Training with/around ankle sprain

[Newton90]

Hi Docs,

I'm not exactly thrilled to be submitting a topic in this particular subforum, but oh well, stuff happens. Earlier today while weight throwing I loudly rolled my ankle and since then the outside of my ankle around and above the fibula has swelled up like a big vaguely ankle-shaped fruit. I'm able to hobble around on it right now as needed without too much pain or discomfort (maybe a 1-2 on the ten point scale, probably from the swelling) and it feels a little loosey-goosey. The doctor at urgent care said no imaging was necessary and was able to tell it was sprained just by looking at it. I checked the forums and found this post which looked pretty helpful and more in-line with my goals than sitting on my butt for 3-4 weeks, so I'll be doing my ABC's and a bit of walking around the house as the ankle permits.

I just had a few questions to run by you about modifying my training (BT block 2) to rehab this silly joint:

In the event that it's painful to move around on for a few days, I'd still like to exercise my legs as best I can. My gym has a variety of machines (leg extension, hamstring curl, etc.) which don't put pressure on the ankle and I can swap in for the main barbell movements/accessories. Does this sound good or would you recommend just sticking with low weight squats and deadlifts to tolerance? I figure I could probably do both without too much concern for timing since I probably won't need a full 3-4 minute rest between sets of bodyweight/empty barbell movements.

Once I'm back to squatting and deadlifting close-ish to normal, should I roll those movements and their accessories back to the beginning of block 2 or should I take them all the way back to block 1?

Cardio in the near future - wat do? Normally I like to go for a brisk walk around the neighborhood or walk on a treadmill at an incline, but those are probably out of the question for a while. Even rowing and cycling machines still transmit force down through the ankle. I suppose I could just do the assault air bike with my arms, but that sounds a little silly.

How will I know when I'm ready to return to heavy throwing? It's far off in the future, I'm worried (perhaps irrationally) that even if I'm feeling great with no pain and my ankles can handle the relatively constant downward force from heavy squats and deadlifts just fine, the ligaments and tendons in my ankle still won't be ready for the wacky uneven torques and forces involved with e.g. weight throwing. If possible I'd like to avoid a repeat of this event.

Thanks!

[Derek Miles]

This thought process could not be more spot on. If your ankle is swollen and painful to walk on, I would lean a little heavy on machines for a few days. I typically will have athletes use the machines for the stimulus portion and as you can start tolerating squatting and deadlifting following behind with some sets to see how things feel. There tends to be an inflection point where it starts feeling okay to squat and deadlift again and at that point you can pare back the machines. I think as far as rolling back to the beginning of blocks, you can likely do what you see fit. Most of the time we don't really need to go all the way back to the beginning if someone does a good job of training around the injury.

For cardio, so long as it's not swelling up on you afterwards the brisk walk is perfectly fine. If not, people tend to tolerate the bike pretty early on and that is normally where we start most people for getting back into cardio. As your range of motion improves and swelling subsides, people tend to tolerate the rower better.

As for the last question, I would say after you are feeling good with some lighter throwing. I know that sounds kinda obvious but I would start introducing some of the movements with weight you know you can handle without issue and walk your way up. Sometimes with injuries like this it can be as much about getting confident exploding through a throw as anything else. From a straight rehab perspective, this is normally when we break out some single leg exercises like a posterior medial tap or single leg deadlift to work some proprioception. You can also put in some short bouts of things like dot drills to get comfortable going fast and in different directions. Post sprains it is often good to just find some random drills to work and then add in some components where you are having to react. Sometimes I'll do things like have athletes grab a tennis ball, stand on one leg and throw it against a wall. It comes back a little different each time and is often enough to make you lose your balance a little bit. As you get better at it, step back a little further. None of these are musts, but ideas of different ways to work on getting back.

[Newton90]

Thanks for the advice! Unfortunately, after seeing my regular doctor and having X-rays taken of the injury, it turns out I'm dealing with a Weber type B fracture of the distal fibula. I've been given a boot, crutches, and an appointment with an orthopedic physician to determine next steps and if surgery will be necessary. So needless to say, it's looking like the recovery might be a bit longer than anticipated. Bummer.

[Derek Miles]

Sorry to hear that man. I guess it's time to get some Ronnie Coleman "Yeah Buddy's" on knee extension and hamstring curls for a few weeks. You can still do some single leg standing exercises on the other side as well.

[Newton90]

Hi Docs, slightly different question this time but I figured I'd reply to the thread I had already started since it's somewhat related. I'm trying to figure out how best to get back into training while working around the ankle issue.

Quick update: shortly after my last post I got a plate and six screws put into my fibula and the orthopedic physician told me to stay off it. During the last month of being on crutches I didn't feel comfortable going to the gym so I've been doing little home workouts to try and stay as active as I could. This last Wednesday he gave me the go-ahead to start putting weight on and walking on the foot (in the boot, of course). I also got set up with physical therapy for the ankle. Now that I can walk and stand without crutches, I've gone back to the gym a couple times but I'm having some trouble with programming around the current limitations and the asymmetries that have popped up over the last month.

I realize this is probably beyond what can be done via the forums, so I'm wondering I should pursue the injury & rehabilitation training or the more general athletic coaching? Since I'm already seeing a PT for the ankle I feel okay in that regard, I'm mostly trying to see what the best option is for getting the rest of my body back on track.

[Derek Miles]

It likely ultimately depends on what your goals are. I feel comfortable saying most of our performance coaches this is well within their realm but on the same side we handle this on rehab as well. If your goal is just powerlifting, the performance side but it sounds like there is some plyometric/change of direction components to your training that may be better served with us.