Whether you're an elite military operative, a seasoned backcountry hunter, or an adventurous hiker exploring the wilderness, there's one adversary we all share - the dreaded sprained ankle. It's an Achilles heel that can cripple the best of us, turning a thrilling expedition into a grueling ordeal.
Terrain remains relentless; our job is to show it we can be too.
But confronting the wilderness involves more than just physical readiness. It requires a mental toughness that equips us to handle visible obstacles as well as the unexpected ones that can catch us off-guard. A mere misstep could jeopardize our entire mission, demanding a resilience that runs deeper than muscles and bones.
This isn't just about preparing for the unpredictable wilderness; it's about turning these uncertainties into stepping stones.
Co-authored with Dr. Jake Purcell, who brings his medical expertise and a shared love for western hunting, this guide arms you with a comprehensive understanding of sprained ankles straight from the subject matter expert. You'll learn how to assess severity, adopt preventative measures, and strategize recovery.
Risks, Prevention, and Treatment of Ankle Sprains in the Backcountry
Sprained ankles can hit anyone, anywhere. But in the backcountry? The risk ramps up, and the consequences can be severe. "Ankle sprains are a common occurrence in most athletic endeavors. The risk of ankle injury is just as prevalent in backcountry athletics," says Dr. Purcell. Sprains occur when the ligaments around the ankle joint stretch beyond their limit, resulting in tears, pain, swelling, and instability.
Take it from the formidably fit Rick Hoskins, friend of Dr. Purcell's, seasoned backcountry guide, and the owner of Hunt Alaska Outfitters.
This year one of Rick’s clients, Frank Gagliardo, (pictured above) brought down a massive bear. In a valiant attempt to keep the hide in once piece, Rick tried to pack it out himself. With mud and water trapped within the fur, the pack was well over 250 lbs.
On icy terrain and with a heavy uneven load, Rick quickly lost his balance and twisted an ankle on his hike out. The pack heaved him downhill and smashed him into the hillside. When his momentum subsided, he was beaten up and had severe pain in his ankle.
Frank attempted to shoulder Rick’s pack, but the hide was too heavy. The two resorted to rolling the hide pack down the hill until they got to their vehicle. When Rick was able to get X-rays, it showed he had fractured bones in his ankle. Luckily, he did not need surgery and recovered with a walking boot. This could have been a deadly misstep if it happened on a mountain goat hunt or deep in the backcountry.
Rick's takeaway? He warns, "...in mountain sports, failure to prepare can be painful and potentially fatal." Rick's words serve as a stark reminder of the realities of backcountry pursuits.
Let's take a careful step back and level-set on the definition of ankle sprains. While everyone has a general idea of what they are, a clear and simple understanding can go a long way toward prevention and treatment.
What Is An Ankle Sprain Exactly?
An ankle sprain is an overstretching of the ligaments around your ankle. This leads to tears, which can range from micro to macro in severity. This not only causes pain but also triggers swelling and weakens your ankle, rendering it unstable. It goes by a few names, chief among them is a rolled ankle.
"Your typical “rolled my ankle” injury is a lateral (outside) ankle sprain." Dr. Purcell goes on to say that, "It happens when your weight goes over the outside edge of your foot and causes injury to the ligaments (highlighted in red below, in the original image from Grays Anatomy… the textbook, not the steamy tv drama)."
Although not as popular in everyday vocabulary, another form of this injury is a medial ankle sprain. According to Dr. Purcell, "Medial ankle sprains involve the ligaments on the inside of the ankle (image 2). It occurs when your foot is twisted up and out, like a duck foot. These are less common because of the strength of the deltoid ligament on the inside of the ankle as well as the bony structure of the foot."
The reason this type of ankle injury isn't as well known as a rolled ankle is because of how it happens. Dr. Purcell says, "This injury is seen more in high velocity injuries like car accidents, falls from height, or tackling. In a study of military cadets, medial ankle sprains made up ~5% of sprains. Most of those were from competing in gymnastics or rugby. If you have a medial ankle sprain, you are more likely to have an associated fracture of the medial and lateral malleolus (a Latin term for, “those bones on either side of the ankle that hurt like hell when you whack them”).
Why Are Ankle Injuries Common in Backcountry Hunting and Mountain Sports?
Ankle injuries are common in backcountry hunting and mountain sports due to uneven terrain and heavy loads. The challenging landscape can strain the ankle, while carrying equipment or game increases the risk of twists and sprains. Deadfall anyone?
That's our best attempt to simplify the academic reasoning. For that version, Dr. Purcell puts it like this, "The ankle joint is a composite of an asymmetric hinge and mortise joint. (Image 3, Mortise, Wikimedia commons) This setup gives the ankle substantial mobility, but sacrifices some stability. When the foot is dorsiflexed (i.e., ankle is flexed up toward the shin) the joint functions like a mortise, solid and stable. When the foot is plantarflexed (i.e., you are pushing off the ball of your foot, like calf raise) stability in the joint is decreased. This means when we are descending and sidehilling we are at the greatest risk for ankle injuries."
So then, how common is this injury then? Unless severe, many hunting-related injuries go unreported, however, backcountry hunting is one of the most difficult sports around. As such, let's take a look at some of the most common sports-related injuries to get a sense of how western hunting might trend.
From his time working in ERs, Dr. Purcell verifies that, "Ankle injuries are the most common athletic medical complaint in emergency care facilities." Sourcing robust research, he states, "A systematic study of 70 sports, 38 countries, and 201,600 athletes from 1977-2005 established that ankle injuries were the most commonly injured body site in 24 of the 70 sports."
While 'backcountry hunting' was not called out specifically in the study, Dr. Purcell was quick to point out three similar sports were included in the study, including, wall climbing, mountaineering, and orienteering. From the study, he reports, "In all three of these disciplines, ankle injuries were the most commonly reported."
That's a staggering statistic that shows us the scale of the issue. And it's no different in the backcountry. Ankle sprains can be as common as they are painful. With this in mind, is an ankle sprain inevitable for hunters or are there actions you can take to prevent the injury?
Prevention of Ankle Injuries (Prehab)
Preventing a sprained ankle is a matter of prehab - and if you're scratching your head with the word, Dr. Purcell can clear it up for you: "The only difference between rehab and prehab is whether you are already injured."
As a community dedicated to physical and mental strength to withstand the extremes of the wild, we've designed the most comprehensive set of programs to deal with any and all scenarios a hunter may be faced with. This includes physical therapy components, whether you're participating because of injury-driven rehab or taking preventive measures.
It's the reason MTNTOUGH created the evidence-based MTNPT fitness program for physical therapy. In a sport littered with injury, this program helps hunters heal up from missteps on the mountains, or help prevent them in the first place.
The program, although not designed by Dr. Purcell, has his complete buy-in as a way to prevent ankle injuries; he says, "Doing ankle exercises in the MTNPT program, preseason and offseason, is the best way to keep from injury."
Aside from working your ankles, Dr. Purcell points out an important yet ignored way to prevent ankle injury, stating, "Another thing overlooked when training the lower legs is proprioception and balance. Proprioception is knowing where your body is in space. When we injure the ankles we stretch out the nerves and sheaths in that area. This makes our brains a little less “sure” where our foot is when we are putting it down."
You can see how important this could be while sidehilling or crossing deadfall. How do you fix this then? Dr. Purcell's recommends practicing your balance on a flat surface using one foot and with your eyes closed. Extensions of this method include walking on your toes, heels, the inside and outside of your feet - this will train your body to recognize its boundaries and teach your muscles how to reposition your feet during close-calls with rolled ankles.
For full effectiveness, you'll need to focus on using the muscles around your calf, shin, and ankle. A few modifications he recommends include doing the same drill on a bosu ball, board, trampoline, pillow, or foam pad.
It's not an easy exercise by any means, but if you'd like to add difficulty, Dr. Purcell says to "Close your eyes for an extra challenge."
Assessing the Severity of Ankle Injuries
If you want to accurately assess how serious an ankle injury is, do what physicians do. Thanks to Dr. Purcell, here's what you need to know.
Ankle injuries can range from a pesky annoyance to a full-blown knock-you-off-your-feet pain. "When doctors assess ankle injuries, they grade them based on instability, pain, and ability to bear weight. Grade I is lowest, consisting of microtears of the ligaments. Grade III is highest, with complete ligament tears," says Dr. Purcell.
But he's quick to bust a myth here, stating, "The grading scale shouldn’t mean much to the mountain athlete. It is more for research purposes and does not accurately predict your recovery."
The real questions in the mind of the mountain athlete, as Purcell explains, are not about the grading but about action and recovery: "What matters to us is; 1) when do I need to see a doctor? 2) How long is my recovery going to be? and 3) how do I prevent this from happening (again)?"
Knowing when to see a doctor can be tricky, especially when you're a tough-as-nails mountain athlete.
"If you are concerned, go see your doctor. I believe that is a good rule because all injuries do not present the same," Dr. Purcell advises. He knows mountain athletes often bear the pain, but every injury needs its due respect.
Taking a tumble in the backcountry is one thing, but knowing what happens next can be a different beast entirely.
As Purcell explains, "If you show up to the ER or urgent care, staff will start their assessment using the Ottawa Ankle Rules. These rules are the most effective tool to decide whether someone needs an X-Ray for the foot and ankle." It's a practical tip for a self-assessment to know if it's time to head to the clinic.
But, as tough mountain athletes, there's a trap we can easily fall into. "The biggest pitfall I see is that above-average Joes, like my friend Rick, will bear down and walk on broken bones," warns Dr. Purcell.
Don't be like Rick; if you're in pain, get it checked out.
Remember, each ankle injury tells a different story, and it's crucial to listen to what yours is saying. Dr. Purcell leaves us with this nugget, "However, most ankle sprains do not meet the criteria for X-Ray." A valuable tidbit when you're out in the wild, assessing an ankle injury. Just keep in mind, when in doubt, always see a professional. Stay safe out there, folks.
Recovery, Treatment, and Enhancing Ankle Strength and Mobility
Staring down the long road to recovery after an ankle injury can be frustrating, and feeling as grueling as the first day of a training program, and as challenging as the harsh conditions of a mountain trail. As Dr. Jake Purcell cautions, "Recovery time varies greatly. Most research estimates recovery times between 2 weeks and 1 year."
This is doctor-speak for, "This isn't a sprint; it's a grit-demanding marathon."
Think you're tough enough to rush through the pain? The doctor would like a word with you...
"First, don’t rush this," Dr. Purcell firmly instructs. Gritting your teeth and bearing the pain may feel valiant, but it's counterproductive. Just as in any MTNTOUGH program, your strategy is key. This isn't about simply surviving the process; it's about mastering it.
Adopt the PRICE protocol as your new training mantra: "Protect, Ice, Rest, Compression, Elevation". Like a well-planned expedition, every step is crucial, every action is calculated. Pain management, too, becomes a critical part of your regimen. As Dr. Purcell suggests, "Most people can take Tylenol or generic acetaminophen for pain," but remember, dosing is critical. Overdoing it can lead to unnecessary complications, much like overtraining can do more harm than good.
Once the acute stage of your injury has passed, it's time to reestablish mobility. "Second, get your ankle mobility back," Dr. Purcell says. Gently working the affected areas, stretching and rebuilding the strength is as important as the grinding uphill climb during a mountain trek.
Now, onto the cornerstone of your recovery. "Third, DO THE REHAB." Emphasized by Dr. Purcell, this is not the time to return to your usual grind.
Your regimen has changed; your body needs you to adapt. Tap into the resources from MTNTOUGH's own Dr. Tom Walters for rehab exercises - which you can conveniently test out with a MTNTOUGH 14-day free trial.
When it comes to equipment like shoe inserts and boots, it's a matter of personal preference. Dr. Purcell's recommendation? "Training barefoot or with minimalist shoes to build strength through the ankle and feet." This is akin to stripping down your training to the bare essentials, ensuring a strong foundation before introducing additional support.
Ultimately, it all comes down to the golden rule we've always preached here at MTNTOUGH. "The most important takeaway is the most simple. Do the work."
It's the mental grit, the sheer willpower, and the hours of sweat you put in that will carry you through. Your strength and resilience are what protect you and your ankles.
Don't Be A Hunting Injury Statistic
With tales from the mountains shared by our friend Rick Hoskins from Hunt Alaska Outfitters, and vital insights from our very own Dr. Jake Purcell, we've journeyed through the ins-and-outs of the all-too-common ankle injuries that plague hunters in the backcountry.
From the challenging recovery timelines following an ankle injury to the crucial importance of appropriate treatment and rehabilitation, we've underscored the value of patience, perseverance, and appropriate guidance.
Throughout these explorations, MTNTOUGH's role has remained a steady beacon, supporting individuals in hunting, mountain sports, and outdoor activities. It's more than just a fitness program; it's a transformative experience that ignites your physical, mental, and spiritual awakening.
Our concluding encouragement? Embrace the MTNTOUGH philosophy. Prioritize your health and fitness, not just for your outdoor pursuits, but as a lifestyle.
Equip yourself with the strength and resilience needed to enjoy these activities safely and to their fullest.