Ankle sprains are one of the most common types of running injury. While most other running injuries come-on insidiously as a result of overuse, a sprained ankle typically occurs suddenly and traumatically and usually causes acute ankle pain. Depending on how severe your ankle sprain is, you might be asking if you can run with a sprained ankle?
You should not run on a sprained ankle if pain or swelling is present. As you recover from an ankle sprain, you can begin running after an ankle sprain once you have regained full range of motion and strength at the ankle joint, compared to the uninjured ankle.
To help you decide whether you can safely continue to run after a sprained ankle, or if you should rest from running and wait for your ankle to heal, let’s first take a closer look at what really happens when you sprain your ankle.
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What is an Ankle Sprain?
Firstly, there are actually a number of different types of ankle sprain, all of which typically occur acutely and traumatically, and involve different ligaments around the ankle.
The most common type of ankle sprain in runners is the lateral ankle sprain, caused by sudden and forced inversion of the ankle, like rolling your ankle on a loose rock or off a curb.
For the rest of this article, I’ll be focusing on lateral ankle sprains in particular, but just know that the principles also apply to medial ligament sprains of the ankle. Syndesmotic or “high” ankle sprains require a slightly different approach, and are often more stubborn to heal.
Just to recap: a sprain is an injury to a ligament (or ligaments) that cross a joint; the tissues that connect one bone to another.
In a lateral ankle sprain, the lateral ankle ligaments become injured due to forced, uncontrolled inversion of the ankle. As you can see from the image above, the three lateral ankle ligaments are:
- Anterior talofibular ligament (ATFL)
- Calcaneofibular ligament (CFL)
- Posterior talofibular ligament (PTFL)
When overloaded during an inversion injury, damage to the lateral ankle ligaments (as with all ligament sprains) is classified on a scale from Grade I to Grade III.
Grade I (Mild) Sprain
Microscopic damage to the structure of the ligament(s). Slight localised tenderness and little swelling, no joint instability.
Grade II (Moderate) Sprain
Partial rupture (tear) of the ligament(s). Noticeable pain and visible swelling. Little to no joint instability.
Grade III (Severe) Sprain
Complete rupture (tear) of the ligament(s). Significant swelling, pain and joint instability.
Typically, mild (grade I) and moderate (grade II) ankle sprains are successfully treated without surgery. However, severe (grade III) ankle sprains sometimes require surgery and post-operative rehabilitation.
So as you can see, the treatment, rehab and recovery time needed for any ankle sprain will vary greatly depending on the severity of the sprain.
Read this article next to learn more about the healing time of different grades of sprained ankle, how long your ankle is likely to take to fully recover, and what you can do to speed the process up!
Can You Keep Running with a Sprained Ankle?
Great question, but in reality if you’ve suffered an ankle sprain, the acute ankle pain you will be feeling will be enough to stop you from wanting to run. Even a mild ankle sprain is painful enough to stop most people from wanting to run on the ankle.
The real question perhaps should be:
When can you start running again after an ankle sprain?
I say this specifically because once the initial lateral ankle pain has subsided, it’s natural for us runners to want to start running once again.
However, one of the biggest problems I see with ankle sprains is that runners often re-injure a sprained ankle, if the ankle ligaments (and tissues around the ankle joint) haven’t been given the opportunity to heal properly in the fist place.
It’s better to be a little more cautious and allow the injury to heal properly, than to rush the process and sustain more ankle sprains in the future due to weakness, diminished ankle proprioception (balance), and instability.
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I would expect a Grade I ankle sprain to stop you from running for 1-2 weeks, even if resting and protecting the joint allows the majority of your pain to ease in the first few days of the injury.
Once the initial pain has subsided, you can use some of the basic ankle rehab exercises shown in the videos below to begin strengthening the injured ankle.
In the worst cases, a severe Grade III sprain can take 4-6 months to recover, including time for surgery and extensive rehabilitation.
Every injury is unique of course, and you should take advice from your physiotherapist. However a good rule of thumb for when you can run after a sprained ankle is when there is no pain, bruising or swelling present, you can hop pain-free both back-and-forth and side-to-side on the injured ankle for 5 x 20 seconds.
That’s when I would get you to embark on a progressive return to running programme.
Later in this article, I’ll discuss the steps you need to take to return to running safely after an ankle sprain.
When Must You Stop Running with an Ankle Sprain?
If you’re in the process of returning to running after an ankle sprain, it is vital that you listen to your body and take notice of any pain or weakness you feel from your ankle.
If you begin to feel ankle pain, instability from your ankle, or you notice any swelling after running, it is important for you to stop running and seek advice from your physiotherapist.
The inevitable question is:
What if I have a marathon (or other event) coming up soon, and can’t afford lost training time?
Well, there are some options available in terms of bracing, or splinting or strapping your ankle to give your ankle the stability that your injured ligaments should otherwise provide. In my opinion, ankle strapping with zinc oxide tape (or equivalent) is the best choice.
However, you can’t afford for your ankles to become reliant on strapping for stability, and I only advocate runners use this as a tool to help get them to the start line on race day. This isn’t a replacement for good old-fashioned rehabilitation and strengthening!
Ankle Sprain Rehab Exercises
Earlier in this article I mentioned the importance of ankle rehab exercises you can do to strengthen your ankles after a sprain, both encouraging the healing process and helping to prevent ankle sprains in the future.
Here is a selection of gentle ankle exercises you can do in the early stages of your ankle sprain rehab:
Here’s an ankle rehab routine you can follow along with with some slightly more advanced weight bearing exercises to strengthen the muscles around the ankle joint…
Of course, there are so many different ankle rehab exercises you do, and it’s important not to overlook balance and proprioception, as well as strength.
Here are some great tips from physio Tom Goom for retraining your balance after a sprained ankle:
How to Return to Running After an Ankle Sprain
When it comes to your successful return to running after an ankle sprain, or any injury for that matter, gradual reintroduction to loading is the key.
As mentioned above, successful pain-free completion of the multi-directional hop test is a pre-requisite to you starting a gradual return to running plan.
Be sure to initially run on even terrain (rather than more challenging trails) so as to reduce the risk of rolling your ankle once again… that would be just too frustrating!
The free return to running plan you can find right here will guide you step-by-step through the process of building up your running mileage once more.
Best of luck with your ankle sprain recovery. Whether you choose to try and run with a sprained ankle or opt to rest and give your ankle time to recover, be sure to listen to your body.
If in doubt, ask your physio!
