runners with recurrent ankle sprains

You’re on a roll, minutes within a personal record, until you fall to the ground in pain. It’s your ankle again! Runners with recurrent ankle sprains know the routine all too well. One ankle sprain can turn into a never-ending cycle of rolling your ankle, swelling, instability, and starting from square one when it’s time to get into your running shoes again.

If you think there is no relief from your recurrent ankle sprain, I’ve got good news! I have devised the ultimate strength training guide for runners with recurrent ankle sprains to make your ankle stronger and resilient.

Why You Always Sprain Your Ankle

Many runners who sprain their ankles often do so because they suffer from chronic instability of the area. Chronic instability of the ankle is not the same injury as a sudden ankle sprain. If you sprain your ankle once, it doesn’t necessarily mean you will sprain it again. Runners with recurrent ankle sprains could be experiencing chronic ankle instability, which means something else is going on in their foot.

If you’re wondering, “why do I always sprain my ankle?” A quick overview of the anatomy of the ankle and a look at what can go wrong will tell you why.

Anatomy of the Ankle

The ankle is more complex than you may realize. Most people think it’s made up only of the joint they can feel and see on the inside and outside of the foot. The ankle actually has two important joints: the true ankle joint and the subtalar joint.

The true ankle joint is what you see and feel on the outside of your foot. It’s a system of three bones: the talus, tibia, and fibula.  The true ankle joint allows you to move your foot up and down.

The subtalar joint is situated below the true ankle joint. It allows your foot to move from side to side. The bones that make up the subtalar joint structure include the talus and the calcaneus, which you know as your heel.

Ligaments, which are cartilages that connect bone to bone, keep your ankle mobile and stable. The three important —and most injured—ligaments in the ankle are the anterior tibiofibular ligament (ATFL), calcaneofibular ligament (CFL), and posterior talofibular ligament (PTFL). It’s in these ligaments where the instability and recurrent sprains occur.


An ankle sprain happens when the ligaments in the ankle tear or stretch. Majority of people who suffer an ankle sprain  do so on the lateral (outside) part of the ankle. It’s caused by inversion of the ankle or turning the ankle in.

People Most at Risk for Ankle Sprains

Those at risk for ankle sprains are athletes, people who have had prior ankle injuries, and anyone with low bone density.

Athletes have a higher risk because many sports require sudden movements, swift direction changes, running, jumping, twisting, and landing. If an ankle isn’t strong enough, it will give out —over and over again.

Those who don’t participate in sports can still sprain their ankles when they fall, land or pivot awkwardly, or exercise on uneven surfaces such as sidewalks, and roads. Accidentally stepping on twigs in your path could also result in a sprain.

Runners and Ankle Sprains

Runners and other athletes suffer from recurrent ankle sprains because of the beating their joints and muscles endure. Tight muscles and training imbalances can stress the ankles.

Heavier runners with a history of ankle sprains and/or injury are 19% more likely to suffer from chronic ankle sprains. Uneven surfaces could also lead to sprains. Other causes for runners with recurrent ankle sprains are having high arches and wearing ill-fitting or worn out footwear.

Runners often suffer from mild ankle sprains, which aren’t always a cause for alarm. But even a minor ankle sprain can put a runner at an increased risk for another sprain in the future. One sprain can change a runner’s gait, reduce their ground clearance when running, and cause atrophy of the muscles. All these could result in  instability and recurring sprains.

Degrees of Ankle Sprains

There are three types of sprains. Knowing which type you have will help you and your physical therapist determine a treatment and strength training plan that could get you back in your sneakers in no time.

The three types of ankle sprains are:

1. First-degree sprain – occurs when you stretch the ligaments too far. As a result, pain at the site, swelling, and discomfort arise.

2. Second-degree sprain – happens when the ligament suffers a partial tear. If you have a second-degree sprain, you will experience more pain, swelling, bruising, and limited ankle mobility. It will be painful to put weight on your foot.

3. Third-degree sprain – is a severe injury that occurs when the ligament tears completely. The joint becomes unstable; moving the foot causes significant pain. The swelling and pain is more severe than the other types of sprains.

Regardless of the type of sprain you encounter when running, instability is the likely culprit.

Treatment for Ankle Sprains

If an ankle sprain is left untreated, is not given plenty of time to heal, or the ligaments in the ankle are not strong enough, recurrent ankle sprains and other injuries will follow. As I said before, chronic instability is a concern for athletes and runners, but chronic pain and arthritis in the joint can cause long-term complications.

Runners with recurrent ankle sprains must rest and recover.

Treatment for an ankle sprain depends on the extent of damage and frequency of sprains. In most cases, surgery is not necessary for ankle sprains. I recommend more effective, targeted training at the gym.

Exercises to Strengthen Your Ankle

One of the things you need to be aware of is that overstretched ligaments is not the only cause of chronic ankle instability. Proprioception dysfunction and muscle incoordination could also result in an instability.

Before getting started with any exercise regimen, it’s essential to talk with a medical professional to rule out a fracture. Few ankle sprains result in a fracture. However,  a fracture must be ruled out if you cannot put weight on your foot, swelling won’t go down, or you cannot manage the pain. If you aren’t sure, see your doctor.

The doctor will use the Ottawa Ankle Rules to determine if you need an X-ray after suffering an ankle injury. The Ottawa Rules are an effective method for discerning an ankle sprain from a fracture. It was developed to avoid costly radiographs every time an athlete experiences an acute ankle injury.

Ottawa ankle rules 1

Lateral View

Ottawa ankle rules 2

Medial View

The Ottawa Rules have five features:

  1. 1. Bone tenderness along the distal 6-cm of the posterior edge of the fibula or the top of the lateral malleolus (lateral view).
  2. 2. Bone tenderness along the 6-cm of the posterior tibia and tip of medial malleolus (medial view).
  3. 3. Bone tenderness at the base of the 5th metatarsal (lateral view)
  4. 4. Bone tenderness at the navicular (medial view)
  5. 5. Unable to put weight on the foot after suffering an injury and for at least four steps during the evaluation.

When you’re in the clear, it’s time to get started on your strength training regimen.

Top Exercises for Stronger Ankles in Runners

Don’t start a strength training plan until the pain begins to subside. During the first three days of treatment, only gentle movements are allowed. Gently move your foot from side to side and up and down to keep it mobile. These movements  allow your ankle to begin the healing process.

It can take up to two weeks before you begin strength training. Here are the top exercises I recommend for runners with recurrent ankle sprains.

1. BOSU balance

This balance trainer tool engages the muscles in the foot and leg to support themselves without putting unnecessary stress on the ligaments in the ankle. As the ligaments work to support the ankles, they will slowly become stronger. If you experience instability while on the BOSU ball, use a supportive device such as a cane, wall, or tabletop to maintain balance. Use one foot to stand on the ball for as long as you can. Try this exercise on the injured ankle at least five times.

2. Heel raises

heel raises for runners with recurrent ankle sprains

If you need to stand against a wall for stability, I advise you to do so. To perform this exercise, stand with your feet a few inches apart. Rest your hands on the wall or a chair in front of you. Keep your knees straight as you slowly raise your heels off the floor. When you reach the top of the heel raise, hold it there for a minimum of five seconds before gently lowering your heels to the floor. Repeat the exercise 5-10 times.

3. Standing one leg balance

This exercise tests the balance in the injured foot. To complete it, stand on the injured leg and maintain your balance as long as you can. Raise the healthy leg off the floor using slow and controlled movements. As your ankle gets stronger, move the exercise to a BOSU ball or a flat piece of foam for a challenge.

An alternative to this exercise is standing on a pillow with your eyes closed. Stand on the injured leg and rotate your head. You will be wobbly, but as the ankle heals and neuro-receptor function improves, your stance will become solid and stronger.

4. Squat

Squats for runners with recurrent ankle sprains

The squat is a great exercise as it doesn’t just work your ankles but also the areas that support your ankles, including your quads and calves. To do the squat exercise, place a chair behind you for support, but try not to sit on it. Stand tall with your feet shoulder-width apart. Slowly drop down into a squat until your bottom touches the chair. Return back to the starting position. Do the squat five times if you’re just starting out.

5. Dynamic stretching

There are two stretches that will be beneficial for strengthening your ankles: isometric dorsiflexion and isometric eversion. You will need an exercise band for these two exercises.

To do isometric dorsiflexion, sit on the floor and stretch your injured leg out in front of you. Put the band around the top of your foot and wrap the other end around a heavy sofa leg or exercise machine. Pull your toes back towards your body. You will feel resistance from the band. Hold the stretch for 10 seconds. Work your way up to 20 stretches.

To complete the isometric eversion exercise, sit in the same position on the floor with the band around the foot and around a sturdy base. Pull your foot away from the table leg. Hold the stretch for 10 seconds. Again, work your way up to 20 stretches.

6. SMR for the shin

When you have an ankle injury, don’t focus only on the ankle. Work the areas around it. SMR for the shin improves mobility and muscle function. It also alleviates tightness that may be causing dysfunction in the ankle.

Use a baseball, tennis ball, or foam roller for shin SMR. You can either sit down and manually roll the ball along the shin, or you can place the ball or foam roller on the floor and use your body weight to move across the ball. This increases the intensity of the exercise.

7. Single leg good mornings

If you want a little more of a workout at the gym, the single leg good morning helps improve ankle stability and strengthens hamstrings, calves, and glutes to improve your running. While standing, place the injured leg directly in front of you. Slightly bend the knee and make sure the toes are facing forward. Lift the back foot off the ground and slowly bend down until your fingers are touching your toes on the front leg. As you go down and up, make sure the back foot does not touch the floor.

8. Single leg medicine ball toss

medicine ball toss for runners with recurrent ankle sprains

You will need a partner for this routine. Face your partner and toss the medicine ball back and forth to each other in 60-second intervals. Sounds simple? There’s a catch to this exercise, though. You have to toss the ball back and forth with your partner maintaining your balance on the injured ankle. Do five rounds for 60 seconds each.

9. Heel drops

Stand on a step, a book, or a stool. Make sure it is sturdy. The stairs and a book are ideal because they’re stable. Stand on the elevated surface with your heels hanging off the edge. Slowly drop your ankles to the floor. Do three sets of 8 to 10 heel drops.

10. Scissor hops

To do scissor hops, stand with your legs together. When you jump, scissor your legs out. Land with your legs scissored to the front and back. Every time you jump, you alternate – scissor to the side, scissor to the front.

11. Massage the posterior tibialis muscle and the peroneal

After a long workout or run, a massage feels great, doesn’t it? It can also help strengthen your ankle. Use your thumb to massage along the posterior tibialis muscle. Sit on a chair and pull your injured ankle up so it rests on your knee. Locate the shin with your thumb, and rub your thumb along the muscle between the shin and the calf. Spend about two minutes on the muscle. Once that is done, move to the peroneal muscle.

To massage the peroneals, put your foot back on the floor and move your thumb along the side of the leg. Massage the area for 2 minutes. Make sure the movement is nice and slow. If it feels like you’re pulling leg hair or burning your skin, use a little massage oil or lotion.

Conclusion

If you have recurrent ankle sprains, you need to focus on prevention just as much as much as recovery. Prevention is the key to healthy ankles and reducing injury so you don’t have to suffer recurrent ankle sprains. Whatever the cause of your ankle sprains, nonsurgical treatment with physical therapy for runners will give you the best chance at long-term recovery. All you need is a plan.

All of the exercises I listed can be worked into your recovery and prevention workout regimen. Start with low-impact exercises first before you work your way up to more challenging ankle exercises at the gym. Focus on strength and mobility to prevent chronic ankle instability. I promise, there will be many more injury-free runs in your future.