A sprained ankle is incredibly annoying, especially for runners. It’s painful and swollen enough to keep you off your feet for a while, but it’s also unfortunately easy to push yourself too hard in the healing phase… Which could lead to a worse injury.
So what do you do in the days and weeks after an ankle sprain? No doubt you’ll want to get back to running ASAP, but do you know how to safely start running on a sprained ankle?
If you’re patient and take the right steps, you can come back with stronger ankles and a lower chance of twisting or spraining them again!
What Is An Ankle Sprain?
An ankle sprain is an injury to the ligaments that support and connect the bones to each other. When your ankle twists or turns awkwardly outside of its normal range of motion, it either over-stretches the ligament or causes it to tear.
The majority of ankle sprains occur on the lateral side of the ankle. This is because when the injury happens, your foot rolls onto the outside of your foot—called an inversion—when it’s moving in a downward position and away from your body.
This is one of the most frequent sprains seen in runners. According to research, the most commonly affected ligament is the anterior talofibular ligament. In 65% of sprains, this is the only injured ligament, and 20% of sprains include both the anterior talofibular ligament and the calcaneo-fibular ligament.
You may experience the following symptoms of a sprained ankle:
- Pain while resting your foot and when putting weight on your foot
- Ankle is tender to the touch
- Restricted range of motion
At the time of the injury, you may hear a “popping” or “snapping” sound. You may find that you can’t put any weight on your foot. But if you can, your ankle could feel unstable or like it’s about to give out.
Ankle Sprain Grades
The severity of the sprain varies depending on how many ligaments are involved and how much damage they’ve sustained. The different degrees of sprains are then categorized into the following three grades:
This is a mild sprain where the ligament was only slightly stretched and has microscopic tears. You’ll experience mild tenderness and swelling. In some cases, you may have bruising around your ankle and leading towards your toes.
Generally, with this type of sprain you won’t have any pain when putting weight on your foot, the ankle feels stable, and you’re able to walk with minimal pain.
This grade of sprain is slightly more serious as the ligament will have a partial tear. You’ll experience mild pain when weight-bearing and your ankle may feel a little unstable.
There will be a moderate amount of swelling around the ankle and it will be tender to the touch. Your ankle will also hurt when you try to walk.
A grade 3 is the most severe – this is when there’s a complete tear in the affected ligament. There will be a significant amount of swelling and bruising around the ankle. This can cause the ankle to feel stiff and restrict its range of motion.
The bruising can spread across the bridge of your foot to your toes, even though this part of your foot hasn’t been injured. It will be incredibly tender to the touch and you’ll experience intense pain when you put weight on the affected foot.
Your ankle will feel unstable, and you won’t be able to walk, because you won’t be able to support any of your body weight.
How Long Does An Ankle Sprain Take to Heal?
The healing time for a sprained ankle will depend on the severity of the injury. But that doesn’t mean you’ll be sidelined for three months either!
If you have a mild, grade 1 sprain the healing time can be between 1 and 5 weeks. You should start to notice that it starts healing by day 4, or at least feeling better. A moderate grade 2 sprain can take between 4 and 6 weeks.
A grade 3 ankle sprain will take longer to heal, depending on the tear’s severity and if surgery was required. If surgery was required, you might look at a recovery period of 3 to 6 months.
Fortunately, surgery is rare for grade 3 ankle sprains. In most cases, spending a few weeks in a short leg cast or a cast-brace, followed by rehabilitation, will have you running again in a few months.
Can You Run On a Sprained Ankle?
No, you shouldn’t run on a sprained ankle. The pain you would experience if you tried to run would not only stop you from wanting to run but would trigger a physiological response in your body.
Your blood pressure would rise, stress hormones would be released, and your breathing would quicken. The release of stress hormones can hamper the healing process, as it can interfere with the production of cytokines.
Cytokines are responsible for communicating with the other cells in your body that help control inflammation. If you have too many cytokines, then it will cause excess inflammation. If your ankle’s swelling remains inflamed, the healing process will be very slow.
It’s important to note that running too soon before your ankle has healed properly could cause tissue scarring. This could lead to an impingement, which could cause chronic ankle instability or recurring ankle sprains.
So it’s best to allow your ankle to heal properly before you attempt to go for a run.
When Can You Start Running on a Sprained Ankle?
Paying attention to how your ankle looks and feels will give a really good idea if it’s okay to go for a run. Here’s how to tell when your ankle is ready for action. Remember that to run safely, you must check all three boxes.
When There’s No Pain or Swelling
A good sign that your ankle is at the end of its healing process is if you can go about your day-to-day activities, walk, and climb up and down stairs without any pain. If discomfort or pain occurs, your ankle still has some healing to do.
Compare your injured ankle to your other one to see if the swelling has completely gone. If there’s still swelling around your ankle, then it would be best not to run as the muscles will compensate for the injured ligaments.
This will alter your gait, and the new movement pattern caused by your muscles trying to support the ankle can lead to you re-injuring your ankle. It can also lead to an overuse injury in the knees, hips, and lower back.
When You Can Bear Weight Without Instability
Your injured ankle should be able to bear weight on it without pain and without feeling like it’s going to give out. If your ankle feels like it’s still unstable and you do try to run on it, the load and the excessive stress could re-injure it.
This would cause long-lasting damage, where the ligaments take longer to recover or they may never fully recover. This would increase your risk of developing chronic ankle instability, which will lead to recurring sprains.
When Your Range of Motion Is Back to Normal
Your ankle is a complex hinge joint that allows for flexion—plantar flexion—and extension—dorsiflexion. Before you head out for a run, make sure your range of motion is back to normal, as it plays a vital role throughout your gait cycle.
During your gait cycle, dorsiflexion occurs during the stance phase, which helps propel the body forward.
Plantar flexion occurs almost immediately, and it continues through the stance phase and into the swing phase. The swing phase is when your first foot leaves the ground, and it will end when it makes contact with the ground again.
During the stance phase, your foot and leg have to bear your body weight, which is often considered the most important phase of your gait cycle.
But if your muscles and joints can’t move through the entire range of motion, it’s going to affect your entire gait cycle. Not only will you not be able to run fast, but you won’t be efficient, there will be poor force distribution, and your risk of injury increases significantly.
This can lead to overuse injuries like shin splints, Achilles tendonitis, runner’s knee, and plantar fasciitis, to mention a few.
How to Start Running On a Sprained Ankle
It can be incredibly frustrating when you’re injured and have to limit your runs and workouts. But it’s important to note that running before your ankle has properly healed can cause more long-term damage.
To reduce the risk of re-injury and prevent chronic ankle instability, follow the tips below. This will ensure a safe transition back into running and your daily activities.
Rest It Properly First
The first step you want to take after you’ve sprained your ankle is to reduce the swelling and pain. Make sure to rest your foot as soon as possible and apply ice to the ankle in short intervals—10 to 15 minutes every few hours—for the first 3 days.
To help reduce the swelling, keep your ankle elevated above your heart and take an over-the-counter pain reliever like ibuprofen or naproxen.
Monitor your sprain daily, and once all the swelling has gone down and you can comfortably put weight on it, then you can start with rehabilitation exercises.
Do Ankle Rehab Exercises
As the sprained ankle heals, the joint becomes stiff, and the ligaments and muscles weaken, leaving your ankle vulnerable to re-injury. Rehabilitation exercises will help restore range of motion, strengthen balance, flexibility, and help maintain a healthy joint.
Your ankle should be healing nicely around the 2nd and 3rd week and there should be little to no pain. Now you can add the following range of motion exercises into your daily routine:
Roll a towel up and sit on the floor with your legs straight out in front of you. Then place the towel under your calf so you can rest your leg while your foot is elevated. Then, point your foot forwards and use your toes to write the letter of the alphabet in mid-air.
Try to do these exercises 3 times a day on both feet.
You’ll need to sit in a chair and place the towel on the floor in front of your foot. Then, using only your toes, grab the end of the towel and scrunch it up.
Try and repeat this exercise 8 times on each foot. Stop immediately if you feel any pain.
Sit flat on the floor with your legs straight out in front of you. Then place a resistance band—with light resistance—around the ball of your foot. Hold the other end of the resistance band close to your body and push your foot downwards against the band.
Your toes should point forward slightly. Repeat this exercise 10 times on both feet. If it feels like the resistance is too easy, then go up a level.
As your ankle continues to heal, you can then look at adding the following exercises into your daily routine:
- Heel raises
- Single leg stand
- Standing calf stretch
- Resistance band ankle out
- Plyometric hop
Return to Light Cross-Training
Light cross-training is a great way to maintain fitness without aggravating your ankle. If you’re looking for cardio alternatives to running, then you can try swimming, riding a bike, or rowing, as no pressure is placed on the ankle.
You could also focus on strength training by breaking up your workout so that you target specific muscle groups. This would help correct any muscle imbalances that you may have along your kinetic chain.
Gradually progress to weight-bearing exercises like walking on a track or using the elliptical. Monitor your ankle before, during, and after your workout. If you have any pain during your workout, stop immediately.
It’s also important to note that if swelling occurs after your workout, you give your ankle some more time to heal.
Start Running Slowly
If you’ve been able to use the elliptical or bike and haven’t had any swelling or pain after the workouts, you can slowly return to running. It’s best not just to start running out the gate but rather use a jog/walk approach.
Try alternating between jogging for one minute and then walking for three minutes. You can do six to eight sets of this when you first start to see how your ankle feels before, during, and after.
Repeat the same process on your next planned run, but jog for two minutes and walk for three minutes. Keep repeating the process, each time slowly increasing the time spent jogging and reducing the walking time.
Once you’re able to jog for 30 minutes continuously without breaks, you can consider increasing your frequency and speed of running. It’s also best to start running on a track as it provides a flat, stable surface, and will place less stress on your joints.
Make sure you gradually increase your training intensity, pace, and distance for three to four months after sprained your ankle. Pain and swelling would be an indication that you’re overdoing it, so be sure to check your ankle after every run.
Use a Brace or Tape
Depending on the severity of the sprain, your doctor may recommend that you wear a brace or use Kinesiology tape on your runs. But if you’ve sprained your ankle a few times, you may feel more confident running with a brace.
This can help prevent re-injury by supporting and protecting the ligaments for a few months, but it’s best used as a short-term strategy. If you’re thinking of wearing the brace on every run for the foreseeable future, you should speak to your doctor or physical therapist and get their advice.
Strengthen Your Ankles
Add exercises that specifically strengthen the muscles and ligaments into your daily routine. By strengthening the muscles around the ankle, it will help reduce pressure on the ankle joint.
It will also improve ankle joint mobility, stability, and balance. This will help reduce your risk of injury when you need to react quickly to obstacles and changing terrain. To strengthen your ankles, you can include the following exercises in your routine:
- Standing Heel Raises
- Heel Walks
- Toe Walks
- Single Leg Balance
- Single Leg Lateral Hops
- Box Step-Overs
- Single Leg Mini Squat