Snap, Crackle & Pop?

Ankle sprains are one of the most common injuries in basketball. Reasons being is from landing on another person’s foot and/or rolling the ankle. A sprain is the stretching and or tearing of a ligament (ligaments connect bone to bone).

The most common sprain is a lateral or inversion sprain affecting the anterior talofibular ligament. Other ligaments can be sprained with inversion stress, those being the calcaneofibular ligament and the posterior talofibular ligament.

Two other types of sprains that are less common but sometimes more serious are the medial or eversion sprain of the deltoid ligament and the high sprain involving the tibiofibular ligaments.

A concern with any type of sprain is a fracture. Sometimes the force of the injurious movement is enough to cause the tendon to actually pull off part of the attaching bone; this is called an avulsion fracture. Sometimes the position that the person lands in places too much stress on bone rather than the ligaments. The bony structures commonly fractured during an ankle sprain are the lower or distal tibia and fibula. Sometimes there is enough force and rotation to also cause injury to the fibular head (near outside of the knee), 5th metatarsal (side of foot by little toe), calcaneus (heel) or the talus (internal ankle). Another concern with extremely severe trauma to the ankle is dislocation.

So now what do you do? When is it time to go to the doctor? Ankle sprains are graded from mild I to severe III depending upon the damage to the structures. The stronger the injury force, the likelier a more severe sprain or even a fracture. If the pain is extreme, there is deformity (something just doesn’t look right) or pain is made worse upon attempts to weight bear or walk, then it is a good idea to get an x-ray to rule out a fracture or dislocation of the ankle.

Okay, so it is not that bad but the ankle is swollen and tender, what to do now? Remember the tried and true: R.I.C.E.

• Rest – Take time off from activities including sports and excess walking.

• Ice – Apply an ice pack for 15 – 20 minutes every other hour during waking hours for the next two to three days

• Compression – Use an elastic wrap from the toes up mid calf, apply with even pressure.

• Elevation – Elevate your foot above heart level, in class hip level is fine. When sleeping prop up end of bed by placing bricks or books under foot end.

Concerned about returning to play? Even a mild sprain will slow you down for a while. The most important thing to do is to decrease swelling and maintain range of motion. Swelling is best controlled by I.C.E. as described above. Performing pain free active range of motion exercises such as the Achilles Towel Stretch to 20-30 seconds and the Alphabet (using your foot) will help to speed recovery. As long as there is NO limp, walking to and from class is fine, though stairs should be avoided early in the recovery period. Once the pain and swelling is under control and the range of motion is restored strengthening exercises may be begun. Returning to full practice needs to be gradual, practicing ball handling skills and set shots such as free throws can be performed anytime as long as there is no limp or pain. Many times to perform at pre-injury level will take weeks; often helpful is the use of rehabilitative exercises.

Questions concerning criteria to return to play and specific exercises can be addressed to Joanna at 573-582-8000.

Posted: 2005-11-01