It is that time of year again – later in the summer, when many people are getting excited for the brisk fall air, pumpkins, and football. Not too long, we will have a foot of that white stuff that we call snow (at least up here in the Midwest). With that, basketball season rolls around. Quick brain teaser question to get started – what is one of the most common injuries in both of these sports?
ANKLE SPRAINS!
Okay, enough of the weird “setting the scene”. Let’s take a dive into ankle sprains. We are going to focus on lateral ankle sprains, different from a “high ankle sprain”. Lateral ankle sprains are more common, but there needs to be a separate blog for high ankle sprains for a variety of reasons.
If you have played sports, there is a high chance you experienced some sort of ankle sprain throughout the duration. If you are playing right now, I hope you have a great and healthy season. If you do have an ankle sprain, PLEASE take the active approach to get back in the game sooner rather than later. Things have changed greatly when it comes to ankle sprains – different ways of treatment, precautions, etc. We can now get athletes back in the game faster, so let’s find out why.
OLD Methodology
With any acute injuries (especially ankle sprains), you may have heard of the treatment – R.I.C.E.
R.I.C.E. stands for Rest, Ice, Compression, Elevation.
The order would be injury, ice, compression, elevatation and you would be resting for at least two weeks. The doctor used to put people in walking boots for 2 weeks most of the time, which leads to immobilization of the ankle for longer periods of time and takes longer to rehab.
This used to be the standard practice after an ankle sprain, but just like anything in the rehab or healthcare world, this methodology was challenged and progressed. What they found with the old R.I.C.E. methodology, is that it didn’t promote acute healing of the area and it took athletes longer to get back to playing. Even the doctor that invented R.I.C.E. has said that there are better ways now-a-days.
This is “outdated” because of two main things – the “R” and the “I” of R.I.C.E.:
Ice slows down the inflammation process. Inflammation is the first stage of healing, and we want that process to occur. The goal is to speed through that process as fast as possible to get to the other more advanced stages of healing where the area can mature faster. This equates to the athlete getting back to playing quicker.
Rest/Immobilization is one of the last things you want to do if you have a mild (Grade I) or moderate (Grade II) sprain of your ankle (which makes up a vast majority of the ankle sprain injuries). It has been shown time and time again in research that early controlled motion is much more productive than sitting in a boot for 2 weeks and resting.
There is a great systematic review conducted by Gaddi, et al., where they looked at 24 different articles – which equates to hundreds/thousand athletes observed. They looked at more of a functional approach to rehab rather than R.I.C.E. and immobilization – almost all the articles leaned towards a more functional approach.
There is one tough part to this. Even though many PTs have progressed past the old methodology, there are still a shocking number of doctors and PTs that still have the old mindset and a much more conservative approach.
The body is insanely resilient, so let’s try to promote healing! NEW Methodology
So the question is – if we are not supposed to R.I.C.E. or be thrown in a boot, then what are we supposed to do?
This is where I would promote to come work with Empower U or your trusted physical therapist, but let’s dive a little deeper as to “why”.
Passively, compression and elevation are going to be the injuries best friend. This is going to act as an elevator system to help pump old inflammation/blood out of the area, to bring in new and healthy blood to help heal faster.
Actively (with a physical therapist, athletic trainer, etc.), there are many benefits. After the injury, there may be swelling/inflammation that sits in the area for too long, which turns into almost a Jello type feeling. The professional can help get that old swelling out, to bring in new blood to bring a ton of great healing properties to the area.
Another reason is that our joints in and around the ankle become very stiff due to the injury and to help protect the area. The professional will be able to perform a variety of joint mobilizations to restore normal joint play faster, which will GREATLY reduce pain. When there is better mobility and less pain, the corrective exercises can be started.
The goal with corrective exercises is to take away any limps we may have while walking (or “babying” it), and get to early motion exercises then progress to athletic exercises when deemed appropriate by the healthcare professional. There is a very good chance that you may be able to accelerate to more athletic movements fairly quickly, which will get you closer to returning to sport quicker! There is more to the treatment side, but I won’t go into all the depths that the therapist is having to consider, but the odds are greatly on the athlete’s side.
So, for a quick side by side comparison:
Old way for a mild ankle sprain: Thrown in a boot for 2 weeks, immobilization, very passive interventions. Would not be surprised if it took the athlete 6-8 weeks to return to sport.
New way for a mild ankle sprain: Early intervention and motion, speed through inflammatory process, get to more progressive exercises faster. Has a very good chance at returning to sport within 2 weeks.
Isn’t that interesting? You used to be immobilized in a boot for 2 weeks, but now you have a chance to return to sport in 2 weeks if done correctly. Moderate ankle sprains may take slightly longer, but it will be much faster than the old methodology.
If you have an ankle sprain, get into a rehab professional as soon as possible to reduce the amount of time missed due to an injury! If you do not have a rehab professional, request an appointment, and we will get you scheduled with performance physical therapist from the Empower U team!
Gaddi, D., Mosca, A., Piatti, M., Munegato, D., Catalano, M., Di Lorenzo, G., Turati, M., Zanchi, N., Piscitelli, D., Chui, K., Zatti, G., & Bigoni, M. (2022). Acute ankle sprain management: An Umbrella Review of Systematic Reviews. Frontiers in Medicine, 9. https://doi.org/10.3389/fmed.2022.868474
