So I stuck my foot in a pothole and fell straight forwards and the ankle took a bit of a beating as well as some superficial roasties. The ligaments were definitely stretched more than is normal and some bone bruising is likely. It’s hard to know exactly how you fall as it happens so fast but I ended up extended straight out on the road.
This was one of my final training runs in taper week before Ironman 70.3 South Africa. Talk about sucky timing. Its been a difficult decision, I will not race this weekend.
Skip further down if you want more practical advice regarding training; and yes I recommend that you seek professional advice!
I have heard much advice and sympathy these past days. But professionally I am having to suck it up and do as I would advise. Get it diagnosed (I may have to wait until I get home to Ireland), manage the symptoms and start to rehab it so that it returns to full strength, flexibility and mobility. It is not smart to run on stretched, torn, or inflamed and painful ligaments and soft tissue. I will also see an osteopath to make sure that the stretching that happened when I fell hasn’t pulled anything out-of-place which it feels like.
I did use some anti-inflammatory patches locally on the area in the first 24 hours, and although I am not a fan of overly suppressing the inflammation and hence the bodies natural repair process the ankle hurt like hell so we chose this approach, Garron tried an alignment method, I ate whacks of raw ginger, ice was used later when the patches were off (perhaps I could have done it more), I kept the foot mobile as this improves movement and is halting the stiffness and I am doing lots of little movement exercise as the foot allows increasingly (but would like to get some guidance when home), and also intuitively I was plastering a product on it (under a compression sock) from South Africa called Zam-Buk which has really helped massively (interestingly first made in the UK! it contains eucalyptus oil, camphor, thyme oil, and sassafras oil).
Although allowing the healing to happen as naturally as possible hurts I didn’t use anti-inflammatories orally or topically outside of this 24 hours as the pain had subsided unless I was doing silly stuff (which I didn’t) and I wanted the body to do her job and inflammation in moderation is just that – healing.
It sucks but what can I say; the hard training never goes to waste, the lessons and experiences along the way are in the bank.
So please folks take care of your ankles. I have seen athletes have their careers ended due to ankle injuries. It’s a delicate joint with a lot of bones and plays a huge role in our running and sporting mechanics as well as proprioception and balance. We must encourage strong supportive ligaments and healthy joints. I am not a trained physio or chiro/ osteo/ sports medic…. so please take on board some expert advice if an ankle injury happens to you; don’t be a hero.
Here is some further worthwhile reading.
Owner’s Manual: Not “Just” An Ankle Sprain. Preventing and recovering from ankle sprains includes being aware of their intricacies
And these are important about cortisone injections (READ they are NOT the miracle cure) and NSAIDS like ibuprofen, meloxicam, aspirin, flurbiprofen etc (my synopsis is avoid unless short-term only and in acute situations only for as long as needed to relieve excess inflammation and pain)
Are Cortisone Shots for Tendon Injuries Worth It? Study: Shots Provide Short-Term Relief but Inferior in Long Term
You have to ask yourself how important is the short versus the long-term when making your decisions. I am in for the long-term.
There are many ways to support the acute process and also the healing process with nutrition and also energy healing. Please contact the clinic if you would like to know more.
Also this article written by Tom, highlights the importance of activity in the recovery of soft tissue function and strength. http://useful.coach/articles/nutrition-for-soft-tissue-training-recovery-and-injury-prevention/
Until the next challenge,
PS And to all my friends racing ironman South Africa 70.3, please nail it for me.
Update No 1:
So it is one week on since the pothole stole my opportunity to race. I saw my osteopath in Ireland this morning and he was kind enough to effectively resprain my ankle in order to align the ankle. I won’t lie, it hurt, AGAIN. Not only this my neck and back were jammed and the right knee had a few issues. This demonstrates that a simple fall is never without consequences. Forces are absorbed by the body as best it can do and this does need addressing by an expert such as an osteopath or chiropractor.
Also the time-line for healing may be somewhat longer than I hoped; so be it. You cannot rush these things but you can also work with the body in her healing.
So what will I be doing?
- Continue icing and massage to encourage tissue detoxification, circulation, healing and regeneration.
- Work my diet in favour of healing with the inclusion of foods to manage inflammation and supply much needed nutrients to the joint and surrounding soft tissue.
For example turmeric, ginger, chili, bone broth, wild/ organic oily fish (salmon, sardines, mackerel), deeply coloured vegetables and fruit, spices and herbs, and avoiding all of the junk. Green tea doesn’t suit me but can be helpful. Ensuring optimal intake of healthy fats is also encouraged and mineral rich nutrient dense foods (ie lots of variety from natural foods!). Don’t cut your carbs completely if your training colume is reduced; healing needs energy so choose the mineral rich carbs such as roots, buckwheat, millet, oats, rye, amaranth, teff, brown rice. Protein is very important, protein is a structure building macro so when you consider this it is obvious that protein must be on the plate of most meals!
- Although I chose food as my main therapy I did take some collagen as support above and beyond my bone broth.
Supplements containing collagen, turmeric, glucosamine, hyaluronic acid, bitter cherry and circulation and lymph supporting herbs can be helpful. High doses of gentle vitamin C also. Manganese, zinc, Vitamins A and D can also support the repair process. Glutamine, HMB, creatine, and arginine may be helpful for strength (and immobilised endurance) athletes not wanting muscle loss. Proteolytic enzymes are something to consider should scar tissue be an issue (avoid if you have stomach ulcer/ inflammation issues).
- Help the roasties to heal using aromatherapy oils and ointments such as Zam-Buk, Calendula, arnica, pure oils like jojoba and rose seed, etc. The main issue seems to be the scab getting too dry. I have contained any infection with eucalyptus oil the only oil that I had with me travelling (lavender or tea tree would have been good options also).
- Taking a blend of Tree and Plant Essences of Ireland specific to support the healing. The blend contains oak, scots pine, and summers first rose.
- Eating an ample supply of calories and adding in extra sleep and naps – energy and time resting allows healing to proceed unimpeded. Don’t fight fatigue when you are injured this is your body attempting to slow you down; don’t cut calories when injured you body is doing so many energy dependent things in the background that would explode your mind… allow it work its healing magic.
- Spend some time using my PEMF machine to encourage healing.
- Listen to my body, and react accordingly to support the emotional and physical healing journey. yes it is only an ankle, but for many of you it may be far more and it is important to listen and heal intuitively.
Fingers crossed I can expedite the process but I will not hurry it.
PS my osteopath is Eoin Flynn; he is simply brilliant.
Update 2: March 3rd 2017 – 5 weeks later:
I was last in with the osteopath 2 weeks ago and he was delighted with my progress; he said that I was healing approximately 20% ahead of schedule and that the ligaments were especially strong. So what did I learn along the way?
- Cramps were a problem for over a week and this baffled me but apparently an injury leaves you more prone to cramps. I took extra magnesium but a product called hotshot might have suppressed the cramps from happening altogether.
- Expect sore muscles, the muscles close to the injury have to do more work while the ligaments and soft tissue repair, the muscles in other parts of the body compensate also. Expect to feel sore where you didn’t expect it and be sure to include stretching, mobility, flexibility and strength into your programme for these compensating body parts, the whole body and not just the injured part of the body.
- See this as an opportunity to not only do rehab on your injured bits but on other weak areas too. For example I realised that the ankle I injured was actually my strong side so I am working on the other side also.
- Things that I found helpful: the bosu ball, the wobble board, cords and TRX bands, frozen peas and a facecloth, my pullbuoy and extra naps 🙂
- Exercise that I did: I gradually worked my way along the following; adding in more progression as my body told me it was ready and guided by my coach Annchen Clarke. Some sessions were a testing session to see how the body responded before I added in a longer session. I was prepared to be patient; if something felt wrong I didn’t do it.
- Swimming with a pullbuoy and no kicking
- Very gentle rehab and stretching, progressing intuitively.
- Strength work in the gym working on other areas that were uninjured; I saw this as a great opportunity to do some swimming specific strength work and core work. As my ankle healed up I then added in more lower body focused work.
- Bosu ball and/ or wobble board circuit with bands and cables.
- Adding kicking back into the swim in short sets and working this up to a full strong kick (I was working on my flexibility and dorsiflexion to prepare for this).
- Using more motion in my ankle while in the water aqua jogging. The water felt a very safe place to test the ankle against the resistance of the water. Eventually I was able to run along the shallow end in a high knee stride allowing the foot to take gentle weight (due to water taking most of the weight).
- Cross trainer; gentle and short to start, then progressing into higher resistance, steeper incline and faster pace.
- When the ligaments felt sufficiently strong I got back on the indoor bike trainer; taking the shoes off on the bike as uncleating is hard on the ankle. Again test this gently and gradually work back up your intensity and pace. Start with a short set allowing recovery in between so that you can see how the ankle responds.
- Increased loading in strength, conditioning and rehab sessions; keep focused on whole body also!
- The next goal is to be back on my running feet but the rehab and strength and mobility work will continue on for weeks to months.
- An injury makes you feel way more tired than your brain can comprehend. Allow it rest, allow it time, be patient. You will come back stronger if you just play by the rules. It takes a lot of energy to heal the body and this is just reflected in feeling tired.
- Be intuitive in how you approach your rehab and healing. Your body knows best so it bodes well to LISTEN.
- Good diet makes a massive difference to the rate of healing and the limitation of inflammation.
- The water (swimming pool) is an amazing safe place to rebuild trust in movement and impact.
If you return too soon, not only are you asking your body to compensate in other parts of the body for a weakness related to the injury but you risk re-injuring yourself and leaving yourself permanently weaker.
Update 2: March 31st 2017 – 9 weeks later: