Trail running is generally quite safe as far as outdoor sports go. However, one of the more common injuries that a trail runner might have to deal with is a sprained ankle. While ankle sprains are not serious injuries, and they nearly always recover completely, they will probably keep you from running your favorite trails for at least a few weeks.
Avoiding ankle sprains.
The best thing for a trail runner to do about ankle sprains is to learn to avoid them! Although women are especially susceptible to ankle sprains because our bones and tendons are lighter and thinner, doing exercises to strengthen the ankles is a wise move for any trail runner. For beginners, simply standing on one foot and balancing is a good start. You will feel your muscles and tendons working to maintain your balance. Progress to standing with your eyes closed, and doing other exercises such as bicep curls while standing on one leg. Once you are confident with these moves, you can advance to ankle-strengthening exercises on a stability trainer such as a BOSU ball.
Trail running also requires much more focus than road running. While you can get away with “zoning out” on the pavement, trail running requires constant attention to foot placement. Make a deliberate effort to maintain your focus as you run, especially on faster descents, and as you get tired. It’s amazing how many ankle sprains occur on that final downhill at the end of a long run!
Diagnosing an ankle sprain.
By far, the most common type of ankle sprain is an inversion sprain. It occurs from the foot rolling inward, for example if you mis-step on a root or stone. The ligaments on the outer side of the ankle are stretched and damaged by the twist.
An inversion sprain is fairly simple to diagnose. The pain is focused on the outside of the ankle. The area around or above the outer ankle bone will usually start to swell immediately, and bruising may appear within minutes or hours after the injury.
To confirm that the sprain is a simple inversion sprain, roll the ankle joint passively (supporting it with your hands) in the four directions: inward, outward, forward and backward. If intense pain is felt in any direction other than rolling inward, it may be a complex sprain (multiple ligaments) and more difficult to treat. Fortunately, sprains in other directions are rare among trail runners.
There should not be any sharp pain on weight-bearing. To test this, first have someone push on the sole of your foot to simulate weight-bearing. If there is no sharp pain, then try standing on the injured foot. If there is any sharp pain with weight-bearing, then there may be a bone fracture or dislocation.
If the sprain is a simple inversion sprain, you can probably treat it yourself. However, if you suspect that it is a complex sprain, fracture or dislocation, or if you are not confident about treating it yourself, definitely go see your doctor as soon as possible.
Treating an ankle sprain.
Treating a simple inversion ankle sprain comes in two stages: immediate attention on the trail, as soon as the injury occurs, and long-term care.
The amount of time it takes for an ankle sprain to heal depends upon how much swelling there is. Most of the swelling occurs in the minutes after the injury – so the goal while still on the trail is to avoid swelling by keeping fluids from migrating to the injury site. Raise your injured leg, immediately. Lean it against a tree or other object if possible; the goal is to raise it as high as you can, at very least above the level of your heart.
Apply cold if possible. Water bottles can work. Hydration packs are even better, because they wrap around the injury site. Compression helps to avoid swelling too, and can be applied by snugly wrapping a tensor bandage around the site or with a compression sock, if you have either of these with you.
If the sprain is a simple inversion sprain, you should be able to walk out. Give yourself fifteen or so minutes with the leg elevated before getting up. Take special care over rough areas, to keep the ankle stable and not to re-twist it. If you have athletic tape with you, you can tape your ankle to stabilize it for the hike out. This video shows a method of taping the ankle that still enables enough movement to be able to walk out (unlike other taping methods designed for rest and recovery, which immobilize the whole ankle).
Once you make it back home, rest the ankle, elevate it whenever possible, and apply cold packs or ice. Taking anti-inflammatories (such as Ibuprofen) will also help to reduce swelling and pain. Walking will be painful for at least a few days. But if walking becomes difficult, or if you are concerned about the pain, definitely go see your doctor.
If you are a repeat sprainer.
The aim is to avoid spraining at all, because spraining the ankle weakens the ligament, and may make you more susceptible to spraining it in the future. However, if you are a repeat sprainer (or if you are going on a group run on rough trails, where there is a higher chance that someone may twist their ankle), here are some supplies that you can carry with you:
- A compression sock: This does not need to be a running sock – you can find cheaper compression socks, designed for people with heart failure, at your local drug store. Put the compression sock on the injured ankle as quickly as possible following the injury (keeping the foot elevated, too).
- Athletic tape: Make sure this is actual athletic tape. Other tapes may stretch, and will not immobilize the ankle. I am a repeat sprainer, and I reduce the tape’s weight and size by carrying a pre-measured piece of tape wrapped around my lip balm.
- Optional: If you are running with a more substantial first aid kit, tincture of benzoine (also known as Friar’s Balsam) is helpful. It will make the tape stick much better. It is recommended if legs may be sweaty and dirty, or if it is a long route and you may need to wear the tape for many hours. A razor may also be a good idea to shave hairy legs before applying the tape!
Your best bet is to avoid ankle sprains in the first place. Keep your ankles strong, and maintain your focus while running technical trails. And have fun!