[andystart]

Hi folks,

I’m new to the Uphill Athlete community.

I was just about to design and implement a 26 week training schedule after reading Training for the New Alpinism when I went over on my right ankle doing some winter climbing in Scotland. It was nothing major, but was quite a jarring twist and at the time I felt it through my whole body, particularly the ankle and knee. After a few minutes I was fine and I walked off the mountain no problem.

The next couple of days though it swelled up and was pretty painful for a while. So I just rested it. I’ve twisted ankles before and it’s never lasted more than a few days or so, but four weeks later and, whilst it’s definitely getting better, I’m still a long way off having full range of motion without pain.

Strangely, both my knees ache after sitting still for a while (something I’ve never had before). Also, the calf tendon and shin above the bad ankle constantly feels like it’s had a massive workout the day before, when I’ve done very little on it apart from casual walks around the park and one box step session a few days ago.

Anyone any thoughts on a good way to proceed? Any physio or light training anyone would recommend? Or is it just a matter of continuing to take it easy until the pain goes away? I’m slowly eating into the first weeks of my potential training with doing very little, which is a little frustrating.

Any advice much appreciated! Thanks, Andy

Topic

[Thomas Summer, MD]

Thomas Summer, MD on April 20, 2020 at 1:52 am #40667

Hi Andy!

Do you know how the injury exactly happened? Where was/is the pain? Where was/is the swelling? You are probably still limping?!
“winter climbing in Scotland” sounds tough! But being injured is even tougher. Anyway, don’t worry, we will help;-)

cheers!
Thomas

[andystart]

andystart on April 20, 2020 at 7:53 am #40674

Thanks for your response Thomas, much appreciated!

It was our last day of the week and we found a great spot on the mountain to slide down (it was great fun, but a bit silly in hindsight). So I’m picking up some speed sliding down on may ass and I stupidly put my cramponed, mountain booted foot down to slow myself. The crampon did its job perfectly and stopped me dead sending all the momentum into my ankle and leg. So my straight leg and whole body took a bit of an impact and then I went over the top of my ankle extending it back and inwards. It hurt, but it can’t have been anything too bad as I felt fine after few minutes – no pain anywhere until the day after next.

The pain and swelling were kind of at the front of the ankle and maybe slightly to the right. Now the swelling has reduced, the pain is mainly at the front and is worse when I try to fully flex the ankle rather than extend it. Looking at a diagram, I’d want to point to the area where the Inferior Extensor Retinaculum is, but I have no idea if that’s where the issue lies.

Fortunately I’m not limping. I can walk and climb stairs and do a lot of movement without problem. But if I try to run or climb or anything the requires full range of movement the pain kicks in. It’s really not that bad I don’t think, but it’s taken four weeks to recover to where I was hoping I would be after four days. And I’m chomping at the bit to get started on my training for a big climb in October!

Apologies for the long explanation, I’m unsure how to describe these things succinctly.

Many thanks again in advance,

Andy

PS. They say Scottish winter climbing is the best training ground in the world!

[Thomas Summer, MD]

Thomas Summer, MD on April 20, 2020 at 2:38 pm #40700

Hey Andi!

Do you have the possibility to get examined by an orthopedic, or a physiotherapist? It’s difficult to make a diagnosis without an examination, but for me, it sounds like you also injured the syndesmosis. I would limit dorsiflexion. Is cycling possible without pain?

Unfortunately, I’ve never been to Scotland yet. But I like Scottish whisky;-)

[Pete Dickinson MS,PT]

Pete Dickinson MS,PT on April 20, 2020 at 6:42 pm #40712

Andi,
I concur with Thomas….about the whiskey! I agree that prolonged healing response would indicate ligamentous or chondral involvement in the injury. This would necessitate a slow and steady rehab approach, and expectation of improvement. Change your exercise method to keep up your volume, and listen to your ankle’s response to load/impact. If you don’t progress, some investigations are reccomended to make sure there isn’t more of an injury than was initially indicated.
Pete

[andystart]

andystart on April 22, 2020 at 6:58 am #40732

Thanks both. And again, much appreciated.

Having read up a little on Syndesmotic ankle sprains, it seems to ring true. So a longer recovery would be expected, but not too long fortunately. I was worried if it persisted I would have to rethink my trip in October, as I need to be fit. But I feel more at ease now.

Slow and steady sounds like good advice. I don’t have a bike, but I went out for a very gentle jog for the first time today and whilst I could feel my ankle all the way, it seemed to hold up pretty well. I’ll assess how it feels over the next 24 hours.

I think improvement is starting to increase at a better rate in just the last few days, but if it doesn’t continue I’ll think about seeking advice. Our lockdown is pretty strict here in the UK though, so it couldn’t be until restrictions are lifted.

I may have a wee dram of scotch to celebrate!

Thanks again guys for your responses,

Andy

[Thomas Summer, MD]

Thomas Summer, MD on April 23, 2020 at 6:22 am #40812

Hey Andy!
How does your ankle feel after the run? Be careful with running. Any option for x-training?

I drank laphroaig from 1999 yesterday;-)

[andystart]

andystart on April 26, 2020 at 3:19 pm #40920

Hi Thomas,

Thanks for following up. I wanted to leave it a couple of days to respond to see how it felt. Your instinct about running was probably right. The ankle didn’t feel brilliant the next day. Nothing drastic, but the pain a touch more prominent. But Friday it felt absolutely fine and yesterday I did an hour of step climbing with no problems at all. So, in general, further improvement, which is positive I hope.

Is there any x-training you would recommend?

Laphroaig is a lovely whiskey and, at that age, a real treat!

Thanks again,

Andy

[Pete Dickinson MS,PT]

Pete Dickinson MS,PT on April 26, 2020 at 7:24 pm #40923

Andy,
Pool work can be a great way to get in some similar running movement patterns without the load. For a start to return to running I would do a walk/jog program, 2min walk/1min jog. Do this for 15min, see how you respond, if little pain or swelling, you can increase the program.
Cheers,
Pete

[Thomas Summer, MD]

Thomas Summer, MD on April 28, 2020 at 3:04 am #40970

Hey Andy!

1h of step climbing sounds good. Any pain afterward? If that doesn’t cause any problems I would continue with it. As long as you don’t get too much dorsiflexion!?
If you have access, pool work (swimming/aquajogging) would be great.
Maybe you find the possibility to ride a bike!?
I would also recommend compression socks.
And of course whisky – locally and per os;-)

cheers!
Thomas

[andystart]

andystart on April 29, 2020 at 9:35 am #41026

Thanks again both.

What I’d do to have access to a pool at the moment! For me, that won’t be possible until restrictions are lifted. I did another step climb today for 75 minutes with a 35lb pack at just below threshold, which felt great and no issues with the ankle (a good podcast masks the tedium of the surroundings!).

The walk/jog program and the biking (and whiskey) sound like good options. It’ll be 6 weeks on Friday since the injury and whilst it feels like it’s on the mend, it’s disappointing not to be able to get off to a good start with my 24 week Uphill Athlete plan. But I’ll have to keep adapting it and see if I can get back on track with it when full movement returns.

Thanks again for your advice both,

Andy

PS. There is little to no pain now when the foot is fully flexed without any resistance, but if I put some weight on it and try to fully flex it or try to do anything explosive, like a squat jump, that’s when I feel pain. Slow, but improvement none-the-less!

[Thomas Summer, MD]

Thomas Summer, MD on April 29, 2020 at 1:01 pm #41037

sounds like you are making good progress!? Keep up the good work, but listen to your ankle. In the case of doubt, better do less than more.

cheers!