyond their limits and tear. Ankle sprains vary by grades of severity from a mild “twisted ankle” sprain to complete ligament ruptures, avulsion fractures or even broken bones.
How Does Running Affect Your Ankle Sprain Injury?
Research has shown that maximum ankle joint load increases 4 to 5 times that of a person’s body weight during walking and up to 10 times during running. Moreover the ankle joint bears the greatest load of the total supporting force. The knee joint (35.8%) takes second place and finally the hip joint (6.3%). Also, when progressing from walking to running, the peak Achilles tendon force increases from 3.4 times of a person’s body weight to 6.4 times of the body weight .
Following ankle injury, there is often related weakness of the ankle plantar flexor and invertor muscles apart from the commonly targeted weak peroneal muscles. Should you decide to resume running prematurely before the injury rehabilitation is complete, a combination of decreased ankle muscular strength and control, will increase the risk of recurrent ankle sprain!
Furthermore, resuming running too early during the healing process can cause the ligament to scar in a stretched position. Consequently this leads to recurring ankle sprains and chronic ankle instability, according to a 2015 research by Clinics in Podiatric Medicine and Surgery.
When Should You Start Running Again ?
According to tissue healing time frame; soft tissue injuries such as a sprained ankle heal in three phases
- the acute or inflammatory phase,
- the sub-acute or proliferative phase,
- the maturation or remodeling phase.
The acute phase typically only lasts for three days after injury. The sub-acute phase begins at day 4 and lasts for about three weeks. During the maturation phase, scar tissues form to fix the damaged ligament. Running may be resumed during this phase of healing when ankle rehabilitation and return-to-running training have been completed.
The length of time it takes to resume running largely depends on the extent of your injury. A mild injury can take up to two weeks to heal. A severe one – months. As the severity of ankle sprain needs to be accounted, they are graded based on the extent of injury.
Grade 1 Ankle Sprain: Mild
Mild tenderness and swelling can be apparent due to microscopic tear of the ankle ligament fibres. These tend to get better after a period of rest. In addition, any resulting swelling, stiffness and pain can improve with targeted exercises, neuromuscular training and therapeutic treatments. Additionally, it can also help with balance and weakness. A useful indication in resuming running is when you’re able to walk an unlimited distance without ankle pain. This can happen as early as 2 weeks after injury.
Grade 2 Ankle Sprain: Moderate
Moderate tenderness and swelling around the ankle with ligamentous laxity can suggest a partial rupture of the ankle ligament fibres. Hence, only after a thorough rehabilitation program with return-to-running/sports training is one able to recover to range of motion, muscular strength, movement control, balance and power. For moderate ankle sprains, running can often resume within 3 to 4 weeks after injury.
Grade 3 Ankle sprain: Severe
Significant tenderness and swelling can be indicative of a complete rupture of the ankle ligament fibres. These injuries can lead to ankle instability if left untreated and often require surgery to reconstruct the damaged ligament and usually require longer rehabilitation time as compared to a simple ankle sprain. Although specific guidelines vary by orthopaedic surgeons, you will likely have to wait at least 14 to 16 weeks after surgery to resume running. Only resume after receiving clearance from the surgeon and physiotherapist!
Setting a goal-oriented training strategy
You should follow a standard return-to-running plan that uses a walk/jog approach. For example, your first outing might be six sets of jogging for one minute and walking four minutes. Then, after a day off, you can do six sets of two minutes of jogging and three minutes of walking.
You can keep repeating this process until you are jogging 30 minutes continuously without breaks. Then, slowly increase your speed and frequency of running. For example, from running every other day to running two days in a row and taking a day off. Just until you’re back to your normal running speed and typical training routine.
Initially, you should always start jogging/running on a flat, stable surface like a road/track. This is so that you would not hurt your already vulnerable ankle. Once your ankle strength and balance are better, you can ease your way back into running on more challenging terrains.
How can Physiotherapy help?
Physiotherapy can help shorten your recovery process and at T&T Physiotherapy Centre, experienced physiotherapists have both the skills and equipment to get you running sooner and help you minimise your risk of re-injury.
Contact T&T Physiotherapy at 62993929 or visit our website https://tntphysiotherapy.business.site/ to arrange your individualised physiotherapy consultation.
Acknowledgment: This article and the images are contributed by Bernard Sim & Chen Wenying (T&T Physiotherapy). 181 Kitchener Road, #01-14/15/16, New Park Shopping Arcade, Singapore 208533
References:
- Willy, R. W., Halsey, L., Hayek, A., Johnson, H., & Willson, J. D. (2016). Patellofemoral joint and Achilles tendon loads during overground and treadmill running. journal of orthopaedic & sports physical therapy, 46(8), 664-672.
- Richie, D. H., & Izadi, F. E. (2015). Return to play after an ankle sprain: guidelines for the podiatric physician. Clinics in podiatric medicine and surgery, 32(2), 195-215.
- Definition of an ankle sprain, GP Notebook Website http://www.gpnotebook.co.uk (3 February 2010, date last accessed)
- Mattacola, C. G., & Dwyer, M. K. (2002). Rehabilitation of the ankle after acute sprain or chronic instability. Journal of athletic training, 37(4), 413.
by Yashwini Ravindranath
Born & raised in Malaysia, Yashwini earned her M.D. studying in Moscow's Russian National Research Medical University. With an affiliation towards research, all things coffee and the startup ecosystem, she now contributes articles to GetDocSays View all articles by Yashwini Ravindranath.
