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Meet Your Ankle; Your Unsung Hero

Whichever discipline of running you prefer there’s one joint that takes more punishment than any other, likely it’ll often defy belief at its resilience and snap back from the brink of injury when it should have snapped itself. This unsung hero is a genetic masterpiece in anatomy, biomechanics and neurology requiring only a little training to function beyond what you could ever expect. That joint, formed primarily by the Tibia and Talus, is the ankle and while it easily damaged it's even easier to protect it with a little effort and know how.

While the Talus and Tibia are the main bony components of the ankle joint they are accompanied by the Fibula which sits on the outside of the ankle providing support, attachments for ligaments and tendons while remaining a non-weight baring bone. Below the talus lie an arsenal of other bones that can become damaged during an ankle injury although these are considerably less common.

Being a complex joint highlighting every injury or issue with the ankle isn’t achievable in a short article so this targets the most common of injuries, that which was recently voted the most common injury in surveys of the UK Mudd Queens and Kings respective groups; The inversion sprain. A terribly common injury that confuses and misleads athletes and clinicians alike.

What is an inversion sprain?

An inversion of the ankle occurs when the ankle rolls outwards over a planted weight baring foot and can result in violent trauma to the area or nothing at all. Ankle sprains make up around 80-85% of all sports injuries and inversion sprains make up 80% of those! Often misinterpreted as ‘Luck’ training the muscles, tendons, ligaments and capsule itself play a huge part in escaping these potentially devastating injuries unscathed. However, no matter what you do luck will still play a part.

Recently while training parkour I managed to all but destroy my ankle in a very tame looking freak accident that in all likelihood couldn’t have been prevented. It’s been a month now since I snapped through 5 ligaments, broke 3 bones in 6 places and tore some tendons for good measure. I was told I wouldn’t walk in 6 months but 4 weeks on I’m back climbing, walking and occasionally I’m able to burst into an almost respectable shuffle. I’ve used this 4 weeks to add to my bank of prehab and rehab knowledge through studies and trial and error and this is my plan, as of now, to bulletproof my ankles.

I was unlucky, but I could have done more to prevent this injury. I was, however equally lucky, my injury could have been much worse.

What happens when I ‘roll’ my ankle?

Throughout the body receptor cells are found in every joint, muscle, tendon, ligament and monitor the position of their target tissue in relation to others around them. These receptors collectively termed proprioceptors relay information to the spinal cord and higher centres of the nervous system which processes the information. When the receptors of the ankle joint suspect that an inversion sprain is about to occur, the spinal cord processes the information and orders a coordinated contraction of the peroneal muscles which act to resist inversion, straightening the ankle and resisting the injury.

While this neuroanatomical circuitry is a piece of evolutionary (sorry kids, no god here) genius this reflex response is only as strong as the stimuli and muscle it activates.

Throughout Obstacle Course Racing, cold water submersions are common, often celebrated theme. As runners, we flock to test ourselves throughout winter against the coldest of races while in the summer we welcome them as a break from the onslaught of the beating sun. But be warned, they aren’t as innocent as they seem. The bodies proprioceptive fibres are dramatically inhibited by the effects of cold on the tissues resulting in a slower reaction to inversion increasing the chance of a more severe injury.

While a slowed proprioceptive reaction stimulus is one injury increasing factor, another potentially more severe is that of defective peroneal muscles. If the peroneal muscles are simply too weak, underactive or slow to contract in repositioning to an inversion then all the force of that injury will be transferred into the ligaments of the joint not absorbed in part by these peroneal muscles.

With the ankle being very unstable on the outside its bolstered by 3 strong ligaments of which its most commonly injured is the Anterior Talofibular ligament (ATFL). This ligament connects the Talus to the Fibula as the name would suggest and works to prevent the foot sliding anteriorly to the shin. The next ligament to consider the Calcaneofibular ligament (CFL) that attaches from the calcaneus (heel bone) to the fibular to the lateral part of the fibula. It acts as a stabiliser to the subtalar joint and when injured creates an unstable weight baring surface for you to walk on. The third lateral ligament is the Posterior Talofibular ligament which is rarely damaged so ill skip past this one.

These ligaments are tough bands of fibrous tissues designed to support the joint and to some extent store kinetic energy created in the planting of the food and expel it when pushing off into a run stride.

So, knowing that ankle injuries are common how can you work to protect yours?

Well, there are a number of ways and with every individual being different its best to keep an open mind so don’t take a hard and fast approach. I’ll have likely missed a number of things but do what works for you, be strict in doing so and adapt when needed.

Here are a few exercises for the ankle:

Ankle Circles

Sit on the ground with your legs bent in front of you. Cross one leg over the other and perform slow circles with the ankle that's raised. Make sure to circle your ankle clockwise and counter clockwise to achieve the most benefit.

Ankle Alphabet

This works the range of motion in your ankle. Simply sit in the same position as the previous exercise, and spell out the alphabet with your ankle.

Calf Raises

This exercise teaches your ankles to have control when your body shifts weight. Stand with your feet about hip-width apart, shift weight onto your toes, and slowly lift your heels off the ground. Keep your ankles in a neutral position to prevent them from rolling out.

Shin Raises

Similar to calf raises, raise your toes instead of your heels off the ground. Maintain good control as you raise your toes up and down to prevent your ankles and toes from rolling in.

Single-Leg Balance

This not only strengthens your ankles but also works the rest of your lower body. Stand on one foot, bend your standing knee slightly, and hold for 20 to 30 seconds. You may start to shake; this is a sign that your muscles are working. Control your ankle to minimize the shaking.

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