I was happy to read about the success of the Burr and Burton Unified Basketball team this season. The program, which is part of Special Olympics Vermont, provides a competitive outlet for athletes with intellectual disabilities, and from what I’ve read, this year’s lead-up to the State Championships was exciting and action-packed.
As I write this column, our boys’ team is preparing to play in their championship game this evening, and by the time you read this, the outcome will be known. Amateur basketball holds a special place in my heart. When I was a newly minted sports medicine doctor, I covered a college team, and it was one of the first teams for which I was officially the “team physician.” Along with the excitement and athleticism of the game, there were jammed fingers, knee injuries and collisions. But by far the most common complaint of all was one that many think is no big deal — a sprained ankle.
Sprained ankles come in three different flavors: lateral ankle sprains (injury to the major ligament on the outside of the ankle), medial ankle sprains (injury to the ligaments on the inner part of the ankle), and high ankle sprains (injury to the ligaments above the ankle). Injury severity can range from mild microtrauma to full rupture of affected ligaments. Lateral ankle sprains are exceedingly common in indoor sports, with a reported incidence of seven sprains per 1,000 exposures. In a study of over 500 Canadian high school and club basketball players aged 11 to 18 during one season, lateral ankle sprains accounted for more than one-third of all injuries sustained.
Though basketball players and other indoor athletes like volleyball players are at high risk for ankle sprains, these injuries are also common in the general population and can lead to chronic problems affecting both work and sports participation. For this reason, evidence-based clinical guidelines for the diagnosis, treatment and prevention of ankle sprains were updated and published in the British Journal of Sports Medicine in 2018. According to the updated guidelines, nearly half of all patients who sustain ankle sprains continue to experience pain one to four years after their initial injury. So, when you sprain your ankle, it’s not “just” an ankle sprain. It’s an injury you should address right away to avoid developing recurrent sprains and/or instability of your ankle joint.
Diagnosis of a lateral ankle sprain can be made by physical exam without any special testing or imaging. However, there are circumstances in which you should have an X-ray because some ankle sprains can be accompanied by small fractures. Your health care provider will check to see if you have pain in specific bony areas of your foot or ankle, or if you have difficulty walking, to decide if an X-ray is warranted. If a high-grade ligament injury is suspected, your provider may also suggest an ultrasound or MRI exam, both of which can better visualize soft tissue structures.
Traditionally, lateral ankle sprains have been treated with Rest Ice Compression Elevation (RICE). In recent years, this approach has been studied more rigorously and is actually not as helpful as previously thought. Instead, early initiation of functional exercises, either supervised by a physical therapist or prescribed as a home program, is the most effective intervention for speeding healing and preventing long-term problems. If, because of pain, you need a cast or a boot, it is best not to use it for more than 10 days. Functional bracing, such as a lace up or semi-rigid ankle brace, is a better option, and if you can use this type of support right away, this will allow you to bear weight on your foot and ankle while still affording the needed protection. You can use non-steroidal anti-inflammatories like ibuprofen or naproxen to reduce pain and swelling, but these should only be used for short periods to avoid side effects.
Though most people can return to work or sports after six to eight weeks, there is variability. In 2021, an international panel of experts developed the PAASS Framework to help guide this decision. This framework considers pain during sports and over the previous 24 hours, ankle impairments in things like strength and range of motion, athlete psychological readiness to return to sport, sensorimotor control, and sport functional performance (things like hopping, jumping and sport-specific drills). When returning to your activities, it is important to monitor your workload and adjust accordingly to avoid being among the 40 percent of patients who experience recurrent sprains and ankle instability.
