How to Identify and Treat a Sprained Ankle

Sprained ankles are the most common sports-related injury, with about 25,000 occurring daily. They account for 45% of all basketball injuries, 31% of soccer injuries and also frequently occur in football players, gymnasts, and runners.

So what exactly is an ankle sprain, what do you do for it, and when should you be concerned?

It’s easier to understand ankle sprains if you are familiar with the basic anatomy: the three main bones that comprise the joint are the talus (in the foot), tibia and fibula (in the leg). Basically, it is a hinge joint that connects the leg and foot. The primary ligaments of the ankle include the lateral ligament, deltoid ligament, and the syndesmosis.

The lateral ligament is the most commonly injured in an ankle sprain so we will go into a few more details about it.  It is comprised of three components: the anterior talofibular ligament (ATFL), the calcaneofibular ligament (CFL), and the posterior talofibular ligament (PTFL). These structures help maintain the stability of the ankle.

An ankle sprain usually occurs secondary to an inversion injury. An example is a basketball player jumping up for a rebound and, upon landing, steps on an opponent’s foot and “rolls the ankle”. Often, a “pop” is either heard or felt. Initially there can be swelling and bruising (which can be impressive). With severe sprains, there can be difficulty with weight bearing on the affected side.

When you come into the office after a sprain, we look for significant lateral ankle swelling along with bruising that can extend all the way down the foot and into the toes. There is usually tenderness over the lateral ligament, and with severe sprains over the deltoid ligament and syndesmosis as well. We commonly obtain radiographs (x-rays) of the ankle at the first clinic visit to assess whether or not any associated ankle injury was sustained. For acute ankle sprains, further imaging (such as MRI) is not necessary, as it does not alter the treatment plan.

In case of more severe sprains, treatment involves short term immobilization in a walking boot for comfort and to more rapidly promote healing. However, in simple sprains a boot is not needed and an ankle brace alone provides sufficient protection and stability. Physical therapy is initiated once the patient’s acute pain and swelling subside. The physical therapist works on stretching, proprioception, and strengthening at each session. As the patient progresses, the physical therapist will begin to work on more sports specific training; when this can be done without pain, the athlete is ready to return to play. This can take anywhere from 2-8 weeks depending on the severity of the sprain. We recommend continuing to use a brace during athletic training and competition to avoid re-injury.

Fortunately, most ankle sprains fully heal when proper treatment is initiated; however, there are circumstances in which an ankle sprain doesn’t progress as anticipated. In such cases, further imaging and surgical intervention may be warranted.

If you ever suffer an ankle sprain, or if you have had frequent sprains in the past and continue to struggle with pain or weakness, please call our office today (615.342.0200) to schedule an appointment.

–Lauren Erickson, PA-C

CrossFit Injuries

There has been a lot of publicity regarding CrossFit and injuries lately.  As with any new popular or trendy health fads, there will inherently be a group who jump on the band wagon and a group that speak out against it. Lately I have heard, in an increasing amount, that CrossFit causes injuries.  Yes, I would agree that today you see more injuries from CrossFit then you did 5 years ago. Is that because CrossFit is dangerous or is it simply because there are more people participating in CrossFit?  Just like any other sport, you see more injuries when there is increased participation. Football related injuries increase in the fall, Ski related injuries increase during the winter and so on.

I do want to put a disclaimer out there now that I am neither pro CrossFit or against CrossFit. I am generally indifferent but I think in general CrossFit has been great for the health and wellness industry.  CrossFit provides participants with cardiovascular and strength training while fostering a social experience with others. I’ve heard many patients and friends use the phrase “CrossFit changed my life.” CrossFit got them off the couch and into exercise.

So what do we do about all of these CrossFit injuries? With every other sport there is a shift towards injury prevention and I believe this can easily be achieved with CrossFit as well. The first step is creating awareness within the consumer that there are ways to decrease your risk of injury when participating in CrossFit. I think there are three main areas where CrossFit and the consumer can improve upon to help decrease injuries. 

1. Realize that not all CrossFit boxes or coaches are the same. They are like any other health and wellness gyms/trainers/physical therapists etc. There are some excellent ones and there are those that are subpar. So research your box! What’s your coach’s educational background and do they have the correct credentials? Talk to others who have been to the box, get multiple opinions. Try multiple boxes and see where you feel most comfortable. If you have previous orthopaedic issues, talk to a coach and see if they can modify the WOD (Workout Of the Day) to accommodate you. If they seem uneducated, you need to move on. You want to find the best place for yourself.

2. CrossFit is not individualized.  When it comes to the WOD, you are doing the exact same one as everyone else.  The workouts are not designed for your individual needs and in some instances this can lead to injury. This is particularly evident with individuals who have orthopaedic issues from prior injuries.  The number one predictor of injury is previous injury. So those who have previously dealt with an injury are already at higher risk of injury. You may need one on one training prior to CrossFit.

3. Not Training to failure.  Training to failure to reach that PR (Personal Record) every now and then is ok but training to failure repeatedly increases your risk for injury. As fatigue increases, biomechanics and form go out the window. Our bodies find ways to continue to complete the lift even though our muscles are not performing correctly.  When we perform these exercises with sloppy form it can lead to an acute injury such as an ACL tear with a box jump or a shoulder labral tear with an overhead snatch or press. Our body learns to rely on compensations to complete these lifts and our brain learns these bad movement patterns as correct patterns. Over time these patterns begin to wear on the body leading to a breaking point where you have more of an overuse or chronic type of injury.

Instead of performing each exercise to failure with the goal to achieve as many reps as possible we should focus on performing as many PERFECT reps as possible. Practice doesn’t make perfect, PERFECT practice makes perfect. Technique and form should be valued over reps and speed. Lastly we need to learn to listen to our bodies. Your body will tell you when it’s had enough. You just have to know when to stop pushing and to allow your body to rest. As Dr. Elrod always says, “If it gets where the more you do, the more it hurts, you should back off.”

4. Not Training unilaterally.  We are all innately asymmetrical. Don’t believe me, try brushing your teeth with your non-dominant hand. Normally these asymmetries aren’t a problem. However, when you take it to the next level and symmetrically load a system that is not symmetrical, you increase the risk for injury. You can counter act this through unilateral training. Training unilaterally exposes weakness. As you correct these weaknesses you decrease the amount of asymmetry, decreasing the risk for injury.

If you aren’t sure about form or technique, work with a professional one on one until you feel confident. Olympic lifts are technically difficult movements which require practice to master. There’s a reason they are called Olympic lifts. Work with a personal trainer one on one to master these moves until you feel completely confident in your form.

We gladly work with CrossFit athletes daily and love getting them back to what they love to do.

– Jorge Rojas, DPT