Recently, Andrew Luck, quarterback for the Indianapolis Colts, announced his decision to retire years before his contract was set to run out. In his comments, he stated that he had lost a love for the game and was tired of constantly rehabbing from injuries that kept him from playing to his full potential.
Andrew Luck is 29 years old and had one of the best statistical years of his career in 2018. The quarterback spent 2017 on the bench as he attempted to recover from issues with his throwing shoulder and other injuries he experienced during the 2016 NFL season. Over the last several weeks of the preseason, he had not played due to a “calf strain.” That was the initial injury report from the Colts, but eventually the team changed the diagnosis to os trigonum pain at his left ankle, and finally decided upon a high ankle sprain or proximal syndesmotic injury.
Many fans and journalists have been very critical of Mr. Luck and his decision to retire over a ‘simple’ ankle sprain. However, as foot and ankle practitioners, we know that high ankle sprains can be very complicated to treat and to recover from. Accordingly, I thought I would discuss some of the mechanics of throwing and how it affects lower extremity mechanics, and how a high ankle sprain can make it very difficult to quickly return to the field.
High ankle sprains involve stress, stretching, or tears to the anterior or posterior (or both) inferior tibiofibular ligaments and the syndesmotic ligament that spans the tibia and fibula midshafts. Usually, the injury is just at or superior to the ankle joint, but it can also happen superior to the syndesmosis all the way up to an area inferior to the knee.
The mechanics of a high ankle sprain is the primary reason why it can take so long for certain players to return to play. The normal mechanism for a high ankle sprain occurs as follows. The distal anterior and posterior tibiofibular ligaments are torn with extreme external rotational or forced dorsiflexion in combination with severe ankle sprains. These injuries often happen when an athlete jumps and lands on another athlete’s foot. However, if an athlete’s foot was trapped in position, say in a cleat, a similar mechanism can occur.
As we know, the ankle and lower extremity play a very important role in throwing sports. To follow through on a throw with maximum power, you need to have a planted front leg to throw over. A study by determined that stride leg ground reaction forces during arm cocking and arm acceleration were strongly correlated with ball velocity.1 Additionally, there was no significant correlation with drive leg ground reaction forces.1 The torque of the body’s throwing momentum can be quite high as the opposite arm, shoulder, and trunk rotate through a throwing motion. Those rotational forces are transmitted down the leg and eventually to the ankle and foot.
We know that stability after a high ankle sprain is an issue for athletes. We usually put them in a boot or at least a very high ankle brace to attempt to compress the tibia and fibula together and mitigate some of the rotational forces at the ankle while they heal. This does not always work as well or as quickly as we, the athletes or the teams would like.
I think there is a strong possibility that Luck figured out while rehabbing from this injury that he had to alter his normal throwing motion and use more arm and shoulder to throw the football than he had previously. Since he has had to rehab so much and for so long for his shoulder issue, I imagine that he was hyperaware of any added stress that this change in his throwing style may potentially cause.
Ultimately, we will never know exactly what all the issues were that lead to Luck’s decision to retire from the NFL. However, we do know how important ankle and foot mechanics are to this process. I imagine there is a high likelihood that this ankle injury was the final straw that broke the camel’s back and contributed to Luck’s decision to retire.
Dr. Williams is a Past President and Fellow of the American Academy of Podiatric Sports Medicine. He is the Director of Breakthrough Sports Performance, LLC in Chicago. Dr. Williams has disclosed that is the Medical Director for Go 4-D and a consultant for HP FitStation.
- McNally MP, Borstad JD, Onate JA, Chaudhari AM. Stride leg ground reaction forces predict throwing velocity in adult recreational baseball pitchers. J Strength Cond Res. 2015;29(10):2708-2715.