Hey {{first name | reader}},
It’s Tuesday, which means your weekly fitness check-in. Welcome to Week #39.
Last week I wrote about how happy I was to be running again. I’m not superstitious, but apparently that issue accumulated some bad karma.
On Sunday afternoon, about 400 meters from the end of my run, I stepped in a divot and rolled my ankle hard. I didn’t fall. My run, however, immediately became a hobble.
I love running on JFK Drive in Golden Gate Park. I had never considered how far JFK Drive is from a bus stop until I had to cover the distance mostly on one foot.
The view from my couch
I hold a lifetime membership in Club “Shake It Off,”1 which I know is the worst possible approach to an injury.
Minimizing seems to run in the family. When one of my nieces was little, no matter what befell her, she would pop up and shout, “I’m okay!”
She was frequently not okay.
I spent Sunday evening doing the adult version: saying “I’m okay” from the couch, leg propped on pillows, a bag of frozen peas on my ankle, while searching for the nearest urgent care.
The diagnosis was an acute sprain, not a break. The prescription was rest, ice, compression, and elevation, plus ibuprofen and acetaminophen for three to five days. No running for five to six weeks.
My strength training, meanwhile, will be mostly upper body, with a few machines to remind my legs that they still have jobs.2
A sprain is a ligament injury. Ligaments connect bone to bone; tendons connect muscle to bone. After two Achilles ruptures, I know the tendon side of that sentence far too well.
Most ankle sprains happen when the foot rolls onto its outer edge, stretching or tearing the ligaments on the outside of the ankle. They range from a mild stretch to a complete ligament tear.
And here’s the part I’m trying not to “shake off”: once you’ve sprained an ankle, you’re more likely to sprain it again. A previous ankle sprain is one of the clearest risk factors for another one. That’s why rehabilitation matters. The goal isn’t merely to get rid of the pain. It’s to restore motion, strength, balance, and the ankle’s ability to react when the pavement does something stupid.
So I’m doing this one properly.
Rest doesn’t necessarily mean weeks of total immobility. For many ankle sprains, treatment shifts toward gentle, protected movement as pain and swelling settle, followed by strengthening and balance work. Then comes running.
Not the other way around.
The squat goal has a December deadline. The ankle did not consult it.
The pull-ups, meanwhile, just got my full attention.
I’d planned to write this week about how not to let a setback derail your training. A few hours in urgent care and a trip home on crutches took some of the wind out of my sails.
Next week.
I’ll be writing from experience.
📖 ASK ME ANYTHING
Question: When does a twisted ankle need medical attention?
Answer: If you can’t walk on it, that’s a pretty good reason to get it checked.
Clinicians often use something called the Ottawa Ankle Rules to help decide whether an ankle or foot injury needs an X-ray. Among the things they look for are:
inability to take four steps both immediately after the injury and when you’re being evaluated;
tenderness directly over specific ankle bones;
and, for midfoot injuries, tenderness over two particular bones in the foot.
It’s not a home diagnostic test, and being able to walk doesn’t guarantee that nothing is wrong. But it’s a well-validated way for clinicians to identify people who are unlikely to have a fracture.
You should also seek medical attention for obvious deformity, numbness, severe pain or swelling, or symptoms that aren’t improving.
I could not take the four steps.
I nevertheless thought it might be better after a night’s sleep.
It wasn’t.
I went to urgent care.
💡 MYTH BUSTING
Myth: It’s only a sprain.
Reality: “Sprain” describes an injury to a ligament. It does not tell you whether that injury is trivial.
A mild sprain may heal quickly. A more serious one can involve a partially or completely torn ligament and require weeks or months of recovery. And if you skip the rehabilitation because the pain has disappeared, the ankle may still be weaker or less stable than it was before.
That matters because the best predictor of a future ankle sprain is a previous ankle sprain.
The first one may be bad luck.
The second is why rehab exists.
🍽️ RADISH FUEL BOX
Sunday night was not a cooking night.
Feeling sorry for myself, I opened Uber Eats and ordered what passes for Jamaican food in San Francisco. Then I broke out the dark chocolate.
An underappreciated side effect of real pain is a sudden, urgent need for comfort food.
I have no regrets.
The peas stayed on the ankle.3
📚 WORTH YOUR TIME
I probably should have read this Harvard Health article on preventing ankle sprains before I started running again, but it may not be too late for you.
It’s short, practical, and built around three things:
calf strength, progressing toward single-leg calf raises because two-legged ones eventually get too easy;
side-to-side ankle strength using resistance;
and a lower-calf stretch most of us skip.
It also has a useful explanation of what actually happens to the ligaments when you roll an ankle.
I am reading it now.
Excellent timing.
💪 TRY THIS WEEK
Stand on one foot.
That’s it.
Thirty seconds per side, twice a day. Brushing your teeth is a good time. When that gets easy, make the exercise harder rather than simply standing there indefinitely — assuming you have a healthy ankle and a safe place to do it.
Balance training is one of the better-supported ways to reduce ankle sprains, particularly repeat sprains.
I’ll be adding it to my own rehab when the ankle is ready.
It may be the least athletic-looking exercise I’ve ever recommended here.
It’s also one I probably should have been doing all along.
Stay strong,
{{first name | reader}}
P.S. I told everyone I was okay. I said it lying on the couch under a bag of frozen peas.
1 It pains me to cite any Taylor Swift song, but this one is an earworm I can’t get rid of.
2 On the upside, I won’t be doing Bulgarian split squats anytime soon. I’ll miss the heavy squats and deadlifts. The Bulgarians and I could probably use some time apart.
3 That bag of peas has now done more for my health than any vegetable I’ve actually eaten this year.