Treating a sore ankle with angst and ice: 6 tips

I woke up one morning about 3 weeks before I was to run the Philadelphia Marathon with a sore ankle. Damn.

I had just completed a 21 mile run a few days prior, and despite a few rough patches, the run went well.

But, when I woke up two days later, the ankle was officially sore, and I was officially in a terrible mood. An injury or pain that keeps me from running–even for just a day–is enough to turn on the wicked witch switch. I had plans to do about 7 miles of speedwork on Sunday. But, my ankle hurt just walking from the bedroom to the bathroom.

John asked me what I was doing, and I started whining: “I don’t know! I don’t feel like swimming or biking, and I don’t think I can run.” Wah-wah-wah. Oh, poor, poor me.

Then, John said, “It’s not a big deal, dude. The worst case is that you won’t be able to run Philly.”

Have you ever seen the exorcist? Well, John wished he had one at that moment to deal with my inner demon that really did not want to hear anything about not being able to run the Philadelphia Marathon. The worst case is not a big deal? Grrrr! I have been looking forward to running the Philadelphia Marathon since the moment we signed up for it in the summer. It will be my first “big city” marathon, and my sister-in-law Tracy’s first marathon.

I shot him a look. And, he relented. “I know, I know – it sucks.” Yeah, I’m not sure “sucks” really captures the feeling I would have if I couldn’t run the Philly because of a stupid ankle. What the heck is wrong with it, anyway?

As you are probably sensing, I don’t react well mentally to injury – serious or otherwise. I immediately enter extreme anxiety mode, and start to question whether I have a stress fracture. Most of us have that one thing that we fear–however irrational or unfounded the fear might be. My fear is a stress fracture. And, no matter what the pain, I immediately think I have a stress fracture.

So, as soon as I have a pain that exceeds what I deem “normal,” I do what any person concerned about their health does: I head to Google. Let’s call this the stay-at-home-rather-than-go-to-the-doctor mode. I search (sometimes obsessively for hours) about symptoms and signs that a particular body part might or might not have a stress fracture. Naturally, my anxiety interprets each article–from the one posted to official site of the Orthopedic Surgeon Association to the one posted on CrazyRnnrGuy’s blog–as evidence that I am afflicted with a stress fracture that will take (*shudder*) anywhere from 6 weeks to 3 months to heal. WHAT!? Don’t these people know I have a marathon to run in 3 weeks!?

At this point, I enter the total wacko mode where I am unable to respond reasonably to any argument that I probably don’t have a stress fracture (which, statistically speaking, I probably don’t). I become morose, and a little bit mean, as I start to convince myself that my racing days have ended – before I even really got started. I start to obsess over how weak my body must be because other runners are able to do so much more without injury. Again, wah-wah-wah, poor, poor me.

Then, I become proactive and the obsessive icing mode begins: 20 minutes on, 20 minutes off. At this point, I become hopeful again, thinking that maybe the injury is not a fracture, and if it is a sore muscle, icing will help speed the recovery time. As my obsession reaches its zenith, I pull out the heating pad and heat the afflicted body part in between icing sessions.

Then, a day or two passes, and the pain begins to subside, which indicates that I do not, in fact, have a stress fracture. This cycle happens whenever I experience a pain that is not typical muscle soreness. Thankfully, this full scale panic has only happened three times, if you count Sunday’s ankle pain. With respect to this latest cycle, I’m happy to report that it does not appear to be a serious injury, or even an injury at all. Rather, I believe I had a tight achilles ligament that was causing pain in my side and back ankle area. Whatever the problem, I’m better today, and I’ll be able to return to running tomorrow.

So what can we all take from my irrational cycles in dealing with non-typical pain? Hopefully something.

  1. Icing is an important part of the recovery process–even before you start to feel any soreness or pain. I highly recommend using icing to enhance muscle recovery. After all, sore muscles are inflammed muscles. If you ice them, you will reduce the inflammation. If you have an especially difficult workout, consider icing your “challenge zones” following the workout: 20 minutes on, 20 minutes off. Icing works best when applied as soon as possible after the injury appears.
  2. Consider taking cold showers or ice baths. I know, this suggestion might make me sound loonier than what I’ve already written. But, IT WORKS. Ice baths are not for the faint of heart. I read once that some elite runners will wear parkas while they sit in an ice tube. That’s hard core! The advantage of an ice bath or the cold shower is that it works on the entiretyof your lower extremeties, rather than just the localized icing for a knee or quadricep. If you can stand the cold, you will reap the recovery rewards. The value of an ice bath is probably better for preventative measures and for reducing inflammation after long and hard efforts.
  3. Heating might be helpful, but heating needs to be used with caution because it expands and further inflames muscles. If your issue is one of tightness, heat can be helpful. If you are trying to increase blood flow to a tricky area, alternating cycles of heat and ice can be helpful.
  4. Stretch. If you are like me, you probably don’t give ample time to stretching. I used to have time to go to Yoga 3-4 times a week, which really helped to lengthen and strengthen my muscles. Now, however, I’m lucky if I make it there once a week. So, I don’t stretch as much as I should. What do I get for that? A sore ankle. A good reminder to take care of my muscles. Generally speaking, dynamic stretching is more helpful than static stretching.
  5. Strength Training. For older athletes especially, the evidence is pretty clear that strength training is an important part of your performance progress and injury prevention. This can come in the form of weight training, functional strength training, core work – and preferably a mix of all of those things.
  6. Relax and Rest. Chances are that pain you are feeling isn’t anything serious. But, that doesn’t mean you should continue to have hard workouts while you are experiencing pain. Rather, the RICE formula is still the best response: Rest, Ice, Compression, Elevation. Consider it a good reason to kick your feet up!

I’m grateful my ankle pain was not a symptom of something more serious, which would prevent me from working toward and reaching my goals. The Philadelphia Marathon is one step in my long-term goal to participate in the Lake Placid Ironman 2010.

(Post note: I successfully ran the Philadelphia Marathon in 2010, and completed Lake Placid as well. Click the links to read the race reports from those races. Thanks to the tips I offer here, I’ve been mostly injury free since that time.)

If you have tips or tricks for preventing and dealing with pain and injury, please post them here!


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  2. Hi, Matt – sorry I took so long to reply. I’ve been having computer issues and didn’t see this comment until now. The ankle was just sore – maybe a minor soft tissue issue. It was gone within a few days. icing definitely works.

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