Scott’s Blog

Many have been asking about my process in speeding the recovery of my recent ankle sprain prior to Hardrock. I had about three and a half days to do all I could of intense rehab during these initial stages of healing. Following the basic RICE recipe with some added natural remedies, here it is.

**But please note this isn’t intended as a prescription or recommendation. As all injuries and individuals are different, be sure to get a diagnosis and establish a proper treatment plan with an appropriate health care provider.

REST
Initially I was hardly able to walk so rest was easily the obvious thing to do. I’d like to note I normally have no trouble resting during a taper phase anyhow. However I wasn’t able to do the easy running I would normally have done. I pretty much stayed off the ankle, limiting walking and standing to the bare necessities for the first two days. Day three, the day before the race, I tested it with some running on the course and was up and around a bit more for registration and prepping for the following day. Usually I would be cooking and getting things ready much more during the week prior to a race, so completely staying off of it was difficult, but I forced myself to it. My crew started a few days before the race this time!

ICE
Swelling and inflammation are essential for tissue healing in the initial stages after an injury occurs. Not wanting to inhibit the inflammation process completely, but to keep swelling from becoming excessive, icing is essential during this phase. Helping to flush out stagnant fluids so new fresh fluid can come in and do it’s magic is key. As you can see from the photo, which was taken the day before the race, I had plenty of swelling. I used direct ice by Pro-Tec Ice Up, keeping the ice moving directly over the skin for 5-8 minutes. I also used an ice pack by simply bagging ice and placing it directly on my skin. I usually would apply this for 10-20 minutes with a wet cloth between the ice and my skin to help conduct the cold, and typically with compression and elevation (see below). I used these methods about eight times per day, knowing frequency is key.

COMPRESSION
Compression also helps to reduce excess inflammation via direct pressure over the swollen area. I used compression while icing and elevating, but especially when I needed to stand or walk, as this is the time gravity plays a big role in as the fluids have a more difficult time making their way back to the heart. I used an elastic bandage wrapped around the ice while icing and elevating. In between I used the Pro-Tec Ankle Wrap for compression, which also provided more stability to protect the ankle from re-injury. While sleeping and when wearing the Pro-Tec Ankle Wrap, I also wore a pair of Oxy Socks, which I use often after 50 mile or longer races. Something that I used during the race and the day before was a U-shaped foam and felt insert that wraps around the lateral maleolus to provide compression specifically to the veins in the area of the injury. This dramatically minimizes swelling in the area of injury, allowing for greater range of motion and reducing pain.

ELEVATION
Gravity can either help or hinder swelling. In the case of elevation, it assists the excess fluids accumulating in the injured limb in returning to the heart. I made sure I elevated as high as possible to take full advantage of gravity, knowing that as close to perpendicular to the floor as possible is best. Lying down I put my legs on a column or wall so the ankle was as high as possible above my heart. I would ice during part of elevating and spent probably six hours or more each day in this position. I spent a lot of this time visualizing the healing which was occurring and keeping my energy positive.

ADDITIONAL TREATMENT
In addition to the RICE treatment, when elevating without ice, I was very aggressive with range of motion exercises. Deciding to start this early, I began day one post injury with ankle plantarflexion, dorsiflexion, eversion, and small amounts of inversion, with ankle circles in both directions. On the second day following the injury, I added resistive strength exercises with yellow Theraband for all the ankle motions above, except for inversion, twice daily with 40-50 repetitions each.

I took zero NSAID’s (non-steroidal anti-inflammatory drugs) prior, during, or following the race. Instead I focused on natural anti-inflammatory agents. Arnica montana in oral homeopathic form was taken four times daily in addition to an arnica gel applied to the ankle prior to retiring for the evening. I took bromelin (enzyme from pineapple) in 2400 GDU four times daily and incorporated large amounts of ginger and garlic into my meals. As recommended by my Indian friend Imtiaz, I had a drink comprised of warm soy milk combined with two teaspoons of dried turmeric four to five times per day between meals. Imtiaz also made me a tumeric compress worn Wednesday night while sleeping. The compress was comprised of turmeric, lemon and lime juice, salt and pepper.

Twice daily I used ultrasound courtesy of Emily Baer. I applied pulsed ultrasound for five to eight minutes while my foot and ankle were submerged in bucket of water.

During the race I used an Active Ankle brace from physical therapist John McAward of Durango. Due to the acuteness of the ankle sprain I needed to use a more substantial brace as I didn’t have enough time to retrain the musculature. The Active Ankle brace is comprised of a hard plastic bi-valved shell with padding and a pivot point allowing for ankle plantarflexion and dorsiflexion. Underneath the brace and my sock I used a U shaped piece of felt that wrapped around the lateral maleolus to decrease the swelling.

I felt this was a recipe that allowed me to have as speedy of recovery as possible with the limited amount of time I had in the days prior to Hardrock. Of course, running 100 miles on it put me back to nearly square one, but the second time around I have had ample time and complete healing.

This entry was posted on Thursday, August 23rd, 2007 at 7:02 am and is filed under Nutrition, Racing, Training. You can follow any responses to this entry through the RSS 2.0 feed. You can leave a response, or trackback from your own site.