18: Chronic Ankle Instability in Runners: One Overlooked Cause of Hip and Back Pain

What if your hip pain is actually coming from your ankle? Episode 18 of Interdisciplinary Case Miles follows a 38-year-old ultra marathon runner with lateral hip pain, back discomfort, and a long history of recurring ankle sprains.What many runners dismiss as “no big deal” can lead to instability, altered mechanics, and long-term performance limitations.This conversation connects chronic ankle sprains to changes in the kinetic chain, showing how foot and ankle instability can drive hip and back pain. It also highlights the role of ligament health, balance, and neuromuscular control in keeping runners strong and resilient. Nutrition and hydration are also key factors especially for ultra and trail runners.Fueling, collagen support, and electrolyte balance all influence healing, coordination, and injury risk. Whether you’re running trails in the mountains, training for your next ultra, or dealing with nagging injuries that won’t go away, this episode offers practical, evidence-informed strategies to improve stability, prevent setbacks, and optimize performance. 00:00 – Intro to Interdisciplinary Case Miles Meet the team and today’s focus on real runner cases. 01:10 – Case Overview: Ultra Runner with Hip & Back Pain A 38-year-old athlete presents with lateral hip pain, but there’s more to the story.03:15 – The Overlooked Clue: Chronic Ankle Sprains Why “it doesn’t hurt” doesn’t mean it’s not a problem.06:20 – Hip Impingement vs. Kinetic Chain Dysfunction How foot and ankle issues can drive hip pathology.09:10 – Hypermobility vs. Tightness Explained Why some joints are loose while others compensate. 12:00 – What Happens When You Keep Spraining Your Ankle Ligament damage, collagen breakdown, and loss of stability over time.15:30 – The 2% Stability Loss Rule Why repeated ankle sprains create long-term dysfunction. 18:40 – How Ankle Instability Causes Hip & Back Pain Connection between foot mechanics, glutes, and loading patterns.22:10 – Physical Therapy Strategies for Ankle Stability Balance training, foot control, joint mobilization, and plyometrics.27:00 – Collagen, Nutrition & Ligament Healing What runners need to know about fueling and recovery.30:15 – Electrolytes, Hydration & Injury Risk How dehydration affects reaction time, coordination, and proprioception.34:40 – Trail Running Risks & Cognitive Fatigue Why fueling impacts decision-making and injury prevention.38:10 – Shoe Choice & Terrain Considerations Stack height, stability, and trail-specific risks.42:20 – When an “Ankle Sprain” Might Be More Serious Recognizing fractures and complications. 45:00 – Key Takeaways from Each Expert Simple, actionable advice to prevent and manage ankleinstability.Become a supporter of this podcast: https://www.spreaker.com/podcast/the-running-injury-podcast-formerly-interdisciplinary-case-miles--6623567/support.If you enjoyed this episode, don’t forget to follow and subscribe so you never miss a case.Have a question or a case you'd like us to explore on the show? We’d love to hear from you. Reach out anytime at [email protected].