An ankle sprain can quickly put you out of action but, says Paul Hobrough, carefully assessing the injury and then managing your recovery will help keep your time away from athletics to a minimum

Ankle sprains are a quick way to an enforced holiday from running. You can be floating along, carefree and enjoying the moment, when your foot rolls outwards and nanoseconds later you are rolling on the floor in agony.

The pain is often significant and the prospect of continuing immediately lost. In fact, the next thought is often, “is my ankle broken?”

Rolling your ankle is arguably one of the more common and more painful of the acute injuries (an injury where you know the time and place it occurred) a runner will sustain. To that end, the thought that it might be broken is born out of the sudden onset of pain and the resultant loss of function.

There is a standard test to determine if you should go for an x-ray (although nothing is certain, and I have seen plenty misdiagnosed before now). The Ottowa ankle rules are a set of tests designed by doctors in Ottowa in 1992 to determine if a sprained ankle needed to be sent for x-ray for a suspected fracture.

Their results show that negative Ottowa testing (that is, it doesn’t look like your ankle is fractured) meant that there was only a 1.4 per cent chance of a fracture being present, thus reducing the need for x-ray. The testing performed is based upon pain in and around the lower portion of the shin bones and foot.

It really needs to be carried out by someone with a bit of experience – hence why I won’t outline the whole protocol here. That said, something seen as a very good sign for your painful ankle being a sprain and not a break is if you can bear weight for a few steps after the injury or upon examination.

Assuming you have either self-diagnosed your ankle (with caution and against my recommendation) or you have been checked and given the all-clear in terms of a break, then the following becomes more relevant.

Is your sprain a grade one, two or three? Grade one is deemed to be a mild tear, two a moderate tear and three a full rupture of the ligament. I have been teaching clinicians about ankle sprains for many years and jokingly report that a grade two or three will be accompanied by a photograph of the swelling on the patient’s phone.

Over the years, this has become less of a joke and more of a diagnostic assistance. Everyone is different, of course, but the photograph can sometimes offer help as to where the swelling centralised itself and how diffuse (widespread) it was. This is especially helpful when the patient doesn’t attend to see me for some time after the incident.

Getting back to running

The road back to running needs some important rehabilitation. Initially doing some isometric work on your tibialis posterior tendon (on the inside of the ankle) is a good start. Do this for two weeks, holding for 45 seconds and resting for two minutes – repeated four to times on alternate days.

After two weeks build in exercises to the peroneal longus tendon (on the outside of the ankle) in the same way. There are a plethora of exercises for this injury in my book Running Free of Injuries with tips on how to return to running in a measured way.

I am not a huge fan of using ice on an acute injury after the first 72 hours as I think there is sufficient evidence to show that it might hold back progress. The evidence is quite equivocal, but I am getting better results in clinic using movement and exercise within pain limits. I also do not like using non-steroidal anti-inflammatory drugs for acute injuries as I believe with more conviction that this delays progress.

In short – support, rehab and do not rush back to running. Balance exercises are paramount once you have started the process of strengthening the supporting muscles. The most important part of the process is to seek some medical advice and an accurate diagnosis to ensure your rehab path is on the right track.

How bad is it and what should you do?

Grade one

With a mild grade one ankle sprain, it is usual for the patient to be back to running after around two weeks. The symptoms are mild, the pain is quick to resolve and there will be minimal swelling. I recommend some simple taping when you start back running to just give some mild support and give a bit more feedback from the muscles. Podium Tape provides an excellent quality tape for this which sticks and lasts well, despite wet or sweaty conditions.

Grade two

A moderate grade two sprain needs a little more consideration. There will be more pain, in fact this can be the most painful of the three grades. Recovery can take many more weeks to get back to running and you will most likely be looking four to eight weeks of rehab and a slow return. As with the grade one, the order of the day is to offer a little extra protection in the form of taping.

I like a stirrup strap. Attach the tape halfway up the lateral aspect of the leg and rotate your foot outward (little toe up to the side). Pull the tape around the base of the foot and up the other side (be sure to cover the fifth metatarsal – the knobbly bit as the little toe meets the foot – with the tape) then attach under some stretch to the inside of the lower leg. As the name suggests it looks like the foot is in a stirrup.

The second piece of tape goes at a 45 degree angle across the stirrup piece on the inside of the leg and then wraps around the underside of the foot and back around, crossing over itself at the front of the ankle and finishing over the outside stirrup strip (this is like an incomplete figure of eight). Podium tape will last at least five days once applied.

Grade three

A full rupture is when the ligament has snapped completely. Often there is less pain compared to a grade two but, as with any pain, it is individual and doesn’t always follow rules like this.  The amount of time a rupture takes to get back to running is all dependant on what the medical professional tells you and this may need imaging such as an MRI scan or ultrasound scan to confirm the diagnosis.