THE CLINIC
Ankle Sprain Return to Running

I’m a 62-year-old male who has been running for 45 years. I tripped running and sprained my ankle, in addition to pulling a calf and upper leg muscle too. It’s been about two weeks and most of the swelling is down. What exercises should I do to return to my workouts? I have a stationary bicycle, weight machine, elliptical trainer, cross-country ski machine, stair climber, and various free weights.

Douglas Artkine
Lee, MO

Ankles tend to be chronic swellers, so be sure to continue with the ice until all the swelling is gone. I recommend you spend some time on the exercise bike to restore range of motion; the ski machine will serve the same purpose. Just be sure your activity is limited to getting range of motion back—do not go all out yet. If the weight machine has ankle attachments, that can help you strengthen. Check to see if you can stand briefly on your toes without pain before getting too aggressive.

Once you have normal range of motion and minimal pain (below a five on a scale of one to ten), begin running at half speed in straight lines. Don’t cut or run circles for four or five weeks, and keep icing that ankle!

Ron Kleinman, PT
Akron, OH

First try exercises without your body weight on the foot, gradually progressing to full weight on both feet, and then to your body weight on only the injured foot. Begin by drawing the alphabet with your foot on the floor while sitting. Next try balancing on both feet, then just the injured foot with eyes closed. Try heel raises next, again on both feet, until you can do them on the injured foot alone without holding on. Pool therapy with a kick board will help restore mobility. Progress to deep water running, and then to speedwalking. Progress gradually to jogging, then running, outside.

Remember the four parts to any safe and successful workout regimen: warm-up, stretching, the activity, and stretching/cool down.

Jim Buskirk, PT, SCS
Chicago, IL

Once pain and swelling are reversed, runners often short change the rehab process involved with ankle sprains. Range of motion and strength of the ligaments around the ankle, which have been stretched or partially torn, is essential or another sprain may well occur. In addition, improving your positional awareness (proprioception) will help prevent future injury.

Rubber tubing can help strengthen the outside (lateral) ligaments by placing the tubing around your forefoot, anchoring it to the leg of a sturdy table, and turning your foot so the resistance is on the outside of the ankle. Hold this position for a count of five for a set of ten repetitions, and repeat this exercise two or three times a day.

Often ankle sprains compromise the ability to pull up your foot (dorsiflexion). Try wrapping a towel around your forefoot and pulling up on the foot. This is not a strengthening exercise, but a stretch, therefore perform this two or three times, holding for a count of 15 to 30. To stretch your calf, stand with your forefoot on the edge of a step and slowly allow your heel to drop down. Again hold for a count of 15 to 30, and repeat several times.

Balancing drills will improve your proprioception. Walking on your tiptoes and then on your heels will help. Try these eventually with eyes closed. Next, attempt one-legged hopping. You can return to running once you are pain-free, have full range of motion, and normal strength and balance in your ankle. Start gradually, increasing your distance and speed over time.

Carol Zehnacher, PhD, PT
Frederick, MD

Poor Knee Alignment

I have moderate patellar subluxation [a partially dislocated, off-center knee joint] and over the years I've had tendinitis on and off in my left knee. I completed my sixth marathon and near the end of my training, I began to notice a grating feeling as I was climbing stairs. Due to rotator cuff repair, I took 10 weeks off from running after the marathon, gradually built back up and now am running and spinning at the gym on a regular basis. My longest runs are currently nine miles. I do feel knee pain at times going up the stairs, though I have done strengthening exercises, such as lunges and squats, for a number of years. My sports medicine orthopod said the patellar subluxation was the root cause, though now he has also diagnosed arthritis in my knees. I'm taking glucosamine/chondroitin sulfate and continuing the strengthening exercises—presently weight-bearing straight leg raises. What sorts of outcomes have you seen for surgery to repair the subluxing? And assuming I'm able to stabilize the alignment problem in my knee and continue training, can running cause the arthritis to spread more quickly?

Anne Carlyle
New York, NY

It's very important to increase the flexibility in your quads, ITB and hamstrings. This takes pressure off the patella. The strengthening regimen is good; now you must incorporate stretching. Most of us have some arthritis in our knees. This won't become worse with running. It's the lack of flexibility that could exacerbate the arthritis. Regular stretching is essential, and keep in mind that it takes a minimum of three months to really see flexibility gains.

I feel that surgery is not a good option for you at this time. It could take up to two years to fully recover, with compromised running performance. After such a long period of time, you likely would have found other ways to exercise.

Robert Erickson, MD
Canton, OH

An MRI will give you a look at the integrity of the bone coating inside your knee, which may help you formulate a long-term plan. To absorb shock, you may try wearing a Chopat band around your patellar tendon just below the knee. A physical therapist could try taping your knee to the inside to offset the subluxation. I would avoid hills for now.

Rob Meislin, MD
New York, NY

This maltracking of the kneecap is very common, and causes the cartilage around the bone to prematurely wear away. I recommend light weight, high-rep, pain-free quad strengthening. Running won't make the arthritis worse, but you must be pain free. Avoid downhill running in particular.

Warren King, MD
Palo Alto, CA

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