Ankle Sprains and Calf Strains
Question: I just sprained my ankle. What should I do? How long should I ice? How much time should I take off?
Answer: Unfortunately, ankle sprains are fairly common among runners, particularly in cross country season when individuals run on uneven terrain. However, people with high-arched feet tend to have more ankle sprains because their ankles are rotated outward too far and do not roll in enough (pronate). Ankle sprains are graded on a scale of one to three. Grade one means that you have just stretched the ankle ligaments. Grade two involves more swelling, stretching and sometimes partial tearing of the ligaments. Generally, patients with a Grade two sprain have to take two to seven days off from participating in their athletic activity. Grade three is the most severe type of ankle/ligament sprain and indicates that the ligaments have been torn completely or even torn off the bone.
Unfortunately, swelling is not a good indicator of the severity of an ankle injury. Some patients have a fair amount of swelling in the ankle and have minimal injury; they may have just simply torn or broken the right blood vessel or torn more scar tissue. Conversely, some of the most severe ankle sprains have more swelling in the foot and toes because the ankle ligaments and joint capsules are completely torn and the fluid is essentially rolling downhill towards the toes. One of the best indicators of the severity of an ankle sprain is the ability to put weight on the foot and the ability to move the foot. If you are unable to put weight on an ankle sprain for at least a day, you should go see your doctor and get an X-ray.
Sometimes patients who consistently sprain their ankles do not do as much damage to the ligaments, but more so to other areas of the foot and ankle, such as injuring and chipping off little bones or injuring deeper ligaments that normally do not get stretched with the ankle sprain. (The most common ankle sprain is known as the lateral or inversion ankle sprain, which stretches the outer ankle ligaments.) These patients can continue to ice for several days or even months after an ankle sprain and do not need to stop after 24 to72 hours. Icing for five to 15 minutes is generally all that is necessary. It is important to use caution with chemical ice bags, as they can freeze skin and cause frostbite. Getting an ankle brace can be very helpful. Also, some patients with wobbly ankles or high arched feet, as mentioned above, benefit from orthotic devices. Less commonly, surgery is required to repair or even reconstruct ankle ligaments because of joint-damaging sprains. A good physical therapist can show you several exercises and also utilize other treatments. If you do not have access to physical therapy or a trainer, both of whom could show you rehabilitation exercises and how to tape your ankle, then you may want to try the tips below.
- Immediately ice your foot.
- Use an Ace wrap to help compress the foot and ankle to reduce the swelling.
- Use crutches to reduce the amount of weight on the ankle.
- Once the pain stops, try to balance on the sprained ankle like a stork. If you are able to do this for more than 15 seconds, then gradually stretch out your arms and other leg and start waving them around to force yourself to test your sense of balance.
- Use some surgical tubing or an exercise rubber band to strengthen your outer ankle tendon (evertors/peroneal tendons). You can also strengthen these tendons isometrically by swinging your foot outward (in the opposite direction of your sprain) against the wall and contracting for five seconds and then relaxing. You can do this several times.
- Stretching your calf also helps reduce the tightness that occurs after an ankle sprain. It is never normal to have continuous joint pain accompanied by swelling, and this should be properly evaluated with an X-ray followed by more sophisticated tests as necessary. Grade three ankle sprains are fairly severe and often require the individual wear a cast for three to six weeks. Though these are the least common, they can occur with those people who ignore repetitive grade one and grade two sprains. Preventive exercises, therapy and devices are very helpful in these cases.
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Question: This summer, I started doing more speed work and got a severe cramp in my calf. How did I get this?
Answer: This is a "flat tire" effect or a "calf blow out" and occurs most commonly in males. Women tend to have more flexibility, and therefore more resilience, in their calf muscles because they often wear high heels. Usually when someone gets a calf cramp, it is due to one of three things:
- Changing from training shoes with higher heels to racing flats or spikes with lower heels.
- Increasing hill or speed work. Most people do not keep hills or speed work in all phases of their training throughout the year and when they resume these workouts, the deeper calf muscles (ie., the soleus muscles) are weakened and have to be re-educated to get the runner back up on his or her toes.
- Dehydration. You can avoid calf cramps by being properly hydrated. Unfortunately, for some unknown reason, the soleus and the other deeper calf muscles seem to cramp more than other leg muscles. You can help prevent this problem by noting the factors above, but also by doing heel raises (standing on your toes). It is best to do several repetitions of this exercise with the knees bent, going up on your toes. Placing heel lifts in your shoes help temporarily. Maintaining a proper flexibility and stretching program is also very helpful. Stretching with the knee straight and then with the knee bent is most important and should be done before and after running. After running, it is also helpful to give the calf muscle an ice massage. Occasionally, some cramps are so severe they actually involve tearing the muscle. These patients generally cannot walk and should see a doctor to make sure they did not rupture an Achilles tendon. They will also benefit from a good, organized physical therapy program.
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