Ankle Sprains In Athletes: Key Tips On Facilitating A Return To Activity

Michelle L. Butterworth DPM FACFAS

Managing ankle sprains in athletes and ensuring an appropriate return to activity can be quite challenging.

In addition to being a podiatric surgeon and my partner in practice, my husband is a high school football and baseball coach. Needless to say, we deal with ankle sprains on a very frequent and regular basis. I am usually in charge of the overall treatment of the athlete since he is involved on a more personal level and is usually very anxious to get his player back out on the field.

This is where we, as doctors, have to stand our ground and do what we know is best for our patients and not let the coaches put pressure on us. They want their athletes to be able to play in the big game but they often do not realize that the damage could be greater and the injured athlete could spend even more time away from the sport longer if he or she tries to return too soon.

While the athletes and injuries vary, there is a basic protocol that I follow to treat ankle sprains and determine whether injured athletes are ready for return to their sport. I believe the key to successful treatment in the majority of ankle sprains is initial immobilization.

First, one should assess the severity of the injury. For more severe ankle sprains, we typically use a Cam walker for immobilization. For less severe sprains, we use an Aircast device. The length of initial immobilization also depends on the severity of the injury and typically ranges from one to two weeks. Reduction of pain and swelling is also a key component to successful treatment and I have the patients employ the RICE protocol.

After initial immobilization and reduction of pain and swelling, the athlete begins a protocol consisting of various range of motion and strengthening exercises. The use of a Biomechanical Ankle Platform System (BAPS) board or wobble board can aid in restoration of proprioception. The length of this process varies greatly depending on the severity of the injury.

One of the hardest things for a doctor to determine after an ankle sprain is when the athlete is able to return to his or her activity. Before I release athletes to return to their sport, they have to pass a “return to play” evaluation.

This evaluation is a gradual process that builds in complexity as it progresses. It starts with straight line jogging, proceeds to slow turns and advances to straight line sprinting, quick turns (90-degree turns), balancing on one foot and, finally, hoping on one foot. They have to be able to perform all of these activities without significant pain before they return to their sport. It is also anticipated that the athlete will not be back to 100 percent during that season. This is very important to relay to both the athlete and the coach.

I also believe in the use of ankle braces and dispense them for use after the athlete had had an ankle sprain. I think ankle braces help trigger proprioception. This functional proprioception is crucial for the rehabilitation of ankle sprains and aids in prevention of re-injury.

I have had great success with this protocol in treating and rehabilitating ankle sprains in athletes. I know they are ready to return to their sport safely once they have passed my evaluation. I can be assured that they will not encounter further damage by returning too early and they have been properly rehabilitated to try to prevent recurrence of injury.

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