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Ankle Sprains: Part 2 of 2

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 2 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.
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. In addition to the strength exercises discussed last week, agility and proprioception exercises are necessary to prevent reoccurrence.

Exercise 1: Single Leg Stance (Photo 1): With two chairs sitting beside you for a safety precaution, lift one leg up in the air and stand on one leg. Without placing your hands on the chairs, stand on a single leg for 15 seconds to begin. When that becomes easy add another 15 seconds. Once a single leg stance can be held for a minute with ease and no pain, progress to exercise 2

Exercise 2: Single Leg Stance on Pillow/Foam: A variation of the exercise described above, place a pillow or a foam pad underneath the foot you are standing on. Once again hold the stance for 15 seconds to begin with, increasing by 15 seconds every time the exercise is completed easily. Once a single leg stance on a pillow/foam can be held for a minute with ease and no pain, progress to exercise 3.

Exercise 3: Single Leg Stance on Stability Disc (Photo 2): The next variation of the single leg stance exercise involves a rubber disc that is inflated with air. These exercise balance stability discs can be found on Amazon for as little as $12. Like the pillow/foam exercise, the disc is placed under the foot but this time the goal is to stand on the disc for five seconds at a time, repeating it five times. Once a single leg stance on a stability disc can be held for up to 15 seconds 5 times in a row with ease and no pain, progress to exercise 4.

Exercise 4: Single Leg Stance on Stability Disc w resistance Sportscord (Photo 3): The final variation of this exercise involves a sportscord, which is an elastic band that is anchored on one side of the cord and strapped around the waist at the other. As the patient stands in a single leg stance on the stability disc, the elastic sportscord provides a pull on the body forcing core muscles to activate and creating a dynamic exercise. Begin with holding the stance for 5 seconds 5 times and progress to holding the exercise for 15 seconds 5 times.

Exercise 5: Agility Ladder: (PHOTO 4): Once the exercises listed above become easy, you can progress to more advanced exercises such as the agility ladder.
The exercise progression above aims to increase strength, balance, and proprioception, but how do you know when it is safe to return to play? One way to self test is with a single leg squat. If you can perform a single leg squat to 90 degrees without the knee collapsing or pain in the ankle, it may be time to return to play.
Another way to gauge your ankle stability/function is to fill out an assessment such as the Ankle Joint Functional Assessment Tool, which provides a numerical representation of your ankle instability. A score of >26 indicates that you may have a functionally unstable ankle and you may benefit from an aggressive program designed for your needs. For more comprehensive exercise programs, consultation with an athletic trainer or sports physical therapist would be required.

It is important to note, that if you have a history of ankle sprains, the best way to prevent another injury is to participate in an aggressive preseason strength, agility and proprioception program for 6-8 weeks.

Link to the assessment is found at https://meetinstrumentenzorg.blob.core.windows.net/test-documents/Instrument4149/AJFAT meetinstr.pdf

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!”
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).