Ankle Fracture

author : AMSSM

comments : 0

Training again after an ankle break

Member Question:

"I was recently diagnosed for ankle fracture and had my treatment at a natural health care centre at Toronto called Pinewood. The treatment went fine and I am recovering well. I want to start my routine workouts, but I’m really worried if that will affect my ankle again. Yesterday when I tried jogging, I was feeling uncomfortable with the ankle. So my doubt is, how long will it take to restart my routine workouts?"

Answer from Dr. Michael Cassat, M.D.
Member AMSSM

Great question, and applicable to returning to running after a lot of different low extremity injuries.

Regarding your injury specifically- You didn’t mention what type of fracture you sustained, so I’ll be generic. My first concern with your discomfort in returning to run was to ensure that the fracture itself was adequately healed, and this is usually determined with the use of an X-ray. Occasionally, a CT scan would need to be utilized to evaluate healing.

Assuming that your fracture has adequately healed, there are a few important things in returning to run after an injury. Some of which are just as applicable to new runners as well.

Your muscles, ligaments, and tendons have been resting, often immobilized. This can result in loss of muscle (strength), loss of flexibility (range of motion), and overall loss of stability. When you look at the overall process of running, it is an incredibly complex chain of events utilizing different parts of our body for power and stability. Any weakness in that chain can result in pain, or injury. There needs to be a deliberate process on the runner’s part to restore any strength, flexibility, or balance deficits before even attempting to run to help prevent additional injury. Ideally, the injured leg would have returned to at least 80 percent of the strength of the non-injured leg.

Some specific recommendations:

• Core strengthening- This can include activities such as front and side planks, crunches, sit-ups. The core is important as a stabilizer of the pelvis when landing on a single leg during running.


• Hip strengthening- As you land in running, the hip muscles are important to stabilize the hip rotationally to help from transmitting additional force to the knee and lower leg. Weakness in hip stabilizers has been implicated in everything from illiotibial band syndrome, shin splints, to plantar fasciitis.


• Lower leg strengthening- Ideally, as stated before, the major muscle groups would be at least 80% of the other side. Once this is achieved the remainder of the strengthening can typically be accomplished by running itself. Trail runners might want to be even a little stronger due to the need for extra strength to prevent injuries such as ACL tears.


• Start slow- Although you are still a runner in your head and heart, your body might not remember. Start back with small, more frequent runs. This allows your tendons and muscles time to adapt to new loads. Increase by no more than 10% per week as a general rule, but if this hurt, slow down.


• Watch your surface- Try and master the flats before returning to hill work. Avoid cambered roads which require more strength and stability. Trails should come only after your strength and balance are back to normal.

Ultimately, remember we run for a life time. There are very few shortcuts, and they increase the risk of an overuse injury substantially. Build slowly and methodically, but most of all have fun!

Dr. Michael Cassat
Facebook: https://www.facebook.com/#!/DrMichaelCassat/
Twitter: @drmichaelcassat

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date: January 30, 2016