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

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