A sprain is not ‘just a sprain’

The summer break from school is almost over, and high school sports are just ahead.

Each year, a significant number of students participate in sports, and sports-related injuries are a common reason for orthopedic visits. Injuries are a source of concern and disappointment for coaches, parents and athletes, and return to play is always an important consideration.

One of the more common – but not always benign – injuries that I treat frequently is an ankle sprain. While most sprains generally heal over about 4-6 weeks, it is those that don’t that can have nagging and painful consequences.

The typical treatment for an ankle sprain is the RICE protocol – rest, ice, compression and elevation. As long as X-rays do not show a fracture, I usually encourage my patients to wear an ankle brace and to begin what is known as early functional rehabilitation.

This means physical therapy exercises – done at home or with a physical therapist – that will promote early motion and strengthening. I tell patients that the main reason there is an incomplete recovery from an ankle sprain is that therapy does not start early enough, allowing the ankle to stiffen.

After about three weeks, most sprains progress nicely. If I see a patient at the three-week mark and they are complaining of significant pain and still having a great deal of swelling, I’ll order advanced imaging to look for damage that may not have been visible on the original X-ray.

This can include small fractures, tendon tears or bony contusions or bruises. Yes – you can bruise the bone, and it is a painful injury that can persist for months. This happens when the foot is suddenly turned inward and the two major bones of the ankle joint – the tibia and the talus – collide.

One of the unfortunate consequences of returning to sports too quickly without adequate rehabilitation is chronic pain and weakness in the ankle. I take care of numerous patients each year with chronic ankle instability – a condition in which the ligaments on the outside of the ankle become weak and less able to provide stability after repeated sprains or an inadequately rehabbed sprain. The patient typically comes to me complaining of a sensation that the ankle is going to “give way.”

As you can imagine, this is a significant problem in an athlete where quick starts and stops and cutting movements introduce maximum stress to the ankle joint. I’ll usually try a course of rehab to see if conservative measures will strengthen the stretched, weak ligaments.

If the problem persists, I perform a surgery known as a Brostrom-Gould repair, where the ligaments are tightened, the soft tissue repaired and the patient rehabbed to restore strength and function.

Bracing is a common question that I hear from many of my student athletes. Particularly in sports like volleyball, basketball and soccer where the ankle is put to the test in each game, some athletes inquire about the usefulness of bracing in preventing injury.

I’ll usually recommend a brace for several weeks when they return to sport after rehab. Once full strength and stability is achieved through rehab, I’ll typically encourage them to go without the brace, as natural use of the ankle helps to maintain tone and strength.

As the parent of a high school athlete, I well understand the desire to return quickly to competitive play, particularly when playoff games or scholarship opportunities are on the line. My in-office assessment will include having the athlete jump up and down on the injured ankle and make cutting movements from side to side. If these motions can be accomplished without pain or feelings of weakness or instability, the athlete may be ready to resume play.

My take-home message about ankle sprains is this: Early, functional rehabilitation for optimal recovery, and listening to the body’s cues when returning to competition to ensure safe play.

Dr. Gregory G. Caronis is a board-certified orthopedic surgeon with Advocate Medical Group Orthopedics.