«

»

Ankle Sprains: Part 1 of 2

Guest Coauthors: Alexa Rzucidlo, SPT3 and Zach Brandt

Alexa Rzucidlo, SPT3 is a third year doctor of physical therapy student at Temple University (2019) and intern at Mackarey Physical Therapy. She grew up locally in Factoryville, PA. She graduated from Lackawanna Trail High School and Temple University for her undergraduate degree in Kinesiology. Alexa plans to continue her clinical experience at Grand Junction VA in Colorado.

Zach Brandt is native of Dalton and a 2014 graduate of Scranton Preparatory School. Zach is currently a senior at Penn State University majoring in Kinesiology and intern at Mackarey Physical Therapy with plans to graduate in December. He plans to attend graduate school to attain his doctorate in physical therapy.

Ankle Sprains: Part 1 of 2

What is one of the most common injuries in high school sports? Ankle sprains. In basketball alone, 40% of all injuries are ankle sprains. The most common ankle sprain occurs when the foot or ankle rolls in (inversion), often when landing on the foot of another player after getting a rebound. This excessive motion stretches the ankle ligaments beyond their limits. Because the ligaments hold the ankle bones together and provides ankle stability, even a mild ankle sprain may 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 8 weeks this summer working diligently on a strength, conditioning, agility, and proprioception program to prevent ankle sprains. This column will share his ankle injury prevention program to educate others with similar ankle problems.

Sprains are typically accompanied by swelling and bruising, but you should be able to walk on the ankle, though it will be painful, immediately following a sprain. If you cannot take four steps immediately following the injury 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 (i.e. cast or brace) and limited weight bearing (i.e. use of crutches).

Regardless of the severity of the sprain, immediately following an ankle sprain the priority 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 and/or the use of crutches to allow ambulation without any weight or limited weight on the injured ankle. The best way to do this is with the RICE method: rest, ice, compression and elevation. Rest meaning you should stay off the injured ankle as much as possible in order to allow the ankle to heal. Ice should be applied to the ankle for up to twenty minutes every few hours to help reduce pain and swelling. Compression of the ankle can be done by using medical bandage wrap, this aids in reducing swelling and internal bleeding. Elevation is also used to reduce swelling and is simply done by placing a few pillows underneath the ankle in order to raise it above the level of the heart.

Immediately after a sprain resting is beneficial, but for how long? Even though it may be uncomfortable to walk, movement is important. Movement helps to pump swelling out of the joint and to prevent the ankle from stiffening up. Movement, however, 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 on how severe the sprain is and your pain level, but even partially 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 should not immediately return to sport. Returning to sport without additional training puts a person at risk for more ankle sprains. Some strength exercises that are easy to do in your home include heel walks for strength and side step over drills for agility.

  1. Heel Walk: While wearing sneakers, walk on your heels. Perform as a timed activity, beginning with 15 seconds and advancing as tolerated to 1 minute. Repeat 3 times and perform 2 sessions daily.
  2. Exercise Band Strength Exercises: See 4 Photos
    1. Photo 1. Ankle Pump Down- push down against band
    2. Photo 2. Ankle Pump Up – pull up against band
    3. Photo 3. Ankle Turn In – turn in against band
    4. Photo 4. Ankle Turn Out – turn out against band
  3. 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 1 minute. Repeat 3 times and perform 2 sessions daily.

An important aspect that is often overlooked when it comes to ankle sprains is the ankle’s proprioception. In short proprioception is the body’s ability to sense stimuli regarding position, motion and equilibrium. When a sprain occurs, this proprioception is damaged and the brain is not able to receive these signals. In order to regain this proprioception, a person must work simple exercises that target these stimuli. One simple progression of exercises that is very helpful for the prevention of ankle sprains is a set of exercises that build off of a simple single leg stance.

Model: Ian Cowder, a junior at Dunmore High School where he plays varsity basketball.

Visit your doctor regularly and listen to your body.

NEXT MONDAY – Read Dr. Paul J. Mackarey “Health & Exercise Forum!” Prevention of Ankle Sprains: Part 2 of 2

This article is not intended as a substitute for medical treatment. If you have questions related to your medical condition, please contact your family physician. For further inquires related to this topic email: drpmackarey@msn.com

Paul J. Mackarey PT, DHSc, OCS is a Doctor in Health Sciences specializing in orthopaedic and sports physical therapy. Dr. Mackarey is in private practice and is an associate professor of clinical medicine at Geisinger Commonwealth School of Medicine (formerly The Commonwealth Medical College).