Prevention: Keeping Ankles from Taking a Turn for the Worse
By Martha Thomas

Unless you're a swimmer, there's a 75 percent chance that your sports injury will be ankle - related," says William Hamilton, senior attending orthopedic surgeon at St. Luke's - Roosevelt Hospital Center in New York City. Consider that the ankle is only a third as big as the knee but bears the same weight. Add the stress of hiking, which triples the impact on the ankle, or running, which doubles that again, and it's not surprising that the connective tissue surrounding the ankle occasionally buckles under the pressure. Sprains (injured ligaments) and strains (injured tendons) both cause immediate swelling and pain and, if not treated properly, repeat injuries down the road.

The first line of defense against ankle-torquing obstacles isn't braces, tapes, or stiff backpacking boots. According to Tod Schimelpfenig, risk management director of the Lander, Wyoming - based National Outdoor Leadership School, the key is strength and conditioning. "If someone told me that they had to tape their ankles before taking a course," he says, "I'd send them home to get their ankles in shape first."

Dr. Donald Baxter, an orthopedic surgeon who treats NBA players at Baylor College of Medicine in Houston, cautions that "creating a fixed, immobile joint by taping the ankle just transfers the stress to the knee." The best way to prepare the ankle to deal with the stress itself, he says, is to build the peroneal muscles, which run up the outside of the calf. This exercise, using elastic tubing or a towel, will strengthen the peroneals: Sit upright in a chair with the tubing under the ball of your right foot and both heels on the floor. Holding the two ends of the tubing in your right hand at knee level, gently pull the tubing up and over toward your left leg while pushing the ball of your right foot down toward the floor. Do 20 reps with each ankle, twice daily. Against-the-wall stretches with heels planted and one leg forward, one back, will also help by stretching the Achilles tendon. With your back leg straight, lean forward until the calf tightens. Hold for 15 seconds and then gently bend the back knee to stretch the inner Achilles; switch legs.

If your strengthened ankles do fail you on the trail, classic RICE -- rest, ice, compression, and elevation -- is the best therapy, as long as you act quickly. "A minute's worth of cooling in the field is worth an hour of healing later on," advises Bill Aughton, search and rescue coordinator for the Appalachian Mountain Club in Gorham, New Hampshire. "If you roll your ankle on the trail and it's painful to walk on," adds Schimelpfenig, "maybe that's right where you set up camp for the night." Then you won't have to spend the rest of the season doing laps in the pool.