Ankle Exercises For Common Trail Running Injuries

by Dr Charlotte Robinson, Alpine Fit PT, Fitness, Physical Therapy

Trail running is a very popular sport in Colorado. The state offers a combination of tough elevation climbs with amazing views as a reward and is a great way to enjoy the Colorado outdoors. 

What is the difference between trail running and road running?

The most notable differences between trail running and road running are the steeper inclines and declines as well as running on more uneven terrain. Instead of a steady pace on a non-obstructed road, trail runners are often hopping up and over rocks, navigating sharp switchbacks, and trying to avoid snagging tree roots. 

From a biomechanical standpoint, trail running requires a combination of power, plyometric control, and balance. For this article, we will focus on the importance of these three things in the ankle joint and how to treat common injuries. 

Acute ankle sprain with trail running

With the introduction of plyometric movements and uneven terrain comes an increased risk of ankle sprains. Whether this is your first ankle sprain or 6th, it’s important to treat it correctly early on to avoid long term chronic complications. 

The most common type of ankle sprain is an inversion ankle sprain, which involves the foot collapsing in and runner landing on the outside of the foot. When this happens, the tendons and ligaments are stretched on the lateral side of your ankle and simultaneously crushed on the medial side. 

If not treated appropriately and early on, this trauma to the ligaments and tendons can cause collagen matrix degradation, scar tissue infiltration, and essentially weaken the tendons and ligaments themselves. 

So what are the first steps you can take to avoid long term issues following an inversion ankle sprain?

The most important thing immediately after an ankle sprain is ruling out a potential fracture. If you’re not able to put weight on the foot due to pain or are particularly tender in an area right on the bone, I encourage seeing a medical professional to rule out a fracture

The next steps are to introduce ice packs or similar means to decrease inflammation, protect the injury by not overloading too quickly, and most importantly:  get the ankle gently moving as soon as possible. The general consensus in the medical community is that the RICE protocol (Rest, Ice, Compression, and Elevation) is outdated. 

For my patients that have acute ankle sprains, I recommend the ice, compression, and elevation part of the protocol, but opt for movement instead of rest. After trauma to the tendons and ligaments, movement and LIGHT (key word here) loading of these structures is pivotal for healing and reformation. This kind of therapeutic movement comes in the form of ankle circles or ABCs, ankle isometrics, and trying to normalize your walking gait. 

During this phase, pain should be very minimal with these exercises because as mentioned before, they are not meant to overload the injury and are more beneficial than simply letting the ankle rest.

Your next step after taking these post-injury precautions: see a physical therapist to restore range of motion, strength, and proprioception into the ankle to get you back on the trails as soon as possible!

Chronic ankle overuse injuries for trail runners

Along with acute sprains I also see a lot of chronic overuse injuries in the ankles of my trail runners, most notably in the achilles tendon. With the inclines and declines associated with trail running as well as the aforementioned plyometric control, this puts our achilles at increased risk of injury. 

Unlike an ankle sprain, which is a big trauma introduced all at once, overuse injuries are small micro-injuries that build up over time. This causes changes in the collagen matrix of the tendon, scar tissue infiltration, weakens the tendon, and changes the way that the tendon takes the load. 

How can you bulletproof the achilles tendon?

To bulletproof our achilles tendons, the following things are needed: appropriate ankle range of motion, strength and power in our calf, and ankle stability. Range of motion in the ankle is important; especially if the ankle is being put through a lot of running/scrambling on an incline. 

Exercise for ankle range of motion

If the ankle doesn’t have sufficient dorsiflexion (bringing your toes and foot up towards your shin), the foot tends to have a forefoot strike versus a mid-foot or heel strike. Forefoot striking puts a lot of stress on our achilles tendon and exacerbates the forces absorbed through our tendon while running. 

When running, we absorb 6-8x our body weight with each step, and striking with our forefoot puts all this weight on our achilles instead of distributing more throughout the mid-foot and plantar fascia. Forefoot striking is not a wrong way to run, but this should be a conscious way of striking, not compensation for lack of ankle range of motion. If you have Achilles pain and a forefoot strike, changing this to a mid-foot strike can also help mitigate pain.

Below is my favorite ankle mobility test and corrective exercise – Squat test and wall lunge.

Exercise for ankle strengthening

Once we have determined if our ankle has an appropriate range of motion, the next step is to strengthen it. As mentioned before, we absorb 6-8 times our body weight while running with each step we take. Our calf strength needs to be able to support this increase in load, especially with eccentric loading. Eccentric exercises are a controlled elongation of a muscle and tendon. For example, while running downhill, the calf has to eccentrically control dorsiflexion or its owner would simply go tumbling down the hill. Eccentric exercises are also phenomenal for strengthening and reframing tendons.

Below is a link to a calf eccentric exercise.

Exercises for Ankle Stability

Last but certainly not least; ankle stability. There are numerous other muscles that cross the ankle joint besides the calf and help to contribute to stability and balance in the ankle. While your calf is your big power mover, these muscles make sure your ankle stays in the correct orientation for the calf to fire correctly. The two main groups are your inverters, muscles that pull your ankle medially, and your everters, muscles that pull your ankle laterally. Working on the strength and balance of these muscles is important in ankle health and preventing injury.

Below is a strengthening exercise for your inverters and everters and a balance/proprioception exercise for your ankle joint.

If you’re curious about more ways to prevent injury, talking with a Doctor of Physical Therapy is a great place to start. 

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