First of two parts. Ankle sprains are among the most common injuries in high school sports. In basketball alone, ankle sprains account for 40 percent of all injuries. The most common ankle sprain occurs when the foot or ankle rolls in (inversion), often when landing on the foot of another player — for example, after getting a basketball rebound. This excessive motion stretches the ankle ligaments beyond their limits. Because the ligaments hold the ankle bones together and provide stability, even a mild ankle sprain can cause chronic ankle instability and may lead to early arthritis. Ian Cowder is a basketball player at Dunmore High School with a history of recurrent ankle sprains. He reinjured his ankle last season and spent eight weeks this past summer working diligently on a strength, conditioning, agility and proprioception program to prevent ankle sprains. Today and next week, we’ll share his ankle injury prevention program to educate others with similar problems. Sprains are typically accompanied by swelling and bruising, but you should be able to walk on the ankle immediately after a sprain — though it will be painful. If you cannot immediately take four steps, you may have a more serious injury to the ligaments or bones and should seek medical attention. If the sprain is mild, symptoms usually resolve within a couple of days. Symptoms of moderate ankle sprains include swelling, bruising and loss of ankle motion, and may persist for several weeks. Severe ankle sprains typically require a period of immobilization — such as a cast or brace — and limited weight-bearing. Regardless of the severity of the sprain, the priority immediately after an ankle sprain is to minimize swelling and allow damaged ligaments to heal. If you are unable to walk without a limp, rest may include an immobilization shoe or the use of crutches to allow movement with limited or no weight on the injured ankle. The best way to do this is with the RICE method — rest, ice, compression and elevation. Rest: Stay off the injured ankle as much as possible. Ice: Applied to the ankle for up to 20 minutes every few hours to help reduce pain and swelling. Compression: Use medical bandage wrap to aid in reducing swelling and internal bleeding. Elevation: Place a few pillows underneath the ankle to raise it above the level of the heart, which also reduces swelling and internal bleeding. Immediate rest is beneficial, but for how long? Even though it may be uncomfortable to walk, movement is important, to help pump swelling out of the joint and to prevent the ankle from stiffening up. But movement should be limited and controlled so as not to reproduce pain. It is usually performed in a non-weight-bearing position during elevation. The amount of time you should rest will vary depending on how severe the sprain is and your pain level, but even partial weight-bearing or performing ankle pumps (gas pedals) will help prevent ankle stiffness and weakness down the road. Once the pain and swelling have gone away, you can begin walking normally, but don’t immediately return to sports. Doing so without additional training puts you at risk for more ankle sprains. Here are some strength exercises that are easy to do in your home: Heel walk: While wearing sneakers, walk on your heels. Perform as a timed activity, beginning with 15 seconds and advancing as tolerated to one minute. Repeat three times and perform two sessions daily. Exercise band strength exercises: Ankle pump down (push down against band); ankle pump up (pull up against band); ankle turn in (turn in against band); ankle turn out (turn out against band). Side step-overs: Place several cones on the ground greater than shoulder width apart. While standing with your feet shoulder width apart, tie an elastic band between your ankles. As quickly as you can, step over the cones, moving left to right and then right to left. Perform as a timed activity beginning with 15 seconds and advancing as tolerated to one minute. Repeat three times and perform two sessions daily. An important aspect that is often overlooked when it comes to ankle sprains is proprioception. In short, proprioception is the body’s ability to sense stimuli regarding position, motion and equilibrium. When a sprain occurs, proprioception is damaged and the brain is not able to receive these signals. To regain proprioception, you must work simple exercises that target these stimuli. We’ll look at proprioception and agility exercises next Monday. PAUL J. MACKAREY, P.T., D.H.Sc., O.C.S., is a doctor in health sciences specializing in orthopedic and sports physical therapy. He is in private practice and an associate professor of clinical medicine at Geisinger Commonwealth School of Medicine. His column appears every Monday. Email: [email protected] CONTRIBUTING WRITERS for this week’s column are Alexa Rzucidlo and Zach Brandt. Rzucidlo is a third-year doctor of physical therapy student at Temple University and an intern at Mackarey Physical Therapy. She grew up in Factoryville and graduated from Lackawanna Trail High School, and received her undergraduate degree in kinesiology from Temple. She plans to continue her clinical experience at Grand Junction VA in Colorado. Brandt, a Dalton native and 2014 graduate of Scranton Preparatory School, is a senior at Penn State University majoring in kinesiology, and an intern at Mackarey Physical Therapy. After graduating in December, he plans to attain a doctorate in physical therapy.
Source: The Associated Press