Running safely in slippery conditions

If you slip and hurt your ankle during running, depending on which way you fall, you may injure hamstrings if your foot slips forward when your leg is in front of you, your groin if your leg slips sideways or your knee if your foot twists.

The affect on the damaged area is to jerk the tissues suddenly, which injures the muscle fibres that were working at the time to produce the running action and keep you balanced. It also pulls the ends of the muscles hard where they join the bone, damaging the tendons at these points.

Tendons are tough fibrous tissues that join muscle to bone. Some, or all, of the fibres may be broken. Ligaments that hold the bones together may also be damaged, those forming and supporting the ankle joint are the most likely, but the knee may be affected if the foot twists.

In the case of the ankle, during the fall or slip the foot usually bends inwards and the damage is mainly to the outside of the ankle; to the supporting ligaments and muscles that prevent this action in normal gait. These muscles are not as strong as the calf muscles that propel us along on a run and they may be seriously damaged by such a fall or slip.

The structure of the leg and foot is defined by long muscles and tendons, designed to create the leverage necessary to move the body weight via the foot. Many tendons cross at the ankle, creating a lattice of moving fibres that have special narrow channels across the bones. Once the tissues are swollen, these paths are constricted and movement becomes difficult, so the priority is to reduce swelling. Keeping the blood and lymph flowing is imperative for full recovery back to running.

The lymphatic system, essential in providing the body’s immunity, has problems where an injury has prevented movement; the lymph then slows down and thickens, eventually hardening too much to flow at all and remains stuck at the injury site. As long as the damaged cells remain, movement can be permanently restricted.

It is important therefore, not only to use anti-inflammatory treatment (to prevent fluid build-up) at the time of the incident, but also to clear the damaged tissue away to remove the blockage. This is achieved through remedial massage.

The body can, and will, heal itself and this is encouraged by eating fruit and vegetables containing nutrients that speed recovery. Massage helps, by increasing the blood and lymph flow; removing damaged cells, preventing infection and supplying oxygen and nutrients. It also relaxes any muscles that have remained contracted from the time of the running injury.

Immediate action to take after a running accident
Put arnica lotion on the injury and take arnica tablets. This minimises the damage in an extraordinary way, especially if you can put the lotion on before the area begins to swell (Cconsider carrying a few tablets in a bag and a small bottle of lotion your pocket.) This is sufficient emergency treatment until you can rest your leg.

Traditionally injuries are iced immediately to reduce swelling and pain, repeated for ten minutes every two hours. Opinion is divided about the efficacy of icing for periods longer than 24 hours. I feel that it is better not to slow down the body’s healing efforts with cold. However if arnica is not available, ice reduces the initial swelling. Then the area needs to be raised to help prevent swelling further.

Later action to take for a running injury
Keep weight off the leg and, depending on the severity of injury, rest for 24 hours. Use crutches if necessary, and try and keep the leg elevated as much as possible.

Seek medical advice if the pain does not begin to subside after resting for 24 hours; if the ankle turns very dark purple, if there is a bunch of muscle in a big lump in the hamstrings, or if the pain is next to the bone rather than in the centre of the muscle.

Continue to take arnica (once an hour day one, down to three times a day from about day three) and apply arnica cream or another anti-inflammatory agent.

Keep moving the joint as much as possible within your pain threshold. Stroke the damaged area towards your heart with gentle strokes, as they will need to be very light to begin with.

You may not be able to touch the area at all for 24 hours. If this is the case, massage from immediately above the painful area towards the heart, as this will still provide assistance to the damaged area. Begin to stretch as soon as you can do so without pain preventing you.

After about three days, seek remedial massage treatment. If the injury is severe, probably all that can be done is flushing strokes, but that is fine, removal of the damaged cells and encouraging the blood and lymph flow is the most beneficial thing at this stage.

When you begin to run again, wear a support bandage for the first few outings, but then try to run without it too to strengthen your muscles. Professional remedial massage or sports massage will ensure that all areas of damage are discovered and dealt with to prevent build-up of injured tissue and repeat injuries at the same site.

Exercises and stretches for runners
For the ankles:

• Circle your ankle each way ten times, several times a day.
• Stretching forward, back and side to side, several times a day.
• Raises on a step: stand with heels over the edge of step, slowly raise and then lower your body weight to below the edge of the step, repeat five up to ten times.
• Swimming

For the hamstrings:

• Touching your toes, hold for five seconds three times.
• Seated toe touch: pulling toes back towards you, same as above.

Remember to stretch well before you go out to run again!