March Maddening Ankle Sprains in Basketball Players

With March Madness upon us, it is likely we will see fans sporting their collegiate gear, roaring crowds, busted brackets and…ankle sprains? The prevalence of ankle injuries among basketball athletes is high, with ankle sprains being the most common injury. In addition to that, studies have shown that the injury is more likely to occur during competition rather than practice. Players will commonly twist their ankle on the landing after jumping for rebounds, shots, and blocks or when they plant and make quick cuts. More often than not, players will experience an inversion sprain. This is when the ankle rolls inwards and damages the ligaments on the outside of the foot.

We now know that ankle sprains are common, however, the severity of the sprain can vary. There are three different grades to categorize the severity.

Grade 1: Mild or First Degree
At this stage, when the ligaments are stressed with certain range of motion testing, the individual will experience pain due to the ligaments being stretched or slightly torn. A persons range of motion is limited in only one direction and there is limited bruising. There is tenderness and pain strictly over the injured area.

Grade II: Moderate or Second Degree
At this stage, there is slight laxity within the ankle due to the ligaments being partially torn. Instability of the ankle during weight bearing is apparent. In addition, bruising and swelling are present and the edema in the joint will limit range of motion. The individual will complain of diffuse tenderness and increased pain. This sprain typically is the most painful.

Grade III: Severe or Third Degree
At this stage, there is an abnormal increase in range of motion and significant laxity and instability due to ligaments being completely torn. The swelling and bruising is severe, however, the associated pain is less than that of a grade II.

After an athlete experiences an ankle sprain, what is the immediate course of action? Initially, the individual should implement the RICE method and use NSAIDS (i.e. ibuprofen, naproxen) to manage pain and inflammation.

Rest: Avoid weight bearing through the injured ankle.
Ice: Use ice to decrease the swelling. Ice can be applied to the injured area for 20 minutes at a time. Avoid placing ice directly on the skin.
Compress: Use compression bandages (i.e. ace wraps) to reduce fluid build-up and provide stability at the joint.
Elevate: Elevate your ankle using pillows or other supportive surfaces. The ankle should be elevated above the level of the heart to decrease swelling.

The athlete will generally follow-up with a doctor. From there, pending the severity, the doctor will decide if the individual requires crutches, elastic bandaging, walking boot, or cast. The healing time will range pending the grade of the injury.

After the pain and swelling have subsided, what’s next? Physical therapy! The doctor will likely recommend physical therapy to help regain range of motion, strength, flexibility, balance/stability, and ultimately restore function to allow for full return to sport.

Range of motion
The physical therapist (PT) will likely begin by passively moving the ankle, which means the PT controls the movement of the ankle. Range of motion exercises will transition from passive to active. At this point the athlete will control the movement of their own ankle. Exercises such as ankle pumps and ankle ABCs will be introduced.

Strength
As the athlete regains pain free motion, the PT will then introduce exercises to improve strength. These exercises will likely include the use of resistance bands and cuff weights or involve weight bearing to strengthen the muscles surrounding the ankle and foot.

Flexibility
After the ankle joint has been immobilized (via braces/casts) the surrounding muscles will have decreased flexibility. Most often, the gastrocnemius and soleus (calf muscles) are tight. The PT will use manual and active stretches to improve mobility.

Balance/Stability
After injury to ligaments, proprioception is negatively impacted. Proprioception is the sense and awareness of the joint position. When there is loss of proprioception it is accompanied by loss of balance. Therefore, the PT will incorporate balance exercises to improve proprioception and receptor activity within the ligaments to allow for increased control within the joint. The increase of control will allow for greater stability. Common exercises include use of single leg stance, uneven surfaces, or a combination.

Return to Sport Activities
After motion, strength, flexibility, balance, and stability are regained the PT will incorporate activities that mimic the demands of basketball (or any other sport, too!). These exercises will enhance agility and endurance.

Although ankle sprains can be a nuisance to basketball players, they do not have to be a devastating or career ending injury. With time and the guidance of a skilled PT, the injured athlete will be able to return to the court and continue playing the game they love.

References:
1. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1978459/
2. https://orthoinfo.aaos.org/en/diseases–conditions/sprained-ankle
3. https://www.mayoclinic.org/diseases-conditions/sprained-ankle/diagnosis-treatment/drc-20353231
4. https://www.moveforwardpt.com/symptomsconditionsdetail.aspx?cid=3c31ac5a-19ef-4c97-a8b6-ea1cfe19ac95
5. https://www.roslynphysio.co.nz/pages/13-17/Balance-and-Proprioception

Piriformis Syndrome – Literally a Pain in Your Butt

Has this winter been a pain in your butt? On top of the winter blues and life, are you getting aches and pains in the back, buttock, and leg that just won’t seem to go away? If you answered yes to either of these, you may have piriformis syndrome. Piriformis syndrome occurs when the piriformis muscle is tight or when the pelvis is not in proper position resulting in mild to severe pain in the back, buttock and occasionally down the leg.

So what exactly is the piriformis muscle?
The piriformis muscle is a flat, band-like muscle located in the buttocks near the top of the hip joint while the sciatic nerve runs underneath this muscle. This muscle stabilizes the hip joint and lifts and rotates the thigh away from the body. During day to day activities this muscle helps us walk, shift our weight from one foot to another and maintain balance. When the muscle gets tight, you get the “pain in the butt”. In the picture below, you can also see how a tight piriformis can pinch on the sciatic nerve causing pain down the leg.

Can physical therapy help get rid of the pain in my butt?
The quick answer is YES!
Often times when patient’s come in with these symptoms, we discover their pelvis is not in the correct position. This may happen from miss-step, crossing legs, standing with more weight on one leg, walking on uneven surfaces, sports and exercise injury, muscle imbalances, poor flexibility, or leg length discrepancy. It is common to see the piriformis tightness is a secondary problem. This is why it is imperative your physical therapist addresses the primary cause by checking hip alignment, leg length, posture habits, body mechanics and the flexibility and strength of the muscles surrounding the hips, glutes, and abdominals. Correcting hip alignment, decreasing tightness, and strengthening the surrounding muscles will help to abolish the pain and prevent future issues. If the primary cause isn’t addressed the pain will come back over time.

Does this sound like you? Does your pain always come back? You may not have address the primary problem yet!

What can you do to help the pain? 

Using a tennis ball or getting a massage to release the piriformis muscle helps! However, to keep the muscle relaxed, it is important to do the following stretches and strengthening exercises to avoid it getting tight again.

Here a few ways to help stretch the piriformis and relieve symptoms (please stop if any stretch or exercise causes increased symptoms or pain).

PIRIFORMIS STRETCH
While lying on your back with both knee bent, cross your affected leg on the other knee. Next, hold your unaffected thigh and pull it up towards your chest until a stretch is felt in the buttock. Hold 30 seconds and repeat 3 to 5 times a couple times per day.

Below are some modifications of the same exercise.

Lay on your back and use a ball to help bring the knee toward your chest. This helps to take pressure off the knee if you have difficult bending your knee.

Sitting in chair, you can do this stretch virtually anywhere and you don’t have to get on the floor. Bring your foot (of the affected side) on your opposite leg. Gently lean forward at the waist until you feel a good stretch in your bum!

SCIATIC NERVE GLIDES

Here are some Sciatic nerve glides that will help to relieve the pain down the leg from the sciatic nerve being pinched. With these exercises, we are attempting to get the nerve to move more freely behind the piriformis muscle. Again, if any of these increase your symptoms, stop doing them.

SCIATIC NERVE GLIDE – Lying on your back
Start by lying on your back and holding the back of your knee. Next, attempt to straighten your knee as much as you are able to feeling a good stretch behind your leg (you may not be able to get it as straight as the picture). Lastly, hold this position and then bend your ankle forward and back as shown. Perform 10 ankle pumps 3 times.

SCIATIC NERVE GLIDE – Sitting
Start by sitting up straight in a chair or on the edge of a bed. Then, extend your knee and hold this position. Next, bend your ankle forward and back. You can also sit toward the edge of the chair and with your leg straight keep you heel on the ground and move your ankle back and forth in this position. Perform 10 ankle pumps 3 times.

STRENGTHENING 

As we mentioned earlier, you can’t just stretch to get results and keep them! So here are a few exercises we recommend to go along with your stretching. These five exercises help to strengthen the glutes and the core. Strengthening these muscles will help to stabilize the pelvis and take pressure off the piriformis so it doesn’t have to work as hard.

HIP ABDUCTION – SIDELYING

While lying on your side, slowly raise up your top leg to the side. Keep your knee straight and maintain your toes pointed forward the entire time. Keep your leg in-line with your body.

The bottom leg can be bent to stabilize your body.

PRONE HIP EXTENSION – BENT

While lying face down with your knee bent, slowly raise up your knee off the ground.

Alternating Leg Extension (Quadruped)

Begin on hands and knees with knees directly under your hips and hands directly under your shoulders. Keep your abdominals tight and engaged throughout this exercise. Raise one leg straight back as pictured without letting your hips drop to one side and without losing your abdominal contraction. Hold for 3 seconds, then return to the start position and repeat with the opposite leg. This is one repetition.

BRIDGING

While lying on your back with knees bent, tighten your lower abdominals, squeeze your buttocks and then raise your buttocks off the floor/bed as creating a “Bridge” with your body. Hold and then lower yourself and repeat.

PELVIC TILT – SUPINE

Lie on your back with your knees bent. Next, arch your low back and then flatten it repeatedly. Your pelvis should tilt forward and back during the movement. Move through a comfortable range of motion.

We know the winter blues can be a pain in the butt, not to mention other life stressors such as work, family,  sicknesses, and chores, so why not get rid of the real pain in your butt – your piriformis syndrome – to help deal with life!

All of these are just a recommendation and may temporarily relieve symptoms and not cure the problem without more treatment. If you need further treatment please reach out to us so we can help!

pictures courtesy of www.hep2go.com