The Common Cause of Running Injuries Most People Overlook

It may sound counterintuitive, but the best long-distance runners didn't get so good from running alone. To run harder, better, faster, stronger, they supplement their runs with other forms of exercise like cross-training, strength training, and interval running. Studies show these are all important elements in any training plan to become a better runner¹ .

But many runners still neglect one crucial component of training: improving their balance. Research shows balance training can be used to prevent and treat acute ankle sprains, and reduce the chances of ankle injuries in the future² .

After all, the last sound any runner wants to hear while running is a Rice Krispies-style snap, crackle, or pop signaling the dreaded ankle sprain. Depending on its severity, a sprained ankle can disrupt even the most carefully planned training schedules and take anywhere from four weeks to a seemingly endless 12 months to fully heal. Ain't nobody got time for that.

The Source of the Sprain

Unlike repetitive stress injuries—like shin splints or runner’s knee—traditional ankle sprains are acute, trauma-related injuries from rolling an ankle on uneven terrain, explains Jason Fitzgerald, a running coach and author of 101 Simple Ways to be a Better Runner. This stretches or tears one or more main ligaments that connect the ankle to the foot, creating swelling and bruising at the site of injury. And it's even more common than you may think: An estimated 25,000 people suffer an ankle sprain every day in the U.S.

But you don’t have to twist your ankle on a trail or an uneven sidewalk to experience a bothersome feeling in your lower leg. Moderate (rather than trauma-related) ankle or foot pain can also affect runners. "A large percentage of runners tend to overstride or pace improperly, which can lead to ankle soreness,” says Chris Johnson, a physical therapist, All-American triathlete, and triathlon coach.

Another reason why runners get the short end of the ankle-sprain stick: Running is a plyometric activity, and bounding from one leg to the next with relatively short contact times puts considerable demand on a runner’s muscles and joints, which can lead to injury, Johnson explains.

And that's where balance training comes in: “If a runner has difficulty balancing on one leg on solid ground, running will be that much more difficult due to the increased forces and dynamic nature of the sport,” Johnson says. Need more convincing to improve your balance? Check out these four reasons:

1. You'll develop Herculean ankle strength.

"Balancing exercises can strengthen the ankle and surrounding musculature that provide stability while running," Fitzgerald says. One study found that athletes with chronic ankle instability demonstrated significant improvements in their ankle strength after completing a four-week balance training programs³ .

2. You'll improve your sense of awareness.

A neuromuscular component of balance known as proprioception (try saying that 10 times fast), or your sense of where your limbs are positioned in space, becomes impaired during an ankle sprain. Single-legged exercises train the brain to anticipate and coordinate movements in one’s leg muscles, making athletes less prone to recurrent ankle sprains⁴ . That's also why strength training, with a focus on improving balance and proprioception, can help runners (especially trail runners) skirt around surprise bumps and obstaces on the ground by heightening their awareness of where either foot will land, relative to other objects⁵ .

3. It helps you balance on one leg (a.k.a. run).

“When you run, there’s a period of time when you’re completely in the air—unlike walking, when one foot is always in contact with the ground,” Fitzgerald says. “In this sense, running can be considered a very coordinated series of one-legged hops.” Single-leg exercises (like the ones we highlight below) can improve running-specific strength and limit any imbalances that might occur.

4. It requires little to no equipment.

Balance training can be done literally anywhere, at any time. Most single-leg rehab exercises fit easily into any routine, allowing injured runners to multitask like a boss.

Your Action Plan

So you've twisted your ankle—now what? First, it’s important to keep pressure off of the injured leg (remember RICE: Rest, Ice, Compression, Elevation). Next up: See a doctor who can recommend the best course of treatment, which may or may not involve an ankle brace to maximize ankle protection and minimize swelling.

Whatever you do, don't run. Running too soon after a sprain may inflict permanent damage. In fact, people who have already had an ankle injury are five times more likely to have another ankle issue in the future⁶ . “Too often, I find that injured runners who seek physical therapy services are in denial,“ Johnson says. “They make the situation worse or prolong it by trying to run through it.” Chronic ankle instability from a poorly treated ankle sprain can also lead to more serious problems such as degenerative arthritis, he says.

A better plan of attack: Focus on low-impact activities, like swimming, cycling, or rowing, which don’t require sharp, sudden ankle motions. As athletes gradually ease themselves back into the groove of running, Johnson recommends safeguarding against injury by not increasing their mileage more than 30 percent each week. (Other pros suggest following the 10 percent rule as an even more moderate plan for increasing mileage.)

Finally, improve ankle strength and minimize the risk of re-injury with simple balancing exercises. These five moves are easy enough to do anywhere, anytime—even while brushing your teeth—to fortify injured ankles.

1. Single-Leg Balance

"Simply balancing on one leg without shoes is a great first step for most runners,” Fitzgerald says. Begin by balancing on the injured leg with a stable object nearby, such as a desk or a table. Perform the exercise without shoes, standing on a flat, stable surface. Count to 10, then rest. Eventually, work up to 60-second holds. Try to do three 60-second sets twice a day.

2. Single-Leg Balance with Additions

For an added challenge, balance on your injured leg with crossed arms, then with closed eyes. Finally, attempt to stand with the injured leg on a cushion (but build up to this slowly). Each of these additions will destabilize the body, making the single legged balance more difficult to perform. For each, count to 10, then rest. Eventually, work up to 60-second holds. Try to do three 60-second sets twice a day.

3. Single-Leg Alphabet Drawing

Once balancing on one leg becomes easy, Fitzgerald recommends dynamic balancing exercises. Stand on one leg, tracing the letters of the alphabet in the air with the elevated foot. “This dynamic motion requires the ankle to work much harder to stabilize the body,” he says. Complete the alphabet on one leg, then switch. Complete three sets on each leg.

4. Single-Leg Squat

Single-leg strength exercises such as pistol squats are very specific to limiting asymmetries and improving running strength, Fitzgerald says. To perform a single-legged squat, begin by standing on one leg, arms extended straight in front of the body. Slowly lower the body so that the standing leg almost makes a 90-degree angle with the ground. Return to the starting position slowly, controlling the movement as you rise. For added ankle strength, perform these exercises barefoot. Work up to 10 reps on each leg.

5. Slow-Motion Marching Drills

To further recuperate functional ankle instability and correct gait imbalances, Johnson recommends dynamic slow motion marching drills. March forward in a slow motion, keeping the thigh and knee flexed at a 90-degree angle. Perform the exercises barefoot with relaxed toes. First, attempt to march wobble-free for 30 seconds. To master the exercise, march wobble-free for 60 seconds.

Works Cited

1. Effects of cross-training. Transfer of training effects on VO2max between cycling, running and swimming. Tanaka H. Sports medicine (Auckland, N.Z.), 1995, Mar.;18(5):0112-1642. Effect of resistance training regimens on treadmill running and neuromuscular performance in recreational endurance runners. Mikkola J, Vesterinen V, Taipale R. Journal of sports sciences, 2011, Aug.;29(13):1466-447X. Run sprint interval training improves aerobic performance but not maximal cardiac output. Macpherson RE, Hazell TJ, Olver TD. Medicine and science in sports and exercise, 2011, Aug.;43(1):1530-0315.
2. Systematic Review of Postural Control and Lateral Ankle Instability, Part II: Is Balance Training Clinically Effective. McKeon, P., Hertel, J. Journal of Athletic Training, 2008; 43(3): 305-315.
3. Balance Training Improves Function and Postural Control in those with Chronic Ankle Instability. McKeon, P., Ingersoll, C., Kerrigan, D., et al. Medicine and Science in Sports Exercise, 2008; 40(10): 1810-9
4. Systematic review of postural control and lateral ankle instability, part II: is balance training clinically effective? McKeon PO, Hertel J. Journal of athletic training, 2008, Sep.;43(3):1938-162X.
5. Effects of a 6-week strength and proprioception training program on measures of dynamic balance: a single-case design. Mattacola CG, Lloyd JW. Journal of athletic training, 2010, Jun.;32(2):1062-6050.
6. Ankle injuries in basketball: injury rate and risk factors. McKay GD, Goldie PA, Payne WR. British journal of sports medicine, 2001, Jun.;35(2):0306-3674. Reinjury after acute lateral ankle sprains in elite track and field athletes. Malliaropoulos N, Ntessalen M, Papacostas E. The American journal of sports medicine, 2009, Jul.;37(9):1552-3365.

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