An­kle in­juries painfully com­mon

The Hazleton Standard-Speaker - - ADVICE - Paul Mackarey (Mackarey, a doc­tor in health sciences spe­cial­iz­ing in or­tho­pe­dic and sports phys­i­cal ther­apy, can be reached at drp­

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 week.

(Alexa Rzu­cidlo, a third-year doc­tor of phys­i­cal ther­apy stu­dent at Tem­ple Univer­sity, and Zach Brandt, a se­nior at Penn State Univer­sity ma­jor­ing in ki­ne­si­ol­ogy, con­trib­uted to this col­umn. Both are in­terns at Mackarey Phys­i­cal Ther­apy.)

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