Trail running is quite popular here in Squamish, due to the fact that we have beautiful spaces to explore right in our backyards. But running on such uneven ground puts us at risk for spraining our ankles, a very common “traumatic” running injury. While there are no guarantees you won’t sprain your ankle, there are a few things to know that could reduce your risk, whether you are a “recurrent sprainer” or someone lucky enough to have never sprained before.
Just before going further into prevention, I’ll take just a moment to describe what an ankle sprain is…a sprain occurs when a ligament (which is a bone-to-bone connector) is stretched beyond it’s normal length resulting in tissue damage (aka tearing) of varying degrees. 90% of ankle sprains occur on the outside and typically involve the anterior tal-fibular ligament (in green in the anatomy image). 
A slightly overstretched has a lower grade than a very profoundly damaged tissue usually labelled on a scale of Grade 1 being the less damaged and the Grade 3 being the more damaged. The degree of damage tells you roughly how long recovery will take and how much rehabilitation needs to be done. A Grade 1 injury can often recover in 7-10 days with minimal intervention besides ice/compression/elevation. A Grade 3 injury can take many weeks to some months and extensive therapy to rehabilitate fully.
Given how this could leave active folks on the sidelines from 1 to 12 weeks, avoiding ankle sprains makes sense. Here are my 4 strategies for preventing ankle sprains:
1. Wake up the Proprioceptors! What the heck are “proprioceptors”? They are sensors within ligaments and surrounding our joints that tell us where we are in space. Can you walk through your bedroom in the dark without stubbing your toe on any of your furniture? You can thank your proprioceptors. Damage in an ankle sprain can involve your proprioceptors, meaning your stability sense will be poor. If you have ever sprained an ankle, do this test: stand on one foot with your eyes closed. A healthy adult should be able to do this without touching the floor with the lifted foot for 30 seconds. Compare with your other side. If you can’t balance well with your eyes closed, your proprioceptors may be temporarily “on vacation”. Fortunately, if you challenge yourself to regular balance exercises, things CAN improve. 
An example of an exercise would be to stand for 5 minutes on one leg at a time (eventually on a soft/unstable surface) 5 days a week pre sports season and then twice a week during the season. This regimen was given to “high risk” (meaning they had had previous sprains) football players and the incidence of injury reduced 77% just with this small intervention.
2. Get stronger. Not a big surprise here but ankle strength diminishes after a sprain and can stay that way unless you specifically demand more from your muscles. I don’t know how many clients tell me “matter of factly” that they have weak ankles. I think the perception is that this is UNCHANGEABLE. Provided you haven’t sustained nerve damage or severed any muscles in the area, you can change this situation with exercises. Plyometrics are excellent ankle strength builders. For a more gentle start, begin standing on a step doing calf lowering and raising, first on two feet and then on one foot at a time. The one foot part is most important but be sure to take it easy on your first session- the DOMS effect can be very brutal if you do too much.
3. Seek outside support. If you have never sprained your ankle, the research doesn’t support using taping or bracing or orthotics to prevent ankle sprains. However, if you HAVE sprained your ankle, you might benefit from something supportive. Taping is frequently applied in the sports, preventatively. However, tape loosens quickly and has no measurable support after 30 minutes. However, the compression on the skin from the tape surrounding the previously injured joint may help the outer ankle muscles react more quickly by increasing proprioception! Elastic wraps offer NO SUPPORT. Some recurrent ankle sprainers may benefit from orthotics (footbeds). Lastly…
4. FOR RUNNERS: Keep these two common running techniques in mind. Firstly, look ahead. Scan 3-5 meters ahead of where you are currently running. The faster you are going, the further you look. Use your peripheral vision for what’s directly below you, you will be fine because you scanned this same area seconds before while you looked ahead. This keeps you focused and on your game too! Secondly, land on the mid foot, with the foot underneath you where is is more neutral (flexed and stable) rather than on your heel (where even a slight unevenness will rapidly tip over the foot).
There you have it! May you be footloose and sprain-free, all season long!
Have a favorite ankle exercise for strength-buiding or challenging balance? Share it in the comments below.
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