November 2011
By: Dan Johnson, PT, Director of Rehab Services
Ankle sprains are one of the most common injuries we see each year in the WCA Sports Medicine Center. With November upon us, basketball is typically the sport that produces more ankle sprains than other sports. The mechanism of injury is usually what we describe as one of inversion and plantarflexion, ie the ankle turning downward and inward resulting in an injury to the structures on the outer side of the ankle. This can happen when running down the court or more commonly when going up for a rebound and landing on an opposing player’s foot.
A sprain is an injury to the ligaments of the ankle and as noted, usually involving the ligaments on the outside or lateral portion of the ankle. Sprains can be classified as mild, moderate, or severe depending on the degree of tearing/stretching of the ligaments. Sometimes, the athlete is not able to bear weight on the ankle at the time of injury while other times, they may be able to return to the game. Obviously, if an athlete cannot bear weight on the ankle, medical attention is needed. However, we have seen athletes continue to play on what they thought was a sprain and come in a week later only to find that they had a fracture of the ankle. The best advice is, when in doubt seek medical attention.
Early medical evaluation and treatment of ankle sprains may include xrays to rule out a fracture, some type of supportive bracing, and crutches as needed. Ice, compression, and elevation is also an important part of early treatment. We always start patients on early range of motion exercises progressing to strengthening and balancing exercises as their symptoms improve. Crutches are used until the patient can walk without a limp although the acute ankle brace should continue until the athlete has full range of motion. Once they have full range of motion, their strength is improving, and they can walk without pain, we start them on a functional progression. A functional progression entails going from walking to jogging, to running, to sprinting, to cutting, and jumping, all based upon their ability to do so. Once they have successfully completed the functional progression they can return to sports specific drills and practice/play as tolerated. We always recommend, some type of protective sports brace or taping when returning to play. Complete healing of the ligament can take several weeks. We always recommend that athletes continue with their rehab until completely healed and then on a maintenance basis thereafter.
Many times, we see athletes in our center who were treated for an ankle sprain a couple of months ago, but they continue to have symptoms of pain when playing sports. The most common cause of persistent pain after an ankle sprain is a lack of rehabilitation. If we see these patients, typically we would place them on a rehabilitation program for several weeks. If symptoms persist, other diagnostic tests such as MRI’s may be needed to rule out less common causes of persistent pain such as osteochondritis dessicans or post traumatic synovitis which are beyond the scope of this article.
