Guest blogger Victoria Junious is a Doctor of Physical Therapy and exercise enthusiast.
I am pretty sure that my ankles are being held together by the anatomical equivalent of playdoh at this point. My ligaments have the structural integrity of string cheese, and the vigor of a decaying tree.
Now, they weren’t always this way. About ten years ago, my ankle ligaments were doing their thing. The robust, tough straps of collagen and elastic fibers held my ankle bones together with the best of them. I completed active warm ups and plyometric drills without a second thought. I had no idea what ligaments even were. I miss that ignorant bliss.
Now, to tell you how that changed, I have to set the scene. Imagine, me, a high school sophomore, who just wanted to play basketball in the fall being forced into cross country for “endurance training.” Mind you, I was a 400 and 800-meter runner in the spring, so it made sense, but I barely had any interest in running half a mile, let alone 3.1.
However, after being harassed by all of the coaches, basketball and track alike, to join the team and due to a predisposition to people please, begrudgingly, I woke up to make every 6AM practice for the next 3 months.
My first meet of my cross country career was a disaster. I found out in the most embarrassing way that it is possible to get lapped on a cross country course. I don’t know what possessed me to keep doing it, other than a mixture of spite and embarrassment, but I ended up running a massive new PR every meet that season.
It felt as though I had transformed into the main character role from a high school anime that no one asked for, one in which I summoned the power of my own will to run faster than my or my coaches’ wildest dreams. I managed to go from the basketball girl that no one really cared about, to third on varsity in one season. To everyone’s surprise, at the end of that season, I even went on to make regionals.
How does this relate back to the straggling floss that are my ankle ligaments now you ask? Because at every meet at which I got faster that season, I had a proportional increase in the number of times my ankles decided to wiggle and wobble. It felt like I misstepped into every hole, every deviation in the ground, and every pebble on every course. At times it felt like the earth itself had a vendetta against my talocrural (ankle) joint. However, although I felt like my ankles were giving way left and right, I was never “hurt,” so I just went about my business.
Unbeknownst to me at the time, my poor ankles were experiencing repetitive microtraumas that ultimately led me to spraining my right ankle for the first time two days before the regional cross country meet that year. It swelled up to the size of a small grapefruit and it was incredibly painful. I ran on it anyway. Eventually, the swelling and pain went away, but the structural integrity of the ligaments had changed. A few months later, I re-sprained it playing basketball. Then I re-sprained a few more times throughout the school year for good measure.
That season of cross country set a precedent for what would become a cycle of injury. Working through the pain, quickly trying to return to play/running, and reinjury would follow me through the majority of my athletic career, through college, and beyond. In spite of my high school athletic trainer’s best efforts I never took the time to address the deficits I had in ankle strength and stability until college, when at one point, I was re-spraining my ankle about every three weeks.
I say all of this because my story is not uncommon. What I was experiencing in the physical therapy world is called “chronic ankle instability.” Basically, I never gave my ankle the time it needed to heal, nor did I fully commit to the rehabilitative measures to make it better.
Even now, ten years later, I recognize the differences in balance, ankle mobility and strength between my left and right ankles. I wish I could go back in time and tell myself to chill out and take the time to fix it, but since I can’t go back in time and warn myself to take ankle injuries seriously, I will tell you.
My Tips for Preventing & Dealing with Ankle Injuries
- Take preventative measures to avoid injury/reinjury – If I would have addressed the “wobbliness” that I felt at my ankles before I sprained it the first time, I might have avoided, or at least reduced, the number of headaches that my ankle gave me over the course of my running career. Even if the ligaments at the ankle are compromised, the muscles at the ankle provide support to the joint as well. The stronger they are, the better the support. In my opinion, if you are in the business of running, a few heel walks, toe walks, intrinsic foot muscle strengthening, and single leg balance activities are in order. Although preventative/maintenance strength programs can feel frivolous and time consuming at times, an injury will suck up way more time and energy.
- Give yourself time to heal – Ankle sprains can take anywhere from a few days, for a mild sprain, to about a year, for a complete tear, to heal completely. As your body works to repair itself, it’s in a fragile state. Modifying your exercise routine to reduce stress at the ankle will decrease your chance of reinjury. I know that this one is a tough one for runners especially. With cross country, indoor track, and outdoor track I never had time to give my ankle a break. I would cross train on a bike or in the pool for two or three days, then go right back to trail running because I felt like if I was not running, I would lose too much fitness. However, when I look back on all of the times that I repeated the cycle of injury I realized I probably spent at least 2-3 weeks cross training over time. If I would have given myself adequate time to heal in the beginning, the amount of time I spent cross training might have been the same or even less. By taking it easy, I could have avoided the cycle completely.
- Use external support. – Realistically, I cannot imagine any athlete sitting out of their sport for weeks to months to allow their ankle sprain to fully heal. However, if you do have to get back to training or competing, consider doing so with some extra support. Ankle braces, ankle sleeves, and support taping can provide your ankle with external support when the internal support, the ligaments, need a little extra help.
- Go see a physical therapist! – Although many ankle sprains will heal on their own, without lasting deficits, PTs can help you identify and address any lasting effects from an ankle sprain and help speed up the recovery process. PTs can also identify any vulnerabilities in terms of weakness, balance, running form, shoe wear, and give you the tools and direction you need to address them and mitigate the chance of injury or reinjury.
Victoria Junious ran track and cross country at the University of North Texas where she got her Bachelor of Science in kinesiology. When she is not in the clinic, she spends her time eating doughnuts, lifting heavy things up and setting them down at the gym, and writing.