Sprains, Strains, and Athletic Injuries.

One of the most common athletic injuries is an ankle sprain. It was my first major sports injury, and I even had one that left me unable to compete for over 6 months when I was younger. Why is this? It's because a lot of things are happening at once to keep you stable while in motion even when walking, but when running, planting, pivoting, and cutting are added to the equation, there are even more variables for your body to compensate for. It's actually a miracle we don't have sprains much more often.

My son sports his CAM boot

Most of the time, sprains happen when you are forced out of your normal running cadence by other factors. These can be pot-holes, cleat divots, opposing players (or your own teammates) running into you, or landing on another person's foot when jumping. One often overlooked factor is how well-trained your body is at recognizing its position in space. This is called proprioception--your body's ability to know its position based on feedback from sensors in your tendons and joints. This is how you're able to close your eyes and still manage to touch your fingertips together (go ahead, you know you want to try it. Just see that it works). It also allows you to know when your foot is positioned properly when standing, or if you need to straighten it out before putting your weight on it.

If you have been actively running, exercising, and working on balancing, your proprioception is probably fine-tuned pretty accurately. If you haven't been keeping up on that for a while, your nerves probably need a little calibration before you push yourself to the limits, because the chances of you landing with your foot and ankle out of alignment go up the more fuzzy your proprioception has become. A foot in its neutral position is much more stable than a foot that is either inverted--rolled inward-- or everted--you guessed it, rolled outward. Landing on a foot that isn't in neutral position is how most non-contact sprains occur.

Preventing a sprain is always better than having to rehab one. As Benjamin Franklin once said "an ounce of prevention is worth a pound of cure," it always takes less effort to prevent an injury than to have to make effort to recover. Sometimes we don't have full control over what happens on a field or court, but we can minimize our risk of injury when we put in effort before we're ever injured.

Typically, balance training is essential for propioceptive training. If you're ever wondering about how this works, I'm sure any physical therapist would love to assist you in creating a training regimen to help you in preventing injury. That's not my area of expertise, because I typically handle acute injuries (repairing things once they've gone wrong), but I do have a cadre of therapists I routinely refer my patients to when rehabbing injuries and training to prevent future ones. In short, get to know a physical therapist, you won't regret it.

This was a painful one. Yes, this is my ankle.

Once an injury has been sustained, there are some things to do immediately. First, don't walk around on it. A sprain, by definition, is a tear of the ligaments involved. The more you walk around on a sprain, the more you worsen the tearing that occurs and increase the inflammation that results. Any injured limb should be stabilized and weight should be kept off it until evaluated by a trained specialist. There are criteria to determine whether or not X-rays need to be taken, but that's my job to know and memorize so you don't have to try and figure it out. Until you can get checked out by a specialist, start with R.I.C.E. therapy. This stands for Rest, Ice, Compression, and Elevation. This is a good acronym to employ for any soft tissue injury, generally speaking.

As I stated earlier, Rest is important for both minimizing the damage done by your injury as well as improving your pain level during recovery. When an injury occurs, your body has mechanisms in place to help repair injured tissues. Part of that involves cells in your body chewing up damaged tissues. These are sped up by pro-inflammation chemicals released by injured tissues. The more you move the injured tissues around, the greater amount of inflammation is experienced. Walking also stretches the tissues that are healing and keeps them from healing.

Ice is a natural anti-inflammatory, so in addition to resting, cooling the injured tissue is important in blunting this inflammatory process. It also helps to decrease pain and swelling by turning down nerve response to pain and by causing the small blood vessels in the area to collapse down, bringing less fluid to cause swelling, and limiting the number of inflammation cells that make it to the area. You'll want to ice for no more than 30 min per hour, and please don't give yourself frostbite by icing too long or directly on skin. Always have a washrag or sock between the ice and your skin so you're protected from being too cold--it happens, so don't let it happen to you.

Compression helps remove swelling from the area. This helps squeeze the excess fluid into your veins and lymphatic vessels (another body fluid system, it's kinda tough to quickly explain so if you want more info, message me) to get the fluid out of the injured tissue. Pressure is painful and swelling really stimulates pressure-sensitive nerves, so removing pressure also decreases pain.

Elevation further assists in swelling removal and allows you to better rest the injured leg. This allows gravity to pull fluid out of the area, further reducing swelling and pain (it also is very difficult to walk on a foot that is propped up on a pillow).

I usually keep my ankle sprain patients in a removable Cast Boot for 2 weeks so that the ankle stays as still and undisturbed as possible. Even with this advice, I again need to emphasize that only a trained physician can tell whether your ankle sprain is a simple sprain or if there are fractures going undiagnosed. Not all ankle fractures look as grizzly as Gordon Hayward's a few years ago, so it is important to get looked at, especially if rest doesn't take away your pain.

These days, it is pretty popular for high level athletes to have surgical procedures for their ankle sprains. Well-known football players such as Tua Tagovailoa have had a "tightrope" procedure performed for a high ankle sprain, allowing them to return to competition weeks or months ahead of conservative treatments. These procedures work well and are generally low-risk. In the future, I'll have a post about the instrumentation and hardware involved so this procedure is easier to wrap your head around.

There are ankle sprains that do require surgical repair or reconstruction. If you are one of those people who are constantly rolling their ankles multiple times a month, you should talk to your foot and ankle specialist about ligament reconstruction. Remember, these are conditions that require specialized training to diagnose and treat, so don't try to play doctor on yourself. Dr. Google isn't as accurate as one might think, and not every condition gets better without surgical intervention. More often than I'd like I have patients who are diagnosed with an ankle sprain who actually have a fracture or ligament tear in the mid-foot that do require a surgery, so a foot and ankle specialist should always be in the back of your mind if you're not sure the classical ankle sprain picture fits you. How can you know for sure where you fit? When in doubt, get looked at by a specialist.